The treatment of muscular paresis by means of eccentric movements / by Rodolph Abercrombie.
- Abercrombie, Rodolph.
- Date:
- 1913
Licence: Public Domain Mark
Credit: The treatment of muscular paresis by means of eccentric movements / by Rodolph Abercrombie. Source: Wellcome Collection.
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![FEB. 8, 1913] Mepican JourNAL 277 THE TREATMENT OF MUSCULAR PARESIS BY MEANS OF ECCENTRIC MOVEMENTS. BY RODOLPH ABERCROMBIE, M.D.Canras., M.R.C.S., L.R.CP., ‘ MEDICAL DIRECTOR, EDGAR ALLEN INSTITUTE, ee Tur treatment of conditions of muscular paresis by means of the so-called eccentric movements originated in Sweden ; though widely used in Scandinavia and Germany, it is apparently little known in England. The terms “eccentric” and “concentric” as applied to muscular movements are rather clumsy; but it is neces- sary to adhere to them, because they are in general use on the Continent. By a “concentric movement” is meant the ordinary movement of a muscle which does work while becoming shorter ; on the other hand, a muscle is said to perform an “eccentric movement” when it does work while becoming longer. The significance of the terms arises from the fact that during concentric move- ments the ends of the muscle approximate more nearly to the muscle’s central point; while during eccentric move- ments they become more widely separated from it. To take a simple example: if a patient flexes his arm at ‘the elbow-joint by means of his biceps, the kiceps per- forms a concentric movement, for it does work while becoming shorter. If now a manipulator grasps the wrist of the patient’s flexed arm, and gradually extends the ‘arm at the elbow-joint while the patient resists the exten- sion, the biceps performs an eccentric movement; for in resisting the extension at the elbow-joint, the biceps does work while becoming gradually longer. _ The general rule for the performance of eccentric move- ~ ments is that the manipulator first puts the muscle into its shortest position, and then gradually elongates it, _ while the patient resists the elongation. _ aare uf aaa ‘Paresis ‘after Fracture. Fae, - The following case, however, shows that the little-used eccentric movements may be of far more value than the more ordinarily used concentric movements. als diesel iH. Mz., aged 11 years, suffering from wrist-drop due to fracture of the lower end of the humerus eight weeks pre- viously. Callus, which had obviously interfered with the - musculo-spiral nerve, was to he felt at the seat of fracture. _ The paralysis had been treated for four weeks, without effect, _ -by means of electrical treatment and massage, and the limb had been splinted with the hand in the hyperextended position. At the commencement of the treatment by eccentric move- ments the paralysis of the extensors of the wrist appeared at first sight to be complete. The hand hung limply in the posi- tion of extreme flexion; the extensors of the wrist were over- tretched, and the power of raising the hand was completely ost. Im such a case exercise of the extensors by the ordinary oncentric movements was obviously impossible; the boy could ot begin to raise his hand, so could not initiate the movement. ‘eccentric movements were here of high value. These were erformed in the following manner: The manipulator first grasped the boy’s hand, and raised it into the position of full extension, thus putting the extensors of the wrist into the shortest position; the manipulator then gradually and slowly llowed the hand to sink into the position of flexion, at the game time urging the patient to delay the fall of the hand. The hand did not fall completely ‘‘ dead,’’ thus showing that the extensors, when putinto the shortest position, possessed a ce of contractile power in the way of resisting elongation, hough in their overstretched position they had seemed quite werless. Sa , repeating the described manceuvre, it was possible to ise the extensors, with the result that rapid daily improve- ok place, so that by the end of ten days the boy could old his hand in a horizontal position. Thus treatment by eccentric movements for ten days produced a more marked ect than one. month’s previous treatment by massage, electrical treatment, and splinting in the byperextended position. | Lane ee : At this stage the extensors were exercised somewhat dif- nily. “The boy held his hand in a horizontal-position, and manipulator pressed it down into the position of flexion, W the boy resisted the movement. Complete recovery of he power of the extensors took. place more slowly, occupying everal weeks, but was ultimately complete. 3 al ae Mee The above case illustrates the advantages of treatment tric movements. In the first place, they enable a . p ensors would not be strong enough to raise the of >t, and thus the patien 1 not initiate ch ere case the value of the muscles to be exercised while still too weak to raise the weight of the limb; in the second place, it will fre- quently be found that a muscle which in the overstretched position appears quite powerless may yet, if put into its shortest position, give evidence of undoubted power.in the way of resisting elongation. The concentric movements ordinarily performed bring the muscle into action in its longest or overstretched, and therefore least favourable, position; eccentric movements, on the other hand, bring the muscle into play in its shortest, and therefore favour- able, position. Thus, by their means, it is possible to exercise a paretic muscle at the earliest possible moment, when it possesses only the smallest trace of contractile power. Herein lies the value of this treatment, for if a muscle can be got to contract physiologically, however feebly, the restoration of function will be far more rapid than can be brought about by merely passive manipulations. In the case of wrist-drop just described, the delay in recovery was Clearly not due to the continued pressure of the callus on the nerve, but was caused by some change in the muscles themselves, which was a sequel of that pressure, for it was only necessary to exercise the muscles for rapid recovery to take place. Anterior Poliomyelitis. In the treatment of the results of anterior poliomyelitis eccentric movements are of great service. It may be.of interest, for the sake of contrast, to quote the description of the method usually employed in England, as given by Mr.'Tabby it When there is footdrop, or paralysis of the dorsiflexors, the attendant may gently press his hand against the sole, and encourage the patient to dorsiflex the foot. It will be noticed that what is described is a concentric movement; it is open to the objection that in a severe case the movement could not be carried out because the strong enough to raise the weight of the foot. To perform them the manipulator would first bring the foot into a position of extreme dorsiflexion, thus putting the paretic muscles into their shortest position; he would then gradually allow the foot to drop, while the patient attempted to delay the fall of the foot. By this means even the smallest trace of contractile power could be utilized, and the muscles could be exercised at an earlier date—often many months earlier—than would be possible by the method followed in England. | Other affected muscles are dealt with on a similar plan. I frequently see cases of this condition, which had been treated without avail by massage and electricity, improve considerably under eccentric movements. It is worth noting that treatment by eccentric movements takes far less time each day than electrical treatment or massage— a matter of importance when numbers of patients have to be dealt with. All three methods may be well used in conjunction. Facial Paralysis. In facial paralysis a similar method is followed. In dealing with the muscles of expression, the manipulator first draws the affected muscle into its shortest position, and the patient attempts to hold it there, and this manceuvre is repeated. If, owing to paresis of the © orbicularis, the eye can only be partially closed, the manipulator first draws the upper lid fully down by means of the forefinger ; he then removes his forefinger, and the patient endeavours to delay the opening of the eye. Later, when the orbicularis possesses more power, the lid is first closed, and the manipulator then draws it gently upwards with the forefinger, while the patient resists the move- ment. Even in old-standing cases, this treatment is sometimes successful. : Paresis of the Upper Limb. In treating the paresis of the deltoid which so often follows injuries to the shoulder, the manipulator first the arm by placing his hand under the patient’s wrist; the manipulator then gradually lowers the arm, while the Loe eS Te EN fee TRO ES REE) Le ee](https://iiif.wellcomecollection.org/image/b3344934x_0001.jp2/full/800%2C/0/default.jpg)
