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Dear list members I am currently doing some research in the importance of rotation within the Bobath concept and the relevance for functional goals as well as stereotypical patterning in hemiplegic patients. I am struggling with a few points in my hypothesis: * if one selects to perform a rotary movement then there is selective activity from higher centres formulating a plan for this movement and adjustment at cellular level to prepare the muscle for the rotary action. At this level there should also exist a selective process of choice of synapses, amount of synapses, choice of muscle fibre type, the number of muscle fibres recruited, the amount of torque required for this movement, balance between selection of concentric and eccentric activity and so on. Does this in fact exist?? Are there any studies to support this theory? * On retrospective analysis of the physiomailbase from 1998 to present, I found many examples to illustrate that the lack of rotation causes a lack of function e.g. Parkinson's disease - reduced trunk rotation reduces the efficiency of walking. I found interesting descriptions of rotation from a biomechanical, kinesiological and joint alignment perspective. I have used these and related them to neuro-muscular processes involved in the preparation for a rotary movement i.e. information from proprioceptors re. joint angle , but, is there in fact a neuro-muscular description of the pattern of rotation? * with regards to stereotypical patterning in hemiplegic patients, I found various e-mails discussing "Bilateral Innervation" and in one mail it stated: "The pectoralis too is bilaterally innervated which explains the problem sometimes experienced with early inward rotation and adduction of the shoulder. " (21 June 2000) A reply to this was: "In my experience (I became a PT in 1966 and I have worked according to principles by Knott and Voss, Bobath, Brunnström and over the last years , motor relearning and motor control research as presented through Movement Science) the return of muscular activity usually happens first proximally, be it increased tone or voluntarily controlled movement. "Bilateral innervation" explains one of the reasons why to me, in a simple way, and I like simple explanations that take away the mystery that used to be around treatment of stroke." [log in to unmask] and: "My understanding of bilateral innervation in this instance stems from the work of Kuypers [apologies for spelling] who retraced on cadavers the peripheral nerves and came up with the classification of medial / lateral pathways rather than pyramidal / extrapyramidal. He observed that the medial pathways innervated the more proximal muscle groups including the trunk. He also observed that the descending ventral corticospinal tract did not cross over but that at spinal level it sent a branch to the opposite side. I don't have my reference to hand but my knowledge stems from lectures delivered by Shirley Stockmeyer." Sheila McEwan Super III Physio From these discussions, I am still uncertain of how 'bilateral innervation' explains stereotypical pattern development in the upper limb of hemiplegic clients? Tania Mayne [log in to unmask]