A survey done in 2002, (Lennon, 2003), to investigate physiotherapy practices for stroke patients found out that the bobath concept was the preferred approach (67%) followed by an ‘eclectic’ approach (31%)(A mixture of different approaches). The survey also identified four theoretical themes that governed the practice of neurological physiotherapy. These were;
- The promotion of normal movement
- The control of tone
- The promotion of function
- The recovery of movement with optimization of compensation
Now, this survey was carried out in the United Kingdom and it would be speculative to assume that the physiotherapists around the world had similar preferences as those in the UK. So, how has physiotherapy evolved over the years? What is the practice of neurophysiotherapy today?
Role of a Neurological Physiotherapist
Physiopedia (2020) defines neurological physiotherapy as a specialist area of physiotherapy focused on treatment of individuals with neurological condition. Neurophysiotherapist’s usually work in close partnership with other members of the multidisciplinary team to rehabilitate the patient. In low income resource settings, i.e. in some low-income/low middle-income countries you might find that only the physiotherapist is part of the rehabilitation team especially after discharge.
A physiotherapist working in neuro-rehabilitation plays the role of helping the patient experience and relearn optimal movement and functional activity. According to Lennon et al (2018) the two essential components of neurological physiotherapy are:
- Movement reeducation
- practice of functional activity
To understand better the role of a physiotherapist helping rehabilitate a patient, we need to understand the neurorehabilitation process.
Lexell & Brogardh, (2014) describe the four principle steps of the neurorehabilitation process;
- Goal setting
- Outcome assessment
This is where the rehabilitation diagnosis and a description of the consequences of a disease or injury for the person and his or her family is made. Without a proper assessment, it will be difficult to make decision on which interventions to use to help the patient. Assessment is the most important step in the neurorehabilitation process.
A proper assessment will yield;
- Activity limitations and participation restriction the patient is facing (Functional abilities of the patient)
- Factors that might influence patient’s recovery
During this step, based on the initial assessment, formulate an overarching goal in the rehabilitation plan and set specific short-term and long-term goals together with the patient. For better results when involving the patient and his family in goal setting process, they must have the background knowledge of the condition. Thus, patient education/family education is important aspect to consider.
During this step, goals made should be meaningful to the patient, which is a very important aspect of the goal setting. The best overall goal should be to improve functioning. Sometimes a goal like recovery might not always be feasible i.e. in progressive neurological diseases such as multiple sclerosis or Parkinson’s disease.
Once the setting of goals is done, the next step in the rehabilitation process is to carry out appropriate interventions. In deciding which interventions to use you need to consider things like the patients’ goals and preferences, evidence base supporting the intervention, cost of the intervention etc.
International Classification of Functioning disability and health (ICF) can be used as reference and framework by which we define our interventions. In particular, we can define if an intervention is aiming at reducing impairment, activity limitation, participation restriction or a barrier in the environment.
To describe it in a better way, any intervention used should be aimed at either;
We eliminate a symptom or an environmental barrier, or we reduce the consequences it has for overall functioning. Example, Use of TENS to reduce spasticity of the lower limb in order to improve functioning. (i.e. gait speed)
Compensation will provide a technic, or strategy, or equipment, or an aid to perform a certain activity in a better way. Example, use of an orthotic device say walking stick, to improve walking.
It will include task- specific, repetitive actions aimed at improving a body function, as well as a specific activity. i.e. Cardio-respiratory training to improve endurance/reduce fatigue to help in walking ability.
Outcome measurements is the last step in the neurorehabilitation process. Outcome measurements can be subjective i.e. those reported by the patients or objective i.e. those assessed by the physiotherapist.
When integrating the ICF in the outcome measurements we have to link the specific outcomes measurements to the ICF. The outcome measurements should assess improvement in terms of;
- Improvement of the body function/ body structures
- Improvement in the activity and participation
To be able to grasp the idea, think about a patient with reduced shoulder range of motion, if your you are to assess the recovery, you could use outcome measures that assess pain (Visual analogue scale) or maybe the range of motion (goniometry) these outcome measures only assess the improvement of body function/structures. If you wanted to measure recovery in terms of activity and participation it would require outcome measures such as action arm reach test.
Lennon, S. (2003). Physiotherapy practice in stroke rehabilitation : a survey. https://doi.org/10.1080/0963828031000069744
Lennon, S., Ramdharry, G., & Verheyden, G. (Eds.). (2018). Neurological Physiotherapy Pocketbook E-Book. Elsevier Health Sciences.
Lexell, J., & Brogardh, C. (2014). The use of ICF in the neurorehabilitation process The use of ICF in the neurorehabilitation process. https://doi.org/10.3233/NRE-141184
Physiopedia , Neurological physiotherapy in Private Practice retrieved from https://www.physio-pedia.com/Neurological_Physiotherapy_in_Private_Practice on 25 September 25, 2020.