Stroke 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 This edition not for sale in North America and Australia; orders from these regions should be referred to Singular Publishing Group Inc., 4284 41st Street, San Diego, CA92105, USA Typeset in 10/12 pt Palatino by EXPO Holdings, Malaysia ISBN 978-0-412-46950-3 ISBN 978-1-4899-3470-3 (eBook) DOI 10.1007/978-1-4899-3470-3 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licenses issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed on this page. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that maybe made. A catalogue record for this book is available from the British Library Library of Congress Catalog Card Number: 94-70257 § Printed on permanent acid-free text paper, manufactured in accordance with ANSI/NISO Z39.48-1992 and ANSI/NISO Z39.48-1984 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 0.. o N «N .Q E ell U PART ONE 'What'