Some Neuro Physiotherapy approaches used by B2LCARE Neuro Physiotherapy team
- b2lcare
- 11 hours ago
- 10 min read
Neuro physiotherapy protocols are highly individualized, reflecting the unique needs and conditions of each patient. Before initiating any treatment plan, it is crucial to conduct a comprehensive assessment of the patient's condition. This assessment includes a detailed evaluation of the patient's medical history, physical capabilities, and specific neurological deficits. Furthermore, it is essential to consider the patient's environmental context, which encompasses their living situation, accessibility to resources, and support systems. Understanding the patient's social and personal circumstances is equally important, as these factors can significantly impact their rehabilitation journey. Ultimately, the primary goal of neuro physiotherapy is to enhance the quality of life for both the patient and their family members, ensuring that the therapeutic interventions are aligned with their personal goals and aspirations.
As the field of neuro physiotherapy evolves, treatment methodologies are continuously being updated and refined. New concepts and modified approaches are emerging, driven by ongoing research and clinical practice. Moreover, the integration of advanced technology, particularly through the application of artificial intelligence, is revolutionizing the way neuro physiotherapy is delivered. These innovations facilitate more accurate assessments, personalized treatment plans, and real-time monitoring of patient progress. The use of technology not only enhances the effectiveness of therapy but also empowers patients by providing them with tools to engage in their rehabilitation actively.
The B2LCARE Neuro physiotherapy team is at the forefront of these advancements, committed to providing the highest standard of care. Our team comprises skilled professionals who specialize in various neuro physiotherapy treatment methods, ensuring a holistic approach to rehabilitation. We strive to create individualized treatment plans that aim to restore functional independence and promote a lifestyle that closely resembles normalcy for our patients. By leveraging the latest techniques and fostering a collaborative environment, we work diligently to support neurological patients in achieving satisfactory outcomes and enhancing their overall well-being. Our dedication to excellence in neuro physiotherapy reflects our understanding of the complexities involved in neurological rehabilitation and our commitment to making a positive impact in the lives of our patients.
Various Methods and Concepts of Neuro physiotherapy treatment :
Proprioceptive Neuro Muscular Facilitation (PNF)
The proprioceptive neuro muscular facilitation is a mass movement pattern involving one and more joints with associated muscle .
What mass movement pattern is characteristic of normal motor activity .Our brain knows nothing about individual muscle action but knows only the movement .
In normal functional mass movement patterns required shortening and lengthening reaction in many muscles in varying degrees .
PNF is an approach used to controlling tone of the muscles and to bring back normal functional mass movements pattern .
Motor relearning programme :
This method, developed by the renowned researchers Carr and Shephard, presents a comprehensive approach to rehabilitation that emphasizes the importance of context and task analysis in the recovery process. The core idea behind this method is that mastering a functional task can be achieved more effectively when the task is practiced in its actual setting, rather than in a simulated or artificial environment. This real-world practice allows patients to engage with their surroundings, which can enhance their learning experience and improve their ability to perform the task in everyday situations.
Moreover, the method advocates for breaking down the entire task into smaller, manageable steps. This stepwise approach not only makes the learning process less overwhelming for patients but also allows for targeted practice on specific components of the task. By focusing on each individual step, patients can build their confidence and skills progressively. This technique is particularly beneficial for stroke patients, who may experience varying degrees of motor impairment and require tailored interventions to address their unique challenges.
The motor relearning program, as outlined by Carr and Shephard, has shown significant effectiveness for stroke patients, facilitating their recovery and enhancing their functional independence. It is essential that this program is initiated once the patient's overall medical condition is stable, ensuring that they are physically ready to engage in the rigorous practice required for rehabilitation. Once stability is achieved, therapists can implement this method to help patients regain lost motor functions and improve their ability to perform daily activities.
In addition to its practical applications, this method is underpinned by a robust theoretical framework that draws from motor learning principles and neuroplasticity. As patients practice the functional tasks within their actual environments, they stimulate neural pathways that may have been affected by the stroke, promoting recovery and adaptation. This holistic approach not only addresses the physical aspects of rehabilitation but also considers the psychological and emotional components, fostering a sense of accomplishment and motivation among patients.
Overall, the method created by Carr and Shephard represents a significant advancement in the field of rehabilitation for stroke patients, providing a structured yet flexible framework that can be adapted to meet the diverse needs of individuals on their journey to recovery.
