Physical Therapeutic Measures in Hemiplegia

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THE management of a patient with hemiplegia is a difficult problem since many of the basic factors are not understood. In general, the purpose of such a program is the prevention and correction of deformities, increase of muscle function, and the instruction of the patient in performing the activities essential to daily living. It has been demonstrated by Dinken1 that there are 22 basic activities regarding locomotion and traveling, 8 having to do with dressing, 7 in toilet activities, 8 concerned with eating, and 15 associated with hand function.

There is no set rule as to when the necessary physical measures should be initiated. It is important in cardiovascular accidents to attempt the differentiation of etiology, as there is a definite relationship in respect to early treatment.

Gilbert and deTakats2 have listed the following differential points:

Cerebral EmbolismCerebral ThrombosisCerebral Hemorrhage

1. OnsetSuddenGradual (55%)Sudden
2. Spinal fluidClearClearBloody
Normal pressureNormal pressureOften slight increase in pressure
3. Average age5360.858.9
4. Average blood pressure143/85166/97213/120
5. Predisposing diseaseRheumatic heart diseaseArteriosclerosisHypertension
Bacterial endocarditisCongenital aneurysms
Postcoronary disease
Hypertensive cardiovascular disease

As a general rule, in those patients having a diagnosis of thrombosis or embolism, the indicated physical measures may be started immediately. In patients with a diagnosis of hemorrhage, little if any treatment should be started until the spinal fluid is clear or at least until the signs of meningeal irritation have practically subsided. Obviously, in some. . .



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