What is Neurological physiotherapy assessment ?

Dr Suvradeep Ganguly
6 hours ago
4 min read

About Neurological Physiotherapy Assessment ?

Neurological physiotherapy assessment is a completely different section from general physiotherapy. Neurological physiotherapy assessment is mainly used to analyze the post effects of various neurological disorders or diseases like Parkinson's disease, brain stroke,

G B syndrome, and poly neuro pathy. Let's understand it in a category-wise manner.

What is the difference between Neurogical physiotherapy assessment and general physiotherapy assessment ?

General physiotherapy assessment primarily involves a superficial evaluation of muscles, tendons, and joints.

In contrast, neuro physiotherapy focuses on the coordination between the brain and muscles.

Our daily activities, such as talking, walking, reacting, and facial expressions, rely on the speed at which our brain sends signals to our muscles through motor nerves and acceptance of various signals from surrounding through Sensory nerve .

The brain's ability to send signals is influenced by stimulation from our body, the surrounding environment, and its capacity to analyze these stimuli.

What are the basic elements of Neurlogical physiotherapy assessment?

Neuro physiotherapy assessment is divided into various areas to evaluate brain function, Cognitive function muscle strength, muscle endurance, motor control, joint coordination, sensory function, balance, gait, and, most importantly, the functional capacity of the brain and the individual stroke patient.

According to Dr. Suvradeep Ganguly, in neuro physiotherapy, we need to assess with a broader perspective rather than focusing solely on motor or sensory function.

The three basic categories in neurological physiotherapy assessments are

1. Cognitive function 2. Sensory function and 3. Motor function.

In cognitive function, we need to analyze the higher mental functions, including the patient's level of consciousness.

Higher Function assessment includes :

Consciousness :

Consciousness involves recognizing the external environment or stimuli and responding appropriately. Therefore, any motor activity response (e.g., walking, speech) from a neurological patient depends on their level of consciousness.

In certain situations, patients may be conscious and alert but exhibit very delayed responses due to drowsiness or lethargy. The Glasgow Coma Scale is used to record motor responses to pain, verbal responses to auditory and visual stimuli, and eye-opening reactions.

Other cognitive function includes :

Orientation about person ,time and place .

2. Attention :

Attention is an essential component of the learning process.

For individuals with neurological disorders, sustaining attention is vital for acquiring new motor control skills.

3.Memory:

Memory is essential for recalling different social events and physiological activities, such as motor control for maintaining sitting balance, standing balance, and walking.

Memory assessment is based on evaluating both short-term and long-term memory.

Assessing the neurological aspects of a patient's mental, emotional, and affective state helps determine their capacity to convey information about their illness, discuss details about family members, and respond with agitation or calmness to different external situations and stimuli.

Communication: Brain injuries or strokes can result in an inability to articulate words or a loss of understanding of spoken language.

Sensation deficit :

A sensory deficit refers to the inability to perceive information from various external stimuli, such as temperature, deep pressure, light touch, and proprioception (the ability to sense body position and movement without visual input). Many stroke patients may possess sufficient muscle strength but are unable to stand upright or walk without leaning forward due to a loss of proprioceptive sensation.

Perception Deficit : In our daily days activity perception played a pivot role to maintain our balance and stability . Perception is the analysing ,correct processing the various sensory information .

Reflex testing :

Reflexes are crucial for maintaining posture and balance during protective movements. For stroke patients, these reflexes help prevent falls.

Some reflex tests include the plantar reflex, abdominal reflex, knee jerks, and ankle jerks.

Evaluation of functional performance :

Assessing functional performance involves identifying the limitations in various essential daily activities, such as turning in bed, standing, walking, toileting, dressing, and climbing stairs.

Different scales are used to evaluate the patient's functional status.

Examples include the Barthel Index and the Fugl-Meyer Assessment Scale.

Evaluation of Movement Control :

The purpose of this evaluation process is to find out “WHY” it is difficult for a neuro patient to perform a specific movement or task .Problems could be bending knee while walking , controlling link between trunk and legs while standing or walking .

We need to assess the following patterns to the root cause of uncontrolled movement .

Tightness of muscle
Active movement and strength.
Uncontrolled movement / associated movement
Assisted movement
Muscle Tone
Coordination between various joints while doing complex movements .
Range of movement of various joints.
Pain e.t.c

Clinical decision making and problem solving :

Clinical decision-making is the most essential and critical component in neurological rehabilitation. According to Senior Neuro Consultant Physiotherapist Dr. Suvradeep Ganguly, solving problems for neuro patients involves gathering information and making decisions based on the patient's needs, primary impairments, functional disabilities, and the relationship between these impairments and disabilities. For instance, the loss of knee joint position perception is a primary impairment, while bending the knee while walking is a functional disability. In this case, both the primary impairment and the functional disability are interconnected.