Right hemiplegic gait
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c Benesh Movement Notation Transcript:
STARTING POSTURE (before bar):
Right hip slightly flexed and right shoulder retracted; these two factors are retained throughout the gait.
Right upper l i m b : elbow flexed; wrist flexed and radially deviated; fingers clenched; hand touching front of body. Right lower limb: internally rotated; slight plantarflexion; heel just off ground.
Left upper l i m b : hanging by side. Left lower limb: in normal position.
Weightbearing: through both feet; feet slightly apart. G A I T :
Speed: 70 steps per minute in bare feet; right a quarter short of left.
Right lower limb, swing phase: foot clears ground with ankle plantarflexed; toes stroke ground first.
Right lower limb^ stance phase: Heel moves towards ground but does not bear weight; knee flexed until one third of the way through swing of left lower limb, jerks into extension.
Upper limbs: left upper limb swings in normal reciprocal pattern; right upper limb held in starting position Left lower limb: normal swing and stance phases.
By courtesy of
alphabet, and a sign system serves a particular purpose in circumstances which rule out the use of alphabets. In each case, conveyance of correct meaning cannot be guaranteed.
Chinese ideograms and musical notation are sign systems which may be considered more successful than alphabets because they can be read and comprehended by people who cannot understand each other1s spoken language. Benesh Movement Notation
(McGuiness-Scott, 1981/82) is a clinical example of a sign system which transcends spoken language. It is adapted from Benesh Notation used to record the choreography of ballet
(Benesh and Benesh, 1977); and it can be used to record gait
and other patterns of movement of neurologically impaired patients• A stave recording a typical hemiplegic gait is reproduced in
Figure 11. The "key** is too lengthy for reproduction here; but it is available in articles published in the journal
"Physiotherapy" (McGuiness-Scott, 1981/82). The author has provided a transcription below the stave which is comparatively lengthy, and she has commented:
"... the written word cannot describe adequately the movement patterns written in Benesh Notation."
(McGuinness-Scott, personal letter) Unfortunately, Benesh Movement Notation has limited application because it requires a great deal of learning. Few physio therapists, and even fewer members of other health care professions, are trained to use it; and it does not offer a means of interdisciplinary communication at present.
Precise definition has also been achieved by simpler graphic codes. At the simplest level, directional arrows are very
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c/3 n X H Facing page 93and practitioners involved in the Riding for the Disabled scheme which gives disabled children the experience of horse riding for recreational-cum-therapeutic purposes (Figure 12). At a more complex level, a standardised, international sign system for assessment and recording of common problems of vertebral joints is already used by physiotherapists
(Maitland, 1979; Grieve,1981)•
Effectiveness of different types of signs: There are few published evaluations of the effectiveness of different types of signs.
In order to determine the influence of different elements of a sign, Easterby and Hakiel (1977) proposed a vocabulary to describe them. For example, they used ’’image” to describe the element which specifies the message carried by a particular sign. They found that comprehension is primarily influenced by the form of the image, independent of its colour or the colour of the background. They could not determine the influence of the shape of the enclosure, whether square, circular or rec tangular. They also investigated descriptive signs, signs
which specify a course of action and signs which are prohibitive. While there is a tendency for descriptive signs to be under stood best, as long as the sign is visually clear, compre hension depends primarily on the image itself (Easterby and Hakiel, 1981).
Taylor (1971) described three types of images which he called ’’symbols”. They are explained by reference to the record card of the Riding for the Disabled assessment (Figure 12):
A. An "image-related" symbol is a pictograph which is related to the subject in a particular context, i.e. the manikin0
B. A "concept-related" symbol retains characteristics of the subject, e.g. the curved arrow to indicate curvature•
C. An "arbitrary" symbol has no visual reference, e.g. the circle to indicate deformity and .the square to indicate normality.
Following Easterby and Hakiel*s conventions, signs developed for an assessment of hemiplegia will be primarily descriptive. Each sign will describe either an ability, if a "pass" is recorded, or an inability. The whole system of signs will describe the patient*s status at any given time. A sign might also specify the physiotherapist’s and the patient’s performance. For example, a sign might describe balance in sitting position. When the physiotherapist has learned the assessment, it might also prescribe the test of balance written in the instructional manual. Other signs might specify or prohibit the use of a walking aid.
Comprehension of signs: Wright (1970) and Easterby and Hakiel (1981) have also shown that an individual’s experience and familiarity with specific signs, or with similar signs, influences the likelihood of correct comprehension.
Physiotherapists are likely to be more familiar with the movement specified by an image than are other practitioners who refer to the record. They would also gain more experience with the signs because they would use them to administer the
assessment and to record their findings, as well as to retrieve information. If other practitioners find the signs of 'a
physiotherapeutic assessment less easy to understand and comprehend than physiotherapists do, the signs may be even less meaningful to elderly hemiplegic patients. The patients may need written descriptions rather than signs, because retired people have less experience with signs than younger members of the population and find them less comprehensible
(Easterby and Hakiel, 1981).
Potential use of signs on the display of the optimal assessment: A sign system provides a means of conveying a large amount of information in a small space, such as an assessment chart printed on a single sheet. The chart needs to accommodate the occasional user, who might refer to it for information "at-a- glance", as well as the assessor who uses it regularly. The studies reported here suggest that correct meaning may be conveyed to different users in different graphic forms;
Firstly, signs may be meaningless if the user has little experience with them.
Secondly, the clear image-related descriptive sign is more immediately comprehensible and effective. Thirdly, the concept-related sign requires the user to have attained the concept already; or the originator must incorporate a key or instruct users formally or informally in order for the sign to convey correct meaning (Easterby and Hakiel, 1981)
Fourthly, the lack of visual reference makes the arbitrary sign more difficult to learn and to remember; but once it is understood it is very effective.
The display should be designed to accommodate the needs of all potential users taking account of the above factors:
A. The information which is used by elderly patients may need to be presented as written statements, e.g. items recording activities such as walking from place to place.
FIGURE 13