Principles of Neurological Physiotherapy

What is a neurological physiotherapist?

Neuro physios manage people with movement disorders as a result of injuries and diseases of the brain, spinal cord and the broader neuromuscular system 

Who does a neurological physio work with?

Clients of all ages who have disorders or damage to brain, spinal cord or neuromuscular system

Clients who have degenerative conditions affecting brain, nerves, or muscles

Clients with movement disorders arising from disturbances of motor or sensory systems 

Types of Conditions

Stroke

Traumatic/ABI 

Spinal Cord Injury 

Inherited Neurological Disorders 

Neurodegenerative conditions (ie. MS, Parkinson’s)

Dizziness/Vestibular Disorders

Balance disorders / falls management 

Cerebral palsy 

Peripheral Neuropathies (Guillian Barre / Polyneuropathy) 

Where do Neurological Physiotherapists work?

Acute wards/ stroke units / neurological wards

Rehabilitation Units- inpatient, outpatient

Private practice rehabilitation 

Rehabilitation in the home/community (ie. transition care programs) 

Domiciliary care facilities

Outreach services 

Principles of Neurological Physiotherapy

Applies knowledge and scientific evidence from several areas

Fosters active participation and self-management

Based on evidence base practice

Patient centered and family centered

Delivered within an ICF Framework

Requires ongoing use of clinical reasoning process

Essential Knowledge Areas

Neuroanatomy

Neural plasticity, recovery processes and prediction of outcomes

Motor control (and changes with ageing or injury)

Motor learning and skill acquisition

Biomechanics of normal movement

Principles of effective coaching

Evidence of efficacy of techniques and strategies

Neurorehabilitation has transformed into an evidence-based domain internationally

Clinicians must review latest high-level evidence to inform practice

Quality of evidence best to worse 

Systematic reviews and meta-analyses

RCT

Cohort studies

Case-controlled studies

Case series and reports 

Background information and expert opinion 

Physio Approaches

Motor learning

Neurodevelopmental

Bobath

Feldenkrias

Brunnstrom

Proprioceptive neuromuscular facilitation

Physiotherapeutic approaches

Insufficient evidence that one treatment approach is more effective than another

Within the various approaches there are both effective and ineffective interventions-these need to be employed selectively

Many similarities and differences between approaches

Emphasis should be placed on reviewing efficacy of individual techniques and task specific treatments

Movement scientist

Motor control and motor skill acquisition

Neurological physiotherapy is delivered within an ICF framework

The client as a person with a health condition in an environment

• Health condition

• Body function and structure

• Activity

• Participation

• Environmental Factors

• Personal Factors

Neurological physiotherapy should target:

Participation restriction, activity limitations and impairments

Participation Restriction

Patient is currently unable to return home from hospital or access the community

Activity Limitations 

Patient requires the assistance of 2 people to walk 

Patient is unable to stand without support

Impairments

Weakness R LL

Weakness R UL

R homonymous hemianopia

Decreased sensation R LL

Decreased proprioception R LL

Reduced DF ROM R ankle

Decrease muscle length in gastrocs/soleus R

Pain in R knee

Neuro physio requires ongoing use of a clinical reasoning process

Assess

• Initial physio assessment

Interpret

• What is their prognosis?

• Formulate a problem list (inclusive of activity limitations and impairments

Goal Setting

• What are the aims of your physio intervention (RAMP) 

• Set SMART goals- to be done with patient 

Treatment Planning / Treatment Implementation

Reassess / Measure Outcomes / Reset Goals

RAMP

Recovery

Adaptation

Maintenance

Prevention

Neuro physio practice is client/family centred

Encourage and respect the client’s autonomy, control and choice

Respect the client’s values, priorities and perspectives

Always involve the client/family in goal making and decisions

Individualize the service delivery

Empower the client

Ensure that therapy is useful and relevant

Neuro physio fosters active participation and self management 

Emphasis on physio’s role as a “trainer” or “coach”

Client and carer/family need to be empowered to:

• Take responsibility for health/lifestyle issues 

• Work with carer/spouse/family as early as practical following diagnosis 

  • Client takes active role rather than passive recipient of therapy 

Neurological Physio Practice

1. Applies knowledge and scientific evidence from several areas

2. Is based on evidence of efficacy of techniques and strategies

3. Is delivered within an ICF framework

4. Requires ongoing use of a clinical reasoning process

5. Is client/family centred

   1. Fosters active participation and self-management