Kim Hyuk Il Glory Hospital HANDLING Kim Hyuk Il Glory Hospital woojuk

Mechanical Impairment Chemical Communication Neural Problem Non-Neural Problem Mechanical Impairment

Movement Movements must be ‘owned’ by the patient and be experienced both with and ultimately without the handling of the therapist. ( Raine 2007)

Therapist have to be: Skilled in the analysis of human movement Aware of the principles of motor learning: - Active participation - Opportunities for practice - Meaningful goals (Mayston 2000)

Handling Therapist should be an instructor and adapt the environment to the patient to allow him to explore( see postural set and the relationship between automatic and voluntary movement) Gentail(1987)

Handling Physical contact with client’s body to directly guide the movement and postural adaptation to a more normal pattern. (Glossary, Neurological rehabilitation, 1990) Using the hand in such ways as to normalize tone and facilitate normal movement. (Davies,1998) Using the hand (and or other body parts) to sustain the performance.

Handling Touch may be one of the strongest direct influence on the patient, physically and psychologically/emotionally. The used of handling is based on clinical reasoning, problem analysis, hypothesis formulation, goal, and which tools to use to help the patient to achieve his goals. Handling is dynamic, specific, and varied; it may be mobilizing (musculature, joint), stabilizing, and/ or facilitatory. The aim of using handling as a treatment tool is to recruit neuromuscular activity in a functional context.

Handling The therapist’s hands may touch, create friction, stretch, compress, and give information about muscle leangth and tension, direction, speed and range. They may produce traction, compress or rotate, demand stability, and/or mobility depending on the problem and the functional goal. Information is specific to the desired activity.

Normal Movement Normal movement or activity may considered to be a skill acquired through learning for the purpose of achieving the most efficient and economic movement or the performance in a given task and specific to the individual. (shumway-cook&woollacott, 1995)

Postural Set A postural set is an alignment of key points that creates the lowest tone for the individual whilst allowing selective movement - Against gravity - with gravity - within a posture

HANDLING To facilitate & new experience change - in muscle tone - in alignment - in movement pattern - in efficiency - in function High levels of performance proficiency include - maxi certainty of goal achievement - mini energy expenditure - mini movement time

Handling principle (patient) 1. Awareness of the change in the body 2. Integration of the whole body and both sides 3. Weight bearing on the hemi-side 4. Key points alignment/ interplay/ control 5. Input of sensation intensity, velocity, direction, range, compression, rotation

Posture of therapist COG in the BOS Tonic muscle Straight back Adduction of shoulder Extension of wrist Less arm movement/more trunk movement

Handling principle Use to trunk & L/E Two hand but different task HAND-> PATIENT -> BRAIN Speed, ROM, Compression, Direction Rotation Proprioceptive input Environment Functional hand

- hobby, job, environment • Appropriate use of voice (communication) • Perception, motivation, ideation - hobby, job, environment • Appropriate use of voice (communication) - with patient’s brain, active & passive • Grip - direct contact. Muscle& skin, gentle • Gravity ( activation of antigravity muscle) • Feet awareness • COG in the BOS ( LOS increase) • Stability & Mobility - task, selective movement

Afferent Input Range of movement Direction Velocity Intencity

HANDLING POSTURAL CONTROL MOBILIZATION MOVEMENT PEFORMANCE

HANDLING Make possible (realignment,information) Make nacessary(demands) Facilitation Let it happen(activity)

BOS INVITE ACTIVITY LET GO HANDLING ACTIVATE PLACE FOLLOW ACTIVITY

HANDLING Eye (observation) Hand (listening) CNS(think/design) Whole body(guide)

Thank you!!!