1. Introduction_BPT_Neurophysio_Preeti.pptx

INTRODUCTION TO NEUROLOGICAL PHYSIOTHERAPY
Presented by
Preeti Yadav
MPT (Neurology)
Dept. of Physiotherapy
Nobel Medical College

INTRODUCTION
• It is a specialist branch of physiotherapy dedicated to improving the function of
individual who have suffered physical impairment caused by neurological
conditions (brain, spinal cord and nervous system).

PhysiotherapeuticApproaches to Neurological Conditions
• Neurotherapeutic approaches plays an important role in managing neurological
disorders as well as diseases.
• These interventional approaches are aligned with motor learning, developmental
patterns and neuroplasticity theory which leads to train non-affected part of the brain
to functionally compensate for affected area of the brain.
• Patients with neurological symptoms, approached with a step wise manner, which
consists of:
 Identifying the anatomic location of lesion causing symptoms.
 Identifying the pathology involved.
 Generating differential diagnosis.
 Selecting appropriate tests and intervention.

Types of Neurological Approaches
• Neurodevelopmental approaches (NDT)
• PNF (Proprioceptive neuromuscular facilitation
• Bruunstorm technique/ Movement therapy
• Roods technique
• Bobath technique
• Sensory Integration technique
• Biofeedback
• Constrained Induced Movement Therapy
• Motor releasing techniques

Treatment Approaches
• Stretching
• Strengthening
• Balance reeducation
• Gait reeducation
• Joint mobilization
• Electric stimulation
• Postural exercise
• Spasticity management
• Advice/Education on lifestyle/fatigue management & exercise.

COMMON NEUROLOGICAL CONDITIONS
• Stroke
• Multiple sclerosis
• Spinal cord injury
• Parkinson’s Disease
• Traumatic Brain Injury
• Mysthenia Gravis
• Gullian Barrie Syndrome

FUNCTIONALASSESSMENT AND ITS IMPORTANCE
 Introduction:
• Functional Assessment in physiotherapy refers toa series of tests and observation
that helps therapists understand how an individual’s health conditions or injury
affects their ability to perform ADL.
• Functional Assessment is a comprehensive evaluation conducted by physiotherapist
to determine a patient’s physical strengths, weakness and limitations.
• It is a comprehensive evaluation designed to understand an individual’s physical
capabilities and limitations.

 Importance:
• Helps to conduct effective rehabilitation.
• Helps to measure progress and ensure treatments are relevant to real life activities.
• It predicts the potential for an individual’s recovery.
• Empowering the individual to regain functionality and improve quality of life.
• Helps to understanding of a patient’s physical capabilities and limitations.
• Helps to enhance patient-centered care and improving outcomes in physiotherapy.
• Helps to tailor treatment plans to the specific needs and goals of each patients.
• Regular functional assessments throughout the course of treatment enable the
therapists to monitor progress and make necessary adjustments to the treatment
plan , leading to more effective outcomes.

 Purpose of Functional Assessment:
• To identify any physical impairments that might be hindering normal function, there
by facilitating a targeted treatment plan.

Process of Functional Assessment in Physiotherapy:
1. Gathering Patient History:
 Initial Phase:-
 Medical History
 Current Condition
 Understanding the patient goals, challenges and daily activities.

2. Setting Rehabilitation Goals:
 Based on the initial consultation, specific, measurable, achievable, relevant and
time-bound goals are set.

3. Physical Examination:
 Observation and Palpation:
 Observation begins with observing the patients' posture, movement patterns, any
visible signs of discomfort or dysfunction.
 Palpation, the process of examining body parts by touch, helps identify areas of
tenderness, swelling or other abnormalities.
 RoM and Muscle testing:
 Evaluating the RoM and muscle strength is fundamental to understanding the extent
of impairment and help in pinpointing specific area that require attention to store
mobility and strength.

