1. Kim Hyuk Il Glory Hospital
HANDLING
Kim Hyuk Il
Glory Hospital
woojuk

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

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

4. 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)

5. 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)

6. 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.

7. 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.

8. 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.

9. 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)

10. 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

11. 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

12. 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

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

14. 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

15. - 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

16. Afferent Input
Range of movement
Direction
Velocity
Intencity

17. HANDLING
POSTURAL CONTROL
MOBILIZATION
MOVEMENT
PEFORMANCE

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

19. BOS
INVITE
ACTIVITY
LET GO
HANDLING
ACTIVATE
PLACE
FOLLOW
ACTIVITY

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

21. Thank you!!!