Physiotherapy Neurological Rehabilitation

1. ADEYEMO, ADEMOLA OLUYOMI
BMR (PT) M.Sc PT
PRESENTATION
DEPARTMENT OF PHYSIOTHERAPY, SCHOOL OF
POSTGRADUATE STUDIES, UNIVERSITY OF LAGOS,
NIGERIA.
FEB. 2015.
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2.  A therapist managing neurological patients prior to the 1940s
may have asked: how can I train the person to use their
unaffected body parts to compensate for the affected parts, and
how can I prevent deformity? The result was a strong
emphasis on orthopaedic intervention with various types of
splints strengthening exercises and surgical intervention.
However, in the 1940s several other ideas emerged, the most
popular being bobath (1985) with others, such as
peto(forrai1999), kabbat and knott (1954), voss (1967), and
rood(1954), pioneered neurological approach to these
disorders recognising that patient with neurological
impairment had potential for functional recovery of their
affected body parts.
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4.  Neurophysiological Approaches are theoretical
concepts based on practical knowledge of
understanding the physiology that helps CNS
function.
 Neurophysiological approaches utilizes CNS
plasticity, it contributes to the adaptation and
reorganization of CNS function.
 Correct and repeated stimulation through
neurophysiological approaches can lead to non
involved part of the brain functionally compensating
for the affected area of the brain.
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5.  Muscle Re-education Approach (1920s)
 Neurodevelopmental Approaches (1940-70s)
◦ Sensorimotor Approach (Rood, 1940s)
◦ Movement Therapy Approach (Brunnstrom, 1950s)
◦ NDT Approach (Bobath, 1960-70s)
◦ PNF Approach (Knot and Voss, 1960-70s)
 Motor Control & Relearning (1980s)
 Sensory integration (Jenn Ayers1920 -1989)
 Contemporary Task-Oriented Approach (1990s)
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6.  Muscle re-education and muscle testing, basically the
principles of neuromuscular physiology are applied
clinically in the treatment of paresis and paralysis
◦ It is the phase of therapeutic exercises developed to the
development, or the recovery of voluntary control of skeletal
muscles
◦ The use of physical therapeutic exercises to restore muscle
tone and strength after injury or disease
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7.  Application of proper/ controlled sensory stimuli to
the appropriate sensory receptors as it is utilised in
normal sequential development
 The controlled input can be
◦ Facilitatory light moving touch, fast brushing , icing etc
◦ Inhibitory gentle shaking / rocking, slow stroking, slow rolling
etc
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8.  Rood theory
◦ Normalize tone
◦ Treatment begin at developmental level of functioning (
Hierarchical)
◦ Movement is directed towards functional goals
◦ Repetition is necessary for re-education of muscular response
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9.  Emphasises the synergic pattern of movement
which develops during recovery from hemiplegia.
This approach encourages development of flexor and
extensor synergies during early recovery, with the
intention that synergic activation of muscles will,
with training, transit into voluntary activation of
movements.
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10.  Brunnstrom (1966, 1970) and Sawner (1992) also described the process of recovery
following stroke-induced hemiplegia. The process was divided into a number of stages
 Flaccidity (immediately after the onset)
 No "voluntary" movements on the affected side can be initiated
 Spasticity appears
 Basic synergy patterns appear
 Minimal voluntary movements may be present
 Patient gains voluntary control over synergies
 Increase in spasticity
 Some movement patterns out of synergy are mastered (synergy patterns still
predominate)
 Decrease in spasticity
 If progress continues, more complex movement combinations are learned as the basic
synergies lose their dominance over motor acts
 Further decrease in spasticity
 Disappearance of spasticity
 Individual joint movements become possible and coordination approaches normal
 Normal function is restored
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11.  Aims to inhibit spasticity and synergies, using
inhibitory postures and movements, and to
facilitate normal autonomic responses that are
involved in voluntary movement control.
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12.  Relies on quick stretching and manual resistance of
muscle activation of the limbs in functional directions,
which often are spiral and diagonal in direction.
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13.  Incorporates functional training for key motor tasks such
as sitting, standing, standing up, or walking.
 The therapist analyses each task, determines which
component of the task cannot be performed,
 Trains the patient in those components of the task, and
 Ensures carryover of this training during daily activities
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14.  Sensory integration provides internal representations
of the environment that informs and guides motor
responses
 These sensory representations provides the
foundation on which motor programs for purposeful
movements are planned, coordinated and
implemented.
 Motor learning and performance is inextricably
linked to sensation, the individuals learns to
anticipate – feedforward or correct or modify –
feedback movement based on sensory inputs
organised and integrated by the CNS
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15.  Based on systems model of motor control and
contemporary motor learning theories
 Emphasizes that effective therapeutic intervention
depends on identification of the system that is critical
to controlling the occupational performance at a
specific time
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