Table Of ContentStroke Rehabilitation
Stroke Rehabilitation
Structure and Strategy
Polly Laidler
MCSP
Consultant editor: Jo Campling
I~I'I
SPRINGER-SCIENCE+BUSINESS MEDIA, B.v.
First edition 1994
©1994 Polly Laidler
Originally published by Chapman & Hall in 1994
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ISBN 978-0-412-46950-3 ISBN 978-1-4899-3470-3 (eBook)
DOI 10.1007/978-1-4899-3470-3
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Contents
Preface vii
The Difference Between Truth and Adequacy by John Hegley ix
Part One 'What' 1
Introduction 3
1 The cause for concern 7
2 Construction of normal movement and ability 19
3 Neuromuscular plasticity 42
4 Cognition 49
Part Two 'Why' 61
5 Analysis, assessment and documentation of stroke 63
6 Abnormal movement and disabled functions 76
7 Cognitive impairments 99
8 Lame dogmas 115
Part Three 'How' 131
9 Teamwork 133
10 Rehabilitative strategies 146
11 Medical intervention, medication and modern technology 212
12 The responsibility 227
Part Four 'Need to know' 243
13 Essential skills 245
14 Resources 256
Postscript 267
Collected quotations 268
Glossary 275
Recommended reading 281
Index 283
Preface
I have watched with growing concern the slow progress in matching
new knowledge to clinical practice. In fact, as more research is
undertaken and the frame of reference opens out to encompass the
wealth of related, but hitherto neglected, issues, the gulfs are widening
between academic 'researcher', 'specialist', 'practitioner' and the patient.
As a member of the British Stroke Research Group, the British Society of
Gerontology and relevant special interest groups of my own profession,
and as a clinical practitioner specializing in, and teaching, stroke rehab
ilitation, the need to bridge these gaps becomes increasingly urgent. This
book endeavours to provide some of the missing links in a logical format
designed for all medical and related health care professionals, and yet
which does not exclude other interested readers. Don't skip the Intro
duction, it answers some of the obvious questions and explains the
layout and language.
My thanks go to all the stroke-survivors, and their families and
friends, who taught me to question myself and my treatments, and to
the many sources of expertise with whom I work or to whom I looked
for their enlightened and specialized experience. I am particularly
grateful to Dr Wayne Wilson phd MA oipcsT, Marie Napier (Social
Worker), Helen Ellis OiPCOT, Simon Wills BPharm MSC ACPP MRPharms,
Brenda Coward SRN (Continence Advisor), Kath Berney RGN OPSN,
Dr Pam Enderby PhD MSC FCST, Dr Chris Gilleard phD, Dr Geoffrey Kidd
MSC phD, Dr Peter Wilson MA BM Bch FRCP, Mr John Sutcliffe FRCS, Dr Alan
Colchester PhD MRCP and Jenny Pennick; Gordon Maggs BSC, Jenny
Strudwick BSc MCSP, Jackie Garratt oipcOT, Bill and Barbara Duke (stroke
survivor and partner) and Kate Hilliar BSC MCSP OiPTP for their valuable
advice and constructive criticism; Peter Razzell, Jean de Lemos, Geoffry
Whitehead, Susan Brazzill and Tom Wright for the artwork and
photography; and to John Hegley, whose poem gently sets the seal of
infinite conjecture to the whole subject.
viii Preface
I am indebted to the publishers and authors who gave me permission
to quote from or paraphase many excellent books and papers. These are
duly attributed in the text and referenced at the close of each chapter.
My thanks go also to Jo Campling, who persuaded me to write this book,
and to Catherine Walker and Lisa Fraley of Chapman & Hall, who
guided me gently through to publication. And finally, and especially, to
Des, who has shared with me the course and conference absences and
the frustrations and exultations, sadness and laughter resulting from my
Need-To-Know the What, Why and How of stroke.
Polly Laidler
Wickham Bishops
1994
The Difference
Between Truth and
Adequacy
by John Hegley
Our Nature of Scientific Activity teacher
explained
that with scientific theories
NEAR is
sometimes close enough.
He gave the example of a law
of which science had been sure,
which had been obeyed
unquestioningly since it was made
but which was later discovered to ignore
certain variables;
sometimes what is seen as objective fact
is in fact only a rough guide,
which does the job of ordering
rather than DESCRIBING reality.
Applying this idea
to what is printed here
adequacy might say
'it's there in black and white',
whereas I think the truth would rather
cite
two shades of grey
of which one's extremely light.
"D
Cii
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N
«N
.Q
E
ell
U
PART ONE
'What'
