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UMPHRED’S
NEUROLOGICAL
REHABILITATION
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UMPHRED’S
NEUROLOGICAL
REHABILITATION
SIXTH EDITION
Darcy A. Umphred, PT, PhD, FAPTA
Emeritus Professor and Past Chair
Department of Physical Therapy
School of Pharmacy and Health Sciences
University of the Pacific
Stockton, California
Gordon U. Burton, PhD, OTR/L
Professor Emeritus and Past Chair
Department of Occupational Therapy
San Jose State University
San Jose, California
Rolando T. Lazaro, PT, PhD, DPT, GCS
Associate Professor
Department of Physical Therapy
Samuel Merritt University
Oakland, California
Margaret L. Roller, PT, MS, DPT
Professor and Graduate Coordinator
Department of Physical Therapy
California State University, Northridge
Northridge, California
Clinical Instructor
NeuroCom International, a division of Natus
Clackamas, Oregon
3251 Riverport Lane
St. Louis, Missouri 63043
UMPHRED’S NEUROLOGICAL REHABILITATION ISBN: 978-0-323-07586-2
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
Copyright © 2007, 2001, 1995, 1990, 1985 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 18: Beyond the Central Nervous System: Neurovascular Entrapment Syndromes: Laura J. Kenny
retains copyright to her original figure 18-6.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and retrieval system,
without permission in writing from the publisher. Details on how to seek permission, further information about
the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information
or methods they should be mindful of their own safety and the safety of others, including parties for whom
they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge
of their patients, to make diagnoses, to determine dosages and the best treatment for each individual
patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the uthors, contributors, or editors, assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.
Library of Congress Cataloging-in-Publication Data
Umphred’s neurological rehabilitation / [edited by] Darcy Umphred ... [et al.].—6th ed.
p. ; cm.
Neurological rehabilitation
Rev. ed. of: Neurological rehabilitation / [edited by] Darcy A. Umphred ; with section editors, Gordon U.
Burton, Rolando T. Lazaro, Margaret L. Roller. 5th ed. c2007.
Includes bibliographical references and index.
ISBN 978-0-323-07586-2 (hardcover : alk. paper)
I. Umphred, Darcy Ann. II. Neurological rehabilitation. III. Title: Neurological rehabilitation.
[DNLM: 1. Nervous System Diseases—rehabilitation. WL 140]
616.8’0462—dc23
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Dedicated to: A sequential process of learning from the first to the sixth edition.
To
Gordon, Jeb, Benjamin, my mother, Janet, my daughters-in-law Julianne and Tassie, and
our four grandchildren, Jackson, Jelena, Alexander, and Cameron, whose love, patience,
and understanding constantly gave and have continued to give me strength and joy.
To
All those special people whose insights, wisdom, guidance, and patience have helped to
give the authors of these chapters their unique gifts and talents, as well as their willingness
to share their thoughts with all of you.
To
Very dear friends, colleagues, and past chapter authors who gave so much energy, dedication,
and service both scholarly as well as practicing clinicians. Over the last 30 years, the book’s
family has changed, as has the evolution of the text. With great regret we have had to say
good-bye to five authors, Mary Jane Bouska, Jane Schneider, Laura Smith, Donna El-Din,
and Christine Nelson. The professions will miss all of you, but your gifts continue to make
a difference.
To
Life, to each person’s journey and to all those who give opportunities for others’ growth
along that journey. Special thanks to my immediate family and all my friends and colleagues
I hold so close to my heart. Because of all of you, my journey has been constantly renewed
with love, warmth, and guidance. No one could feel wealthier than I.
To
Each day we are allowed to walk on this earth. Life is very precious, and how long we
will be allowed to stay is an unknown. I have learned to appreciate this time and hope
none of us become so busy that we forget its finiteness. Enjoy the journey and always
find time to stop and appreciate who you are, what you are, and those gifts you have
been given to share with the rest of us. We walk alone in physical form but surrounded
by all the energies of others as well as our own. Hopefully, as we continue this adventure
we share and give positive thoughts and energy to life and leave having given much
more than we have taken. Each person we meet, whether as a student, a teacher, a family
member, a friend, a colleague or a patient, has something to teach us and, hopefully, we
in turn allow those we meet to grow and learn from us. This is a wondrous journey, and
I hope all of you enjoy your path as much as I have mine.
To
My fellow editors, Dr. Gordon Burton, Dr. Rolando Lazaro, and Dr. Margaret Roller, for
all the time and total commitment they have made to the sixth edition of this text. Few
individuals reading and using this book and the complimentary online video site will
ever appreciate the hundreds if not thousands of hours these individuals made editing
chapters and videos and the totality of their commitment to the future of our professions.
