Italian Journal of Sports rehabilitation and Posturology

1191 - 1239

Authors: Jan van de Rakt, Steve McCarthy-Grunwald

The second part, that will go about treatment of walking after an stroke. We know that the science have found that the pattern of the leg muscle are “definitive“ after an short time. Within an month is an pronunciation and some others find that too long. But we want to express that this pattern are only investigated by patient treated in rehabilitation center ( in the Netherlands 10 -15% of the stroke population) and often on an treadmill or in an laboratory, not at home, on the street etc. Furthermore the muscles that were investigated are only the leg muscle almost never the spine and stomach muscle that could revealed the existence of the diagonal. There are muscles – the m. gluteus max. and med. that give another image( see part 7). They are an little bit present in first two measurement, than we see their appearance in the third measurement very well but in the fourth this appearance is somewhat lesser and in the fifth also. This is not an sign that walking pattern will change, on the contrary !! In Belgium there is done an investigation, what the value was of the swing of the arms when we are walking and that investigation had the conclusion that this was the most economical way to walk. In this part we follow two individuals after an severe stroke and we try to do an assessment. All elements must be assessed and then we try to give exercises in the diagonal and discuss the progression. Both individuals will be still have an severe stroke but the quality of live has improve in some way and that is where therapist are for !! (Jan van de Rakt, Steve McCarthy-Grunwald ; Diagonals Part 8 . Stroke 6 Analysis of walking pattern and treatment. Ita. J. Sports Reh. Po.; 2019 ; 6 ; 2 ; 1191 -1239 ; ISSN 2385-1988 [online] IBSN 007-111-19 - 55 ; CGI J OAJI : 0,101).

1253 - 1294

Authors: Jan van de Rakt, Steve McCarthy-Grunwald

In this part we discuss the problems of two man after having an stroke. No individual after an stroke is the same and in this article all aspect that can influence the training negative are not all mentioned . Deficit in the brain that causes neuropsychology problems as agnosia /apraxia/ afasia /acalculia /alexia etc. have an influence in the treatment of stroke patient and will have an great influence on the outcome. But also the deficit of the frontal part of the brain will have very great influence on the outcome and what is possible. When the stroke makes the individual an different person that it is for all that care very difficult to continue to live and care for this person. But also trouble with the bladder and bowel can give great problems and there can be an deficit on the organ itself but also an malfunction in the brain and combinations are also possible. Al sense ( visual, hearing, taste and smell) can be disturbed on periphery level and central level except the sense from the body that is always an central deficit. Still it is possible to exercise with everybody after an stroke, even unconscious patient can be reach ( Jan Lavrijssen and Henk Eilander ) and sometimes the exercises have success. Not the change on an good success must be the motivation, but the individual with his problem must be the motivation to help him and that ask for an good assessment and then always start an treatment and be critical on yourself. This two patient have an severe stroke but not so severe than the two patient in part 8 and by both lies the problems on several places and through an good assessment we can recognized the problems and also understand the influences of the problems on each other. Participation of you as reader is wanted ! Try to assess the walking pattern of this two persons. We have try to write this part on such way that you can exercises your thinking what is main problem before the solution is given. This to give you the opportunity to train your own neurological thinking process. In this part we look first to walking pattern and try to make an assessment of the problems and possibilities that this two persons have after their stroke. Than the assessment will tell or our expectation are right. The diagonals will be the keystone and give us the information about tone, perception, alignment and balance The cooperation between the not-affected arm and the affected leg is so important but now we must try to see or this cooperation can start on the not-affected arm and goes through the remaining of the diagonal. Use of the cane can tell us that this person has learn to use the diagonal and that means that Motor Learning is possible. The best way, now today, is than differential learning because only by repetition through variation the brain will seek for an solution and often have the person have found this, but have to little power to use it properly , therefore task specific resistance treatment and now we create something an little bit better. ( Jan van de Rakt, Steve McCarthy-Grunwald Diagonals Part 9 Analysis of walking pattern. Learn to assess. Ita. J. Sports Reh. Po.; 2019 ; 6 ; 2 ; 1253 -1294 ISSN 2385-1988 [online] IBSN 007-111-19 - 55 CGI J OAJI :0,101).