Neuromotor development training(NDT) or Bobath approach
This approach is fundamentally rooted in the principles of normal movement and neurodevelopmental strategies. It emphasizes the importance of understanding how typical movement patterns develop and function, particularly in children and individuals with neurological conditions. The primary objective of this methodology is to prevent the occurrence of abnormal movement patterns, which can lead to a variety of complications and functional impairments. Abnormal movements can arise from various factors, including neurological disorders, injury, or developmental delays, and they often result in compensatory strategies that are not optimal for the body’s biomechanics. By focusing on normal movement, practitioners aim to promote more effective and efficient movement patterns that align with the body’s natural mechanics. A critical aspect of this approach is the management of adverse plastic adaptation, a phenomenon that refers to the negative changes in muscle and joint function due to prolonged abnormal movement patterns. Adverse plastic adaptation can manifest in several ways, including muscle shortening, which occurs when muscles are consistently used in a shortened position, leading to a reduction in flexibility and strength. This can also result in joint deformities, where the structural integrity of the joint is compromised, causing pain, reduced mobility, and further complications. To combat these issues, interventions are designed to encourage proper alignment, facilitate optimal movement strategies, and enhance overall motor control. Techniques may include specific exercises aimed at lengthening shortened muscles, strengthening weak muscle groups, and improving coordination and balance. Additionally, education for patients and caregivers about the importance of maintaining normal movement patterns is crucial for ongoing success and prevention of future complications. Overall, this neuro developmental approach is comprehensive, addressing not just the physical aspects of movement but also considering the neurological and developmental factors that contribute to an individual's overall motor function. By preventing abnormal movement and managing the risks associated with adverse plastic adaptation, we can significantly improve quality of life and functional outcomes for individuals facing these challenges.
Neurobic exercise :
Personal growth and brain growth happen outside our comfort zone. Great thinkers and doers are well rounded and well-read and take part in a variety of activities.They constantly strive to experience new sources of enlightenment by pushing boundaries,making new connections,and seeing themselves and the world in new ways. Neurobic exercises help motivate us to take risks and step into areas where we have been afraid in order to expand our minds and grow intellectually and emotionally. Neurobics (neuron+aerobics)are stretching exercises to increase oxygen and give our brain's neurons more life by experiencing or participating in some new activity,situation,or event.
When we stretch our mind, it never returns to its previous shape. Research indicates that taxing the brain(making it ‘sweat’) with unfamiliar exercises can improve our ability tolerance, remember and solve problems.
5.EMG Bio feedback : EMG biofeedback is an advanced therapeutic technique used to measure and display real time electrical activity of muscle along with visual and auditory feedback .It helps patients gain conscious control over involuntary muscle contraction or helps in rehabilitation of muscle power and endurance .
6.Margaret Rood’s Approach :This technique which is used for facilitating and relaxing is based on the following principals .
Providing sensory stimulation to activate receptors for facilitating or relaxing motor responses.
Techniques of stimulation such as stroking , brushing , ice , heating , pressure , bone pounding, slow and quick stretch joint traction and approximation are used to facilitate or inhibit ( Spastic muscle ) motor response .
7.Facilitation and Inhibition technique :
A number of therapeutic techniques can be used to facilitate, activate, or inhibit muscle contraction. The term facilitation refers to the enhanced capacity to initiate a movement response through increased neuronal activity and altered synaptic potential. Facilitation technique is used for activating hypotonia muscle or completely paralysed muscles.
On the other hand inhibition technique refers to the decreased capacity to initiate a movement response through altered synaptic potential. Inhibitory technique is very effective treatment for managing spastic muscles.
8.Constrain Induced movement therapy :
Constraint-Induced Movement Therapy (CIMT) is an evidence-based rehabilitation technique that improves the function of an affected limb (usually an arm) in individuals with neurological damage, such as from a stroke, traumatic brain injury, or cerebral palsy. It involves restraining the stronger, unaffected limb to force the use of the weaker limb, combined with intensive, repetitive, and task-oriented training.
9.Task oriented training :
Evidence from research on function-induced recovery has led to functional/task-oriented training.Central to this approach is the idea that specific task-oriented training with extensive practice is essential to reacquiring skill and enhancing recovery. Theoretically, the interacting systems of the CNS are viewed as organized around essential functional tasks. Thus, an understanding of tasks, the essential elements within each task, and the context or environment in which tasks occur is key to structuring appropriate training.
