Italian Journal of Sports rehabilitation and Posturology

1504 -1521

Authors: Jan van de Rakt, Steve McCarthy-Grunwald

Introduction: Everywhere in the world is there often an distribution in tasks what the physical therapist do and what the occupational therapist do. The first is responsible for the walking and balance part ( the leg part )and the second is the expert on the rehabilitation of the ADL and IADL and the function of the arm. The trunk /head is an area where they are both be present or ……… That means that the effects that will occur of their training on the whole body are not know by members of the rehabilitation team. An person that is excessive busy with lifting of the arm in an flexion synergy will increase the tone of the neck muscle and that can have influence on the possibilities of the mouth and tongue. But this example is nothing, comparing the effect of the balance training on the tone of the affected arm/hand. Extreme training of r the balance/walking will increase the tone in the affected arm and that will have an great influence on the possibilities of the arm. It is even possible that the great amount on the training in the beginning on walking and balance will have an great negative impact on the possibilities of the hand/arm function. Regrettable there is little interest and investigation for this topic. Design: To compare the enormous reactions that people in sport must make to react on the all kind of situations to hold control of whole with that what people after an stroke must do to deal with increase difficulties. We see all that people after an stroke when they stand up, or walk or do other difficult things an increase have of their tone. We see that the affected leg is less fluency but we see also that the arm /hand goes in an associated reaction or even in an increase flexion movement ( maybe) attitude synergy. And after that exercise we see that this tone decrease but always lesser fast. In practice we feel that the function of that arm/hand was decrease after an exercise with an high increase of the tone and it looks like that the further improvement were difficult. Conclusion: Stabilization of the body is very important and play an major role in the treatment of people with an neurological tone change. And it is very important to control that and that science look how this is created and what the best approach is. But our conclusion is that this is an sign that the difficulty is too high and that this person must do something that is too heavy !! .

1546 -1581

Authors: Jan van de Rakt, Steve McCarthy-Grunwald

Abstract An very difficult item because physical treatment for elderly is still an “lesser “ form of physical therapy and an treatment for elderly with dementia is almost “not done”. But out investigation all over the world, it is clear, that movement and especially aerobe exercises have an better effect on slowing down this disease than other approaches including medical treatment [2,3.4]. This part about dementia will discussed this investigations and their conclusion and the translation to the practice. And the first problem is very fast present, because most investigation are only done with mobile individuals with dementia and not with individuals that are not so mobile anymore. That means: “That the greatest problem isn’t properly investigated and that makes things complicated”. People with dementia have an restriction in the capacity, what their brain can copy with. Is that problem : “ Movement”, than are there an lot of possibilities, but exercising/ training ask for an activity close to the border of the possibilities and that can be difficult by this group. The fear for failing is very strong and has an great negative effect, where this people are very sensitive for and can make exercising almost impossible. Another problem is environment, the care givers/family but also other professionals. They often react from their own perspective and search for an solution, that make it work for themselves easier but the independency of the individual with dementia will often fast decrease. The environment can also be an inhibition for movement and that we see often in residences /nursing home and even in their own home, that the possibilities are not optimal to move independent with their own speed. In this part the emphasis lies on what we know about the sciences and how to translate this for the individual with dementia to hold his own possibilities. Further one we start with an assessment, to get an picture, where the difficulties lies and that is often still possible at the beginning of the disease. When the disease is progressing this will far more difficult but with the knowledge of the start, we have an cardinal point. To have an “railway guide” in developmental of this degenerative disease we start with the introduction of the “Rakt-scheme” to focus on the main problems of the people with dementia in the divers moments of this disease. Authorship Credit : The “Equal Contribution” norm (EC). Citation: Jan van de Rakt, Steve McCarthy-Grunwald Physical treatment of individuals with dementia. Part 1 A. Ita. J. Sports Reh. Po.; 2020 ; 7 ; 2 ; 1546 -1581 ISSN 2385-1988 [online] IBSN 007-111-19 - 55 CGI J OAJI :0,101