Possibilities and Limits in Reeducation of Cerebral Palsy
摘要
Following the scheme of the ideomotor model, this chapter addresses aspects of action design, planning, and execution by comparing them with perceptual anticipation of expected results and therefore with mental consent to carry out imagined action. Subsequently, the comparison of what has been actually perceived with what was previously imagined leads to the awareness of being the true author of what has been done. On a planning level, personal motivation vs. environmental possibilities (affordances) interact. The level of executive planning reveals possible presence of dyspraxia, a hidden symptom of cerebral palsy (CP), while perceptual anticipation can be influenced by altered interpretative mental frames. Implementation must also take into account structural characteristics of locomotor system, modified during development both by presence of the primitive central nervous system (CNS) lesion and the altered motor organization. The nature of CP secondary deformities is not due only to lack of movement, but more often depends on tissue metaplasia resulting from CNS injury. Collection of information necessary for motor control is equally affected by alteration of receptors as by the lack of specialized movements necessary for their functioning. Goals and tools of reeducational treatment are elaborated with reference to each level of the ideomotor model: motivation, therapeutic setting, therapist–patient interaction, communication and relationships with family, therapeutic contract, and conclusion of re-educational intervention. Particular attention is paid to the most well-known physiotherapy maneuvers, such as stretching and muscle strengthening, and strategies such as constraint-induced movement therapy (CIMT), Kinesio taping, and Therapeutic Suit adoption.