November 29, 2016

Mrs. Bobath was wrong - hand use comes from my gut

I was dismayed that my NDT certification course did not teach me hand function comes from my gut.  I learned this when a PT had me do abdominal exercises after my back spasms returned.
I was surprised to feel abdominal muscles on my paralyzed side burning from effort.  My ability to reach improved after my abdominals got stronger. 

When you reach for an object (shoulder flexion) the shoulder blade (scapula) helps the arm by sliding forward.  Scapular muscles are attached to the ribs so if weak abdominal muscles do not keep the ribs still, the scapular muscles have a wobbly home base. Having weak stomach muscles meant my shoulder and elbow muscles were overworked when scapular muscles could not do their job.  I repeatedly got tendonitis in the long head of the biceps because this elbow muscle assisted weak shoulder muscles.  My biceps tendon used to swell so badly that it made a popping sound when it slipped out of its groove.  Exercise sessions had to end with ice to reduce the swelling.

I wonder how much faster I would have progressed if my OTs had worked on abdominal strength.  I do not blame my OTs.  As an NDT certified OT I do not know of a motor theory that links hand function to core muscles.  However, athletes like weight lifters and javelin throwers who need superior arm strength know how important abdominal strength is to upper extremity performance.  Stroke survivors exert this same kind of extreme effort when they lift their arm with paralyzed muscles.  Don't believe me?  Therapists use two hands to lift a paralyzed arm.  Even they are challenged when lifting all that dead weight.


  1. Reading your blog over the years, I have often thought I'd like to see your observations collected in a textbook. Your experience and perspective from both sides of the post-stroke recovery team is enormously valuable.

  2. My name is Patrick and we live in New York USA. I saw the address of a doctor in one of the blogs recently.

    I (52 age) had a severe stroke on 7th of April 2016. I was diagnosed with Lupus in January this year and was taking Steroids (prednisone) tablets along with other medicine. No history of BP or diabetes nor heart disease. Am a non smoker and drinks occasionally little for social meets. Before I was diagnosed with Lupus this year in January I was given numerous anti biotic by family physicians since they could not diagnose me. I had joint pain and acidity and cough. I never used to take any drugs since I was quite healthy. I Steroids caused the stroke I had, I was not prescribed any blood thinner nor aspirin then. They thought I was allergic to them. However I am not allergic to any drugs

    On April 7th I was admitted due to stroke and underwent surgery on right side of the brain to stop bleeding and swelling. They retained my bone flap in freezer and on September 20th I had surgery to restore my bone flap which was very successful. I am now able to talk and eat without any help. my speech is quite clear , though not like before. I walks slowly with the help of cane. But cannot walk long. I cannot move my left leg and hand

    But when I took Dr Ben Herbal medication, for one month,I was completely cured, now I can move all part of my body.speak clearly and walk freely. If any one needs his help, contact him Via