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Neurophysiological approaches


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Physiotherapy Neurological Rehabilitation

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Neurophysiological approaches

  2. 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. 2
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  4. 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. 4
  5. 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) 5
  6. 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 6
  7. 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 7
  8. 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 8
  9. 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. 9
  10. 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 10
  11. 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. 11
  12. 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. 12
  13. 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 13
  14. 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 14
  15. 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 15