Types of Functional Tests:
 Strength and Flexibility
 Muscle strength tests
 Flexibility tests – sit and reach test
 Balance and Coordination tests:
 Balance and coordination are critical for maintaining stability and performing complex
movements smoothly.
 Tests are:
o Static Balance Tests: Ability to maintain stability while on standing still. Eg. Single leg
standing.
o Dynamic Balance Tests: Ability to maintain stability while moving or changing positions.
Eg. The Timed up and go Test.

Interpretation by Functional Assessment:
 Identifying Functional Limitations
 Formulating a customized treatment plan: Plan may include-
 Targeted Exercise
 Therapeutic Interventions

Tools & Techniques for Functional Assessment:
1. FMS (Functional movement Screen)
2. Berg Balance & Scale
3. Barthel Index
4. Katz Index
5. FIMS (Functional Independence Measure)

Tools & Techniques for Functional Assessment:


CONCEPTS OF EARLY REHABILITATION
 Early rehabilitation refers to the initiation of rehabilitation
interventions soon after an injury or illness occurs.
 Neurological problems leads to a variety of problems and
different neurological symptom such as disorder of
consciousness, impaired motor control, sensory dysfunction,
cognitive dysfunction and swallowing.
 It involves multidisciplinary approach with a team of
healthcare professionals.

 Aims:
 To improve motor, cognitive and functional recovery.
 To prevent or treat complications such as pressure ulcers,
pulmonary and bladder infections, contractures, heterotrophic
ossification, limb contraction, DVT, muscle wasting as early
as possible.

 Importance:
 Reducing morbidity and improving functional outcomes in
various conditions such as traumatic brain injury, spinal cord
injury and stroke.
 Early rehabilitation plays a crucial role in promoting recovery
and regaining independence for patients with serious diseases
or injuries.

Procedures used in Acute Rehabilitation:
 Mobilize the patient who are otherwise bed-ridden.
 Use of different equipment to help patient sit on their bed.
 To achieve standing we can use tiltable & wheelchairs are
used for sitting.
 Patient who are able to sit in the wheel-chair can be driven out
from the room, which has a positive effect on the patients well
being.
 Passive sitting can be accommodated for the patient who are
in a minimally conscious state.

 Sometime we must use aggressive early intervention such as
casting, splitting.
 Physical exercise can be applied in a functional task oriented
way with the aim to restore activities such as sitting, standing
balance, transfers, gait, reaching and grasping.
 Carefully assess patient for their functional capacities and train
them according to appropriate strategies. For assessing we can
use- Barthel index, Functional independence measure (FIM),
Berg balance Scale.

 In case of extensive neurological deficits and disturbance of
consciousness with poor cooperation we can focus on
preventing complications where we can provide respiratory
physiotherapy regularly throughout the day, change patient
position, prevent contractures.


MULTIDISCIPLINARY TEAM
 Introduction:
It is a group of diverse clinicians who communicate with
each other regularly about the care of a defined group of patients
and participate in that care.

 Advantages of Multidisciplinary care:
 Patient have the opportunity to discuss treatment options
and ask questions of the different specialists involved in their
care.
 Better decision making.
 Provides wider spectrum of knowledge and experience.
 Can work more effectively.
 Improve with care.

 Provide support from the team members to each other.
 Ensures the availability of a wide array of treatment options.

 Roles of MDT:
 Identification of patient’s needs.
 Mutual goal between the team professionals and a shared
understanding on how to achieve them.
 Communication and coordination between all individuals in
rehabilitation including professionals and relatives.
 Evaluation of the aims.
 Set a routine in which individual patients will receive
personal interventions and reach optimal improvements for the
case.

 Roles of MDT:
MDT Role
General practitioner To provide day to day clinical management.
Neurologist To plan & monitor treatment.
Neuro surgeon To perform surgery of brain & spinal cord.
Nurse To manage care and coordinate with hospital.
Physiotherapist To maximize functional ability.
Speech & language
therapist
To manage difficulties with speech, communication,
eating, drinking & swallowing & vocational
training.

MDT Role
Occupational therapist To advise on measures to retain independences.
Nutritionist To ensure optimal nutrition.
Psychologist Deal with depression, other mental health issues.

1. Introduction_BPT_Neurophysio_Preeti.pptx

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