Loads of copies of this book in Sheffiel Hallam Uni learning centre -
Collegiate Crescent campus.Very interesting reading & it was turned into a
t.v. series recently.
Debbie
> From: mdne adams <[log in to unmask]>
> Reply-To: PHYSIO - for physiotherapists in education and practice
> <[log in to unmask]>
> Date: Sat, 23 Dec 2000 00:02:55 -0000
> To: [log in to unmask]
> Subject: Re: School for Bravery
>
> Noemi, thanks for your comments, I have come across patients with ideomotor
> apraxia before and I don't think this applies to this lady. She has had
> numerous tests (including MRI & CT scans) that have consistently
> demonstrated no lesions. Indeed the only positive investigation she has ever
> produced was a very slight change in her ECG after she had been
> hyperventilating for 2 days. Interestingly, this particular incident
> followed on immediately from another member of her family diverting
> attention in his direction.
>
> What experiments do you have in mind ? I will try & get hold of the book you
> recommend, it sounds interesting.
>
> Happy Christmas
>
> Nikki Adams [log in to unmask] ---- Original Message -----
> From: "Noemi Lee" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Friday, December 22, 2000 8:50 PM
> Subject: Re: School for Bravery
>
>
>> -----Original Message-----
>> From: mdne adams <[log in to unmask]>
>> To: [log in to unmask] <[log in to unmask]>
>> Date: 22 December 2000 17:18
>> Subject: Re: School for Bravery
>>
>>
>>> Her movement disorder is an inconsistent right "hemiplegia". She actively
>>> holds her foot in a strongly inverted position when being observed and
>>> claims she is unable to put her foot to the floor. On examination, it is
>>> clear to me and other clinicians that this is active movement rather than
>>> spasm, as she gets tired after a few minutes or if she is distracted by
> eg
>>> her pet dog jumping up and licking her and her foot assumes a normal
>>> position. Passive movement of her knee is met with variable levels of
>>> assistance and resistance from her. There is no muscle wasting. In the
> days
>>> when she did walk publicly, she used to stagger the width of the room and
>>> land comfortably in her chair. When she was living in the hostel, she
> coped
>>> with an 8 inch threshold to her shower independently.
>>> She also claims to be unable to use her right hand, yet impressively can
>>> roll her own cigarettes ! She holds it in a variety of positions but
>>> frequently little, ring & middle fingers held together in extension, but
>>> flexed at the MCP joints.
>>>
>>> The jury is out on whether or not she is doing this in a calculated
> manner
>>> or whether she is unaware of what she is doing. My own view is that it is
>>> probably a bit of both - and that just because we're not sure why , that
>>> shouldn't stop us from trying to encourage something a little more normal
> !
>>>
>>> If anyone out there has had a patient like this before, please let me
> know
>>> your ideas !
>>
>> Nikki, I read a very, very interesting book written by one of the leading
>> neuroscientists. I think I mentioned it before: Phantoms In The Brain by
>> V.S Ramachandran.
>> He writes a great deal about patients after CVA on the right or left
>> hemispheres. I have worked four years with hemiplegic or hemiparetic
>> patients using the Bobath method and I wish the book would have been
> written
>> then.
>>
>> Your patient had a CVA on her left hemisphere. She seems to present,
>> according to your description, more an hemiparetic-apraxia disorder
> movement
>> than a real hemiplegia.
>> What is the CT showing?
>> If her left hemisphere has been damaged she might not present, as
>> Ramachandran describes, mechanisms of defense such as denial, repression,
> or
>> confabulation.
>> Her symptoms seem to be close to what he describes as Ideomotor apraxia:
>> "the inabililty to perform skilled movements on command ( the patient can
>> write a letter independently but not wave good-bye or stir a cup tea when
>> asked to do so).
>> Some experiments with your patients might be interesting to do.
>>
>> Noemi
>>
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