554
CHAPTER 33
(3) Restoration of posture and vasomotor control
The loss of postural sensibility in complete transverse cord lesions above Tio represents
a serious complication, for it makes it difficult and in higher lesions above T5, impossible
for the paraplegic to maintain his equilibrium in sitting and standing position. It is the
task of the physiotherapist to develop that new pattern of postural sensibility, which was
discussed in the chapter on Postural Control. There are three stages in this treatment.
Technique
1
The first stage consists of exercises of the patient in a sitting position in front of a
mirror, during which the arms are raised in various directions, whereby the paraplegic
and tetraplegic learns to compensate for the loss of postural sensibility of the trunk by
visual control. This visual-motor feed-back is a most essential factor in the production
of a new pattern of postural control, to enable the paraplegic to develop his sitting balance.
At first on raising one arm a swaying response follows immediately, but with continuous
balancing exercises under visual guidance this swaying response diminishes, because he
learns to shift the centre of gravity necessary for the maintenance of balance when he
moves his arms, and thus learns to appreciate his position in space. Gradually, commen
surate with the development of the new pattern of postural sensibility, he will be able to
sit with his arms raised and eyes closed and keep his equilibrium (Fig. 2313 and b).
Already, at this stage, sport, especially archery, has proved an excellent remedial exer
cise (Fig. 232). These balancing exercises are also essential in restoring the vasomotor
control in tetraplegics with the aid of an abdominal binder to prevent hypotension by too
much accumulation of blood in the abdominal vascular bed.
2 The second stage in postural readjustment is learning to maintain balance by catching
and throwing a ball or heavier object such as a sandbag. Group exercises have proved
very valuable at this stage (Fig. 233). Sports such as table tennis, throwing the javelin
or club and shot putting can be usefully employed.
3 The third and final stage in restoring balance consists of rapid alternations between
free movements of the arms against resistance, as practised in punch-ball (Fig. 234) or
fencing exercises in the wheelchair, whereby variations of movements and diversities
of situations occur. In this stage, wheelchair basketball has proved invaluable, for the
diversities of situations caused by the movement of the ball, on the one hand, and the
movement of the opponent on the other, have proved of paramount importance for
promoting the new pattern of postural control in the paralysed. Swimming has also
been usefully employed for the restoration of postural control in both paraplegics and
tetraplegics. The paralysed part of the body, especially in higher cord lesions, has the
tendency to float in the water, due to its greater buoyancy (Fig. 235). Therefore, the para
plegic when using the breast stroke will at first experience difficulty in keeping head and
shoulders above water and must develop a new postural control in the water. One of the
most extreme examples of postural reconditioning through intensive training is one of the
writer's former patients who, in the Second World War, lost his left arm in the upper
third of the humerus and then developed after the war a complete paraplegia below T3 as a
result of transverse myelitis. He was previously a keen swimmer and insisted on trying
