Right in the Middle: Selective Trunk Activity in the Treatment of Adult Hemiplegia.

Right in the Middle: Selective Trunk Activity in the Treatment of Adult Hemiplegia 

Davies PM. New York, NY 10010, SpringerVerlag Publishing Co Inc, 1990, paperback, 277 pp, illus, $35. Following the publication of her book, Steps to Follow, the author spent the next 5 years presenting workshops and treating her patients. It was during this time that she became aware that her patients always strived for more and desired more freedom of movement in functional ranges and speeds. The result of her work focusing on treatment in this area is Right in the Middle. This is a text that provides the physical therapy practitioner with much more information related to evaluation and treatment of the patient with hemiplegia. The text begins with a presentation of anatomical and evolutionary considerations of the trunk. All of the book's chapters end with a conclusion that discusses the clinical relevance of the material presented. Of particular interest is one of the earlier chapters that identifies and discusses the specific problems associated with loss of selected trunk activity. Not only are these problems vividly described, but they are also illustrated through numerous photographs and are frequently compared with the movement patterns of children without hemiplegia through photographs and words. The rest of the text is devoted to therapeutic activities designed to address trunk problems associated with poor respiration, lack of stabilization for the extremities, transitional movements, and all upright postures and activities. This book is packed with clinical suggestions for handling the patient who has hemiplegia, and Davie's strong neurodevelopmental treatment background is apparent. It truly does add to the material presented in Steps to Follow. Perhaps because of the depth to which she addresses the trunk, Right in the Middle seems to take several steps beyond the treatment information presented in neurodevelopmental treatment courses dealing with adult hemiplegia. For two reasons, this book appears to be appropriately named: It substantiates how central the trunk is to all motor activities, and it gives scores of treatment suggestions to correct or make right the problems of the trunk associated with hemiplegia. I strongly recommend Right in the Middle to practitioners working with patients with hemiplegia or with other neurological disorders affecting movement of the trunk and extremities. Mary Kay Solon, PT Associated Physical Therapists Inc Fort Wayne, Ind