1) Facilitation techniques in physical therapy aim to stimulate the sensory system to elicit a motor response, based on principles of associative learning. 2) While techniques like NDT and PNF have focused on stimulus-response relationships, a modern understanding recognizes that the brain learns through perception and goal-directed responses rather than simple conditioning. 3) Effective facilitation should incorporate active-assisted learning during functional activities, allowing patients to achieve motor responses without constant sensory cues, in line with theories of associative learning.

1. Facilitation in neuro-
rehabilitation
K. Hariohm
Independent researcher- CEBNR
Tamil translation manager- Cochrane Tamil
Editor- Physiotherapy Journal of IAP
The Indian Center for Evidence based Neurorehabilitation
https://twitter.com/KHariohm

2. Objective
• Clearer understanding of facilitation techniques in PT
• Modern take on older understanding of how to do it

3. These are what I am calling as
facilitation techniques
• The common techniques and ideas in neuro- PT
• Bobath- NDT
• PNF
• ROODs
• Sensory intregration – Jean ayres

4. Where did all come from
• Charles Sherrington
• What did he say
• Stimulus – leads to response (motor)

5. Classical example
• The knee jerk

6. Sensory input
1. Proprioception
2. Touch
3. Vestibular
4. Vision
5. Auditory

7. Stimulate the sensory system motor response

8. Some examples
• Joint compression

9. Sensory integration (?!) (a
classical nonsensical word)

10. What is inadequacy in it
• So basically all PT techniques NDT (Bobath) PNF,
Roods- all have one thing in common
• Stimulus – get a response

11. Goals of fasciation
• Increase tone or decrease
• Increase muscle activation (increase strength)
• Change in behaviour- a crazy theory bordering on utter
nonsense
•

12. • Tone- why you cant change
them
• It’s a property of movement
• Muscle strength- if you need
to change them-
• First rule- over load principle
Changing behaviour- calming the
child and others
yes because the brain is a
computer?

13. So how does facilitation
work
• Brain do respond
• But – it learns- permanent change in behaviour need-
learning
• Brain does not worry about stimulus- it works on
perception – response model
• They respond for a goal- for a perception

14. Classification of physiotherapy
Physiotherapy
Active
Active
assisted?
Impairment
level
Activity or
functional
level
passive

15. Learning in facilitation
• Remember the CNS- learns and adapts
• Learning theories- should be the basis of explaining
techniques

16. Associative learning

17. Associative learning
• Stimulus (unconditional stimulus UCS) (proprioception,
vestibular, touch, electric stimulation etc
• Motor response- (unconditional response UCR)
• Remember our patient should do or get UCR without
UCS
• We need to – conditional stimulus

18. Facilitation- should I still be doing it
• Remember associative learning is a simple and
rudimentary form of learning
• Difficult to do it in a functional activity
• Most of them don’t work- most of the time
• Well if they work- beware weather it is just spontaneous
recovery

19. WHAT IS MODERN
UNDERSTANDING OF FACILITATION

20. • Remember brain- works in the principle of solving a goal- for
a perceived problem
• Well all treatment should be activity or function based
• Remember to learn to swim the most important thing is water
• So- when both are combined- active assisted form of learning
is considered as facilitation

21. example

22. PRINCIPAL, STAFF AND
MANAGEMENT OF UCA COLLEGE
OF PT
Thank you