What does "Starting Again" mean to the many different people this book reaches out to? This positive title may draw the reader to enquire why an immensely experienced physiotherapist is considering starting again. Perhaps it challenges patients to rethink their own limitations, or therapists to reconsider their own management strategies. Does it refer to a change in life for head-injured patients and their carers, or does it hint at a fresh approach to old problems? Since "Steps to Follow" and "Right in the Middle", Pat Davies has not been idle. She has remained aware of what may be new and worthwile in therapy around the world, incorporated it into her own vast experience and taken ideas, concepts and techniques back to her patients to test their clinical validity. This is, therefore, not a pedestrian text but one brimming with new ideas for immediate use. That in itself should be a message of hope for all involved in the consequences of head injury. The future will always hold new and better management strategies, the understanding of the nature and consequences of head injury will improve, and thus there should never be limits placed on what patients can achieve. Reduced to its simplicity and presented in modem day thinking, the nervous system is a neural network. It requires input for output, yet it possesses a delicate, powerful, inherent feedback system so it can drive itself optimally, test itself out, learn and adapt.

Inhaltsangabe1 Getting in Touch Again.- Disturbances of Tactile Input.- Assessing Sensation.- Other Perceptual Disturbances.- Problems Related to Disturbed Tactile/Kinaesthetic Input.- Incongruous Behaviour and Movement.- Spasticity.- Additional Factors Contributing to Increased Tone.- Ataxia or Tremor.- Activities Performed Slowly and with Undue Effort.- Dizziness and Nausea.- Persistent Incontinence.- Memory Disorders.- Behavioural Problems.- Inattention or Shortened Attention Span.- Lack of Motivation.- Enhancing Learning in the Treatment Programme.- Choice of Therapeutic Intervention.- Therapeutic Guiding.- Pressing Juice from an Orange.- Tidying up After Completion of a Task.- Important Considerations for Guiding.- The Position of the Therapist and the Patient.- Comprehension of the Ultimate Goal of the Task.- One Hand Always Provides Information About the Stability of the Support.- An Instrument Is Only Necessary After A Problem Has Been Identified.- Right to the Fingertips of Both Hands.- The Patient's Hand Should Feel Light and Be Easy to Move.- The Patient, Guided by the Therapist, Performs Every Step of the Task.- Verbal Input Is Avoided During A Guided Activity.- The Therapist or Helper Must Feel Relaxed and Confident.- Feeling Through an Intermediary Tool, Object or Sub-stance.- Choosing a Suitable Task.- Mechanical Factors.- Degree of Complexity.- Judging the Suitability of a Task.- Interpretation of Behaviour Signals.- Ways in Which Guiding Can Be Implemented.- Therapeutic Guiding.- Spontaneous Guiding as a Way of Assisting.- Teaching Relatives How to Guide.- Guiding Tasks in Different Clinical Situations.- Guiding in the Intensive Care Unit.- With the Patient Still in Bed.- When the Patient Is Sitting Out of Bed for a Short Period.- Guiding to Overcome Difficulties with Sitting Posture.- The Effect of a Guided Task on the Patient's Sitting Posture.- Guiding in Conjunction with Walking.- While Regaining Independence in the Activities of Daily Living.- Guiding While the Patient Is Getting Dressed.- Increased Tactile Information to Maintain Lying Positions.- The Problem of Incontinence.- Urinary Incontinence.- Considerations for Management.- Faecal Incontinence and/or Constipation.- Considerations for Management.- Avoiding the Negatives Associated with Post-traumatic Epilepsy.- Problems Related to PTE.- The Seizures Per Se.- Anticonvulsant Drug Therapy.- The Attitude of Others Towards the Patient with PTE.- Conclusion.- 2 Early Positioning in Bed and in the Wheelchair.- Turning and Positioning in Bed.- Supine Lying.- Side Lying.- Turning the Patient onto His Side.- Positioning the Patient on His Side.- Overcoming Difficulties in Maintaining the Position.- Prone Lying.- Turning Over to Prone.- Position in Prone.- Sitting Out of Bed.- Transferring the Patient from Bed to Wheelchair.- Moving from Lying to Sitting.- Moving to the Edge of the Bed.- Recommended Transfers.- Method 1. With the Patient's Arms Resting on the Therapist's Shoulders.- Method 2. With the Patient's Arms Down in Front of Him.- Method 3. With the Patient's Trunk Flexed.- Method 4. Using A Sliding Board.- Position in the Wheelchair.- Choosing a Suitable Wheelchair.- Points to Consider.- Suggestions for Using Additional Support.- Adjusting the Patient's Position in the Wheelchair.- Lengthening the Time Spent in Sitting.- Propelling the Wheelchair Independently.- A Standard Wheelchair.- An Electric Wheelchair.- A Wheelchair with a One-Hand Drive Mechanism.- The Importance of Turning and Positioning the Patient.- Preventing Contractures and Deformity.- Avoiding the Development of Pressure Sores.- Improving the Circulation.- Maintaining Mobility of the Spine.- Improving Respiratory function.- Preventing Pain of Cervical Origin.- Reducing Hypertonicity.- Preventing Any Peripheral Nerve Damage.- Accustoming the Patient to Being Moved.- A Case in Point.- 3 Moving and Being Moved in Lying and Sitting.- Requirements for Efficient Muscle Action.- Possible Lengthening Mech>

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