Rehabilitation of the upper limb after an stroke. Part 3. Dissociation exercise

 I am assuming the the reference to Yekutil is a mispelling of Margaret Yekutiel

who wrote a whole book about it in 2001, 'Sensory Re-Education of the Hand After Stroke'.

I don't understand a thing that is mentioned here.

Rehabilitation of the upper limb after an stroke. Part 3. Dissociation exercise

Authors: Jan van de Rakt 1, 

Steve McCarthy-Grunwald 2
1 Physical Therapist NDT teacher IBITA, Course Leader and teacher on the Dutch Institute for Allied Health Sciences
. Nursing Home “Waelwick”in Ewijk The Netherlands.
2 MSc BSc RMN Lecturer in Mental Health Nursing with Dementia Specialty. University of Cumbria, Bowerham Road,
Lancaster, LA1 3JD England.2385

Abstract

Introduction
To increase the possibilities of the hemiplegic arm is this the way to get out the synergy and exercises to
an higher level. The differences are big, high cortical there is an high representation of the hand but on
an lower level isn’t that completely changed. Still there are areas in the brain that have an connection
with the arm, that we can use to get an optimal result and the best way to integrated the remaining
possibilities in the ADL. Still much isn’t clear and the answer is still not there what is necessary to get the affected hand –especially- on an higher level.
Design.
Every person is different and that asked for an personal treatment still …
Once an person after an severe stroke say to me:
“ Brilliant that I can move and managed my shoulder and elbow and have less difficulties with the ADL
and no pain, but at the end of the arm is my hand and that is purpose of all that shoulder movement to
bring my affected hand in an position that I can use him .”
I was silent. He was right, I wasn’t capable to get an good hand-function. He was able to pick up
something and open his hand but only with mass flexion and mass extension . And often when he don’t
look to his hand was the object gone ! The programme from Yekutil is perfect but he couldn’t master the
last part because his damage brain wasn’t capable to build an good projection that allow him to work
with his hand.
Conclusion.
The therapy remain on that level but when stop an while, he experience what he loss in an short time
and his motivation was present again .
Still it is never the treatment-goal to hold that level or ….!!
After the treatment of the flexor attitude and movement synergies, now there is more dissociation
possible and that can be through recovery but also through an good treatment. But that means don’t
stop, going on with dissociation, also with the hand to get the highest possible level!!