This study aims to investigate whether improving the muscle activation and alignment between the shoulder girdle and the trunk will improve trunk stability, allowing greater functional use of the non-affected upper limb. It is investigated in the form of a case study and the treatment is related to the Bobath concept. The case study was of a 60 year old female with a right thalamic haemorrhage. The patient was treated for a one week period. Outcome measures used were the Motor Assessment scale (MAS), Trunk Impairment Score (TIS), Goal Attainment Scale (GAS) and pre- and post-treatment photographs. The outcome measures demonstrated no improvement in TIS, and very little change in MAS. However, the photographs and GAS were able to demonstrate improvement.
The case study demonstrated that even though no activity returned in the affected upper limb, by working through the affected upper limb, it was possible to improve the alignment of the left upper quadrant and facilitate improved trunk alignment and control. This allowed the unaffected upper limb to be free for functional activities. The hypothesis of the study could not be accepted or rejected due to the small sample size and other limitations. However, it is in agreement with case studies by Byrne & Ridgeway (1998), who concluded that it is important to achieve optimal musculoskeletal alignment as a foundation to increase motor recovery and functional independence. Further research needs to be done in this area before conclusions for clinical practice can be drawn.
Christina Mackie
January 2009