Darcy A. Umphred
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Contributors
Paula M. Ackerman, MS, OTR/L Sandra G. Bellamy, PT, MS, DPT, PCS
SCI Post Acute Rehab Manager Associate Professor
Shepherd Center Department of Physical Therapy
Atlanta, Georgia University of the Pacific
Stockton, California
Janet Marie Adams, PT, MS, DPT
Professor Janet R. Bezner, PT, PhD
Department of Physical Therapy Vice President, Education and Governance and
California State University, Northridge Administration
Northridge, California Deputy Executive Director
American Physical Therapy Association
Diane D. Allen, PT, PhD
Alexandria, Virginia
Associate Professor
University of California San Francisco/San Francisco State William G. Boissonnault, PT, DHSc, FAAOMPT, FAPTA
University Professor
Graduate Program in Physical Therapy Physical Therapy Program
San Francisco, California University of Wisconsin-Madison
Madison, Wisconsin
Leslie K. Allison, PT, PhD
Assistant Professor Jennifer M. Bottomley, PT, MS, PhD
East Carolina University Academic ad Clinical Educator in Geriatric Physical
College of Allied Health Sciences Therapy International
Department of Physical Therapy Adjunct Professor at the MGH Institute of Health Care
Greenville, North Carolina Professionals
Coordinates Rehabilitation Services for the Committee to
Brent D. Anderson, PT, PhD, OCS
End Elder Homelessness/HEARTH in Boston
President
Consultant for Amedisys Home Health Care and Hospice
Polestar Education
Vice President for International PhysioTherapists Working
Adjunct Professor
with Older People (IPTOP)
University of Miami
Independent Educator and Geriatric Rehabilitation
Department in Physical Therapy
Consultant
Miami, Florida
Boston, Massachusetts
Ellen Zambo Anderson, PT, MA, GCS
Annie Burke-Doe, PT, MPT, PhD
Associate Professor
Associate Professor
University of Medicine and Dentistry of New Jersey
University of St. Augustine for Health Science
Newark, New Jersey
San Marcos, California
Joyce Ann, OTR/L, GCFP
Gordon U. Burton, PhD, OTR/L
Occupational Therapist, Guild Certified Feldenkrais Practitioner
Professor Emeritus and Past Chair
Highland Park, Illinois
Department of Occupational Therapy
Myrtice B. Atrice, PT, BS San Jose State University
SCI Clinical Manager San Jose, California
Shepherd Center
Katie Byl, PhD
Atlanta, Georgia
Assistant Professor
Amy J. Bastian, PT, PhD University of California, Santa Barbara
Professor Department of Electrical and Computer Engineering
Neuroscience Santa Barbara, California
Johns Hopkins School of Medicine
Marten Byl, PhD
Director
Principal Scientist
Motion Analysis Laboratory
Physical Sciences Inc.
Kennedy Krieger Institute
Handover, Massachusetts
Baltimore, Maryland
Visiting Scientist
Joanna C. Beachy, MD, PhD University of California, Santa Barbara
Associate Professor Santa Barbara, California
Division of Neonatology
Associate Director NBICU
University of Utah
Salt Lake City, Utah
vii
viii Contributors
Nancy N. Byl, PT, MPH, PhD, FAPTA Clayton D. Gable, PT, PhD
Professor and Chair Emeritus US Army, Headquarters MEDCOM
School of Medicine, Department of Physical Therapy and Fort Sam Houston, Texas
Rehabilitation Science Private Practice PT
University of California, San Francisco Adult and Pediatric Neuology
San Francisco, California San Antonio, Texas
Home Ex Pro
Beate Carrière, PT, CAPP, CIFK
Chief Executive Officer
Physical Therapist, Author, Teacher
Odessa, Texas
Evergreen Physical Therapy Specialist
Pasadena, California Mary Lou Galantino, PT, PhD, MSCE
Professor of Physical Therapy
Laurie Ruth Chaikin, MS, OTR/L, OD, FCOVD
Holistic Health Minor Coordinator
Clinical Field Supervisor
School of Health Sciences
VisionCare, Inc.
The Richard Stockton College of New Jersey
Saratoga, California
Galloway, New Jersey
Alain Claudel, PT, DPT, ECS Adjunct Researcher, CCEB
Board Certified Specialist in Clinical Electrophysiology Adjunct Associate Professor of Family Medicine and
Director, Rehabilitation Services Community Health
Community Hospital of the Monterey Peninsula University of Pennsylvania
Monterey, California Philadelphia, Pennsylvania
Carol M. Davis, DPT, EdD, FAPTA Teresa Gutierrez, PT, MS, PCS, C/NDT
Professor Emerita Pediatric Rehab Northwest, LLC
Department of Physical Therapy Gig Harbor, Washington
University of Miami Miller School of Medicine
Ann Hallum, PT, PhD
Myofascial Release Physical Therapist
Dean of Graduate Studies
Polestar Pilates Rehabilitation
San Francisco State University
Coral Gables, Florida
Professor
Judith A. Dewane, PT, DSc, NCS Graduate Program in Physical Therapy
Assistant Professor (CHS) University of California/San Francisco State University
Doctor of Physical Therapy Program San Francisco, California
Department of Orthopedics and Rehabilitation
Jeffrey Kauffman, MD
University of Wisconsin
Holistic Health Associate
Madison,Wisconsin
Sacramento, California
Peter I. Edgelow, PT, MA, DPT
Laura J. Kenny, PT, OCS, FAAOMPT
Assistant Clinical Professor
Clinical Specialist
Graduate Program in Physical Therapy
Occupational Health Department
University of California, San Francisco
Oakland, California
San Francisco, California
David M. Kietrys, PT, PhD, OCS
Barbara Edmison, PT
Associate Professor
Center Coordinator of Clinical Education
Rehabilitation and Movement Sciences
Therapy Services Department
University of Medicine and Dentistry of New Jersey
Santa Barbara Cottage Hospital
Newark, New Jersey
Santa Barbara, California
Kristin J. Krosschell, PT, DPT, MA, PCS
Teresa A. Foy, OT, BS
Assistant Professor
OT Therapy Manager
Department of Physical Therapy and Human Movement
SCI Program
Sciences
Shepherd Center
Feinberg School of Medicine
Atlanta, Georgia
Northwestern University
Kenda Fuller, PT, NCS Chicago, Illinois
Owner
Rolando T. Lazaro, PT, PhD, DPT, GCS
South Valley Physical Therapy
Associate Professor
Specialist in Neurologic Physical Therapy
Department of Physical Therapy
Denver, Colorado
Samuel Merritt University
Oakland, California
