PubMed · 967943
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F M Cowieson, C Sullivan. 1976-06-10. Walking frame adaptation.. https://pubmed.ncbi.nlm.nih.gov/967943/
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PURPOSE: The survey was undertaken to identify current physiotherapy practice for positioning patients in the first week following stroke. METHOD: A postal questionnaire comprised of closed questions, was sent to 674 physiotherapists identified as working with patients in the first week following stroke, who were employed in 155 randomly selected NHS Trusts throughout England. RESULTS: Response rate was 73%. Specific positions were recommended during the first week following stroke by 98 % of respondents. The most common aims of positioning were modulation of muscle tone (93%), preventing damage to affected limbs (92%) and supporting and stabilizing body segments (91%). The positions sitting in an armchair, side lying on the non-hemiplegic side and side lying on the hemiplegic side were recommended by 98%, 96% and 92% of respondents respectively. The components of the positions considered as 'most important' varied between positions, proximal components were usually preferred to distal components. CONCLUSION: Positioning is still an important part of physiotherapy practice and therefore requires evaluation. The positions used and the aims of positioning identified by clinicians accord with those in the literature. However, there is a lack of consensus regarding key components of the positions. The positions identified in this study should now be systematically evaluated for their ability to achieve different aims.
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A 62-year-old Japanese man presented left hemiparesis and left visuospatial hemineglect following a right hemispheric stroke. His CTs and MRIs of the brain revealed a large embolic infarction of the middle cerebral artery territory. A month after the cerebrovascular event, his weakness of the left lower limb almost recovered fully. However, his upper limb motor function was still disabled; in particular, his ability of finger flexion in the left hand was almost lost. Then, vestibular stimulation using either a cold caloric stimulation to the left ear or a warm caloric stimulation to the right ear was performed, and the effect on the hemineglect symptoms were assessed by a line bisection task. After vestibular stimulation, not only his hemineglect symptoms but also his motor functions of left upper limb transiently improved; he became able to make a fist. The improvement of his hemineglect symptoms was obtained by vestibular stimulation using either a cold or a warm caloric stimulation. However, the effect on the motor function was obtained only by the cold caloric stimulation applied to the left ear. Based on the effect of the vestibular stimulation, we postulates that the impairment of the motor function in the present patient is not only a paresis caused by the pyramidal tract lesion but also symptoms related to the hemineglect syndrome.