10.Strength power and endurance training
Muscle performance is defined as the capacity of a mus-cle or group of muscles to generate forces.Muscle strength is the “muscle force exerted by a muscle or a group of muscles to overcome a resistance under a specific set of circumstances.Muscle power is the work produced per unit of time or the product of strength and speed.Muscle endurance is the ability to sustain forces repeatedly or to generate forces over a period of time.Muscle performance is regulated by a number of factors, including motor unit recruitment, motor neuron firing patterns, muscle length and tension, muscle fiber composition, fuel storage and delivery, speed and type of contraction, and movement arm.Techniques that optimize these factors while addressing the specific demands of the task and environment will yield maximum functional capacity
11.Postural awareness and control training
Postural control (balance) is the ability to maintain the body in equilibrium or to control the body’s position in space for stability and orientation. Postural orientation is the abil-ity to maintain normal alignment relationships between the various body segments and between the body and environment. Postural stability control (static equilibrium, static balance, or stability) is the ability to maintain stability and orientation with the center of mass (COM) over the base of support (BOS) with the body at rest (no motion). Dynamic postural control (dynamic equilibrium, dynamic balance, or controlled mobility) is the ability to maintain stability and orientation with the COM over the BOS while parts of the body are in motion.
12.Sensory training for balance :
An important focus of balance training is utilization and integration of appropriate sensory systems. Normally three sources of inputs are utilized to maintain balance:
somatosensory inputs (proprioceptive and tactile inputs from the feet and ankles), visual inputs, and vestibular inputs.Careful examination can identify the patient’s use of inputs to maintain balance (e.g., Clinical Test for Sensory Interaction and Balance.Training is directed to using varying sensory conditions to challenge the patient. For example, patients who demonstrate a high degree of dependence on vision can practice balancing tasks with eyes open and eyes closed, in reduced lighting, or in situations of inaccurate vision (petroleum-coated lenses or prism glasses).
Sensory integration :
Sensory integration refers to the ability of an individual to receive information about the world through his sensory systems: sight, sound, touch, taste, and smell. Our proprioceptive and vestibular systems also give us much needed information. Proprioception refers to the ability to process information from our muscles and joints, while the vestibular system provides information about how we move our bodies in space. Our bodies receive all of this information and our nervous system then interprets and organizes the information to produce a skill or a response.This advanced technique is used for activating surrounding awareness and useful to improve muscle activation , muscle tone and postural adjustment.
Brunstrom Technique :
Brunstrom approach developed by Brunstrom. This approach is effective in the early phase of rehabilitation of stroke patients .Brunstorm approach is helpful for increased motion and tone of the muscle by providing primitive movement patterns of synergistic movement patterns which are observed in fetal life after pyramidal lesion.
Gait and locomotion training
Substantial rehabilitation efforts are directed toward improving gait to restore or improve a patient’s functional mobility and independence. Walking is frequently the number one goal of patients who “want to walk” above all other considerations. Ability to ambulate independently is often a significant factor in determining discharge place-ments (e.g., return to home or extended care facility). The alternative to walking is locomotion using a wheelchair. To establish a realistic plan of care, the physical therapist must accurately analyze the patient’s walking ability.
Postural Awareness Training :
Faulty postures such as forward head, kyphosis, lordosis, excessive hip and knee flexion, or pelvic asymmetries can result in decreased postural stability, inaccurate kines-thetic awareness of true vertical, and pain. Although mild deficits may not affect balance control, deficits that significantly alter the COM position can impair balance.189 Patients are typically unable to self-correct faulty pos-tures. Physical therapy interventions should focus first on improving specific musculoskeletal impairments (e.g., limited ROM, weakness). For example, active exercises to improve standing balance can include standing heel-cord stretches, heel-rises, toe-offs, partial wall squats, chair-rises, side-kicks, back-kicks, and marching in place using touch-down support of the hands as needed (sometimes referred to as the “kitchen sink exercises”)
19.Cognitive re education :
Action compromises not only motor factors but also cognitive and perceptual factors . The obvious conceptual link between knowing ,understanding and doing , that cognition and action are increasingly recognized .
After acute brain lesion (stroke,traumatic brain injury) poor attentional performance or poor memory can have a negative impact on daily functioning .As ability to understand focus and attention is play a vital role for motor learning .
20.Safety training
Prevention of falls for the patient with balance deficiency is an important goal of therapy. Lifestyle counseling is important to help recognize potentially dangerous situations and reduce the likelihood of falls. For example, high-risk activities likely to result in falls include turning, sit-to-stand transfers, reaching and bending over, and stair climbing.
Patients should also be discouraged from clearly hazardous activities such as climbing on step stools, ladders, and chairs, or walking on slippery surfaces.
Resource Person
Dr Suvradeep Ganguly (PT) _ Senior Consultant Neuro Physiotherapist