Therapeutic Goals

— Guide the start of movement or the muscle contractions.

— Affect the strength of the resulting muscle contractions.

— Give the patient corrections.

O Fig. 2.6. Positioning of the therapist's body for the leg pattern flexion-abduction-internal rotation

The verbal command tells the patient what to do and when to do it. The therapist must always bear in mind that the command is given to the patient, not to the body part being treated. Preparatory instructions need to be clear and concise, without unnecessary words. They may be combined with passive motion to teach the desired movement.

The timing of the command is important to coordinate the patient's reactions with the therapist's hands and resistance. It guides the start of movement and muscle contractions. It helps give the patient corrections for motion or stability.

Timing of the command is also very important when using the stretch reflex.The initial com-

mand should come immediately before the stretch the muscle chain to coordinate the patient's conscious effort with the reflex response (Evarts and Tannji 1974). The action command is repeated to urge greater effort or redirect the motion.

In reversal techniques, proper timing between verbal commands and muscle activity is important when we change the direction of the resistance. A preparatory command should be given with the therapist changing hand and an action command should be given with the therapist applying resistance in the new direction.

The volume with which the command is given can affect the strength of the resulting muscle contractions (Johansson et al. 1983). The therapist should give a louder command when a strong muscle contraction is desired and use a softer and calmer tone when the goal is relaxation or relief of pain. The command is divided into three parts:

1. Preparation: readies the patient for action

2. Action: tells the patient to start the action

3. Correction: tells the patient how to correct and modify the action.

Fig. 2.7. Visual control

For example, the command for the lower extremity pattern of flexion-adduction-external rotation with knee flexion might be [preparation] "ready, and"; [action] "now pull your leg up and in"; [correction] "keep pulling your toes up" (to correct lack of dor-siflexion).

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