Therapeutic Goals

— Pressure on a muscle to aid that muscle's ability to contract

— To give the patient security and confidence.

— To promote tactile-kinesthetic perception.

— Pressure that is opposite to the direction of motion on any point of a moving limb stimulates the synergistic limb muscles to reinforce the movement.

— Contact on the patient's trunk to help the limb motion indirectly by promoting trunk stability.

D Fig. 2.4. The lumbrical grip

The therapist's grip stimulates the patient's skin receptors and other pressure receptors. This contact gives the patient information about the proper direction of motion. The therapist's hand should be placed to apply the pressure opposite the direction of motion. The sides of the arm or leg are considered neutral surfaces and may be held.

To control movement and resist rotation the therapist uses a lumbrical grip (D Fig. 2.4). In this grip the pressure comes from flexion at the metacarpophalangeal joints, allowing the therapist's fingers to conform to the body part. The lumbrical grip gives the therapist good control of the three-dimensional motion without causing the patient pain due to squeezing or putting too much pressure on bony body parts (O Fig. 2.5).

D Fig. 2.4. The lumbrical grip

If the patient has no or decreased control over an eccentric muscle activity, for example, going from standing to a sitting position, the therapist can give the patient the kinesthetic information for this goal-oriented movement by putting his hands on the top of the iliac crest and applying pressure down and backward. If some muscles show too little synergistic activity, we can facilitate the desired muscle activity by giving a tactile stimulus. The therapist should give tactile stimuli when and where the patient needs it but only as long as the patient needs it to increase the patient's independence and promote motor learning. The goal is for the patient to be able to control the activity by himself. Normally the therapist has one hand distally and the other hand also distally or proxi-mally when treating patients with extremity activities. If it is necessary to solve the patient's problem

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