ADEYEMO, ADEMOLA OLUYOMI

BMR (PT) M.Sc PT

PRESENTATION

DEPARTMENT OF PHYSIOTHERAPY, SCHOOL OF

POSTGRADUATE STUDIES, UNIVERSITY OF LAGOS,

NIGERIA.

FEB. 2015.

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A therapist managing neurological patients prior to the 1940s

may have asked: how can I train the person to use their

unaffected body parts to compensate for the affected parts, and

how can I prevent deformity? The result was a strong

emphasis on orthopaedic intervention with various types of

splints strengthening exercises and surgical intervention.

However, in the 1940s several other ideas emerged, the most

popular being bobath (1985) with others, such as

peto(forrai1999), kabbat and knott (1954), voss (1967), and

rood(1954), pioneered neurological approach to these

disorders recognising that patient with neurological

impairment had potential for functional recovery of their

affected body parts.

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Neurophysiological Approaches are theoretical

concepts based on practical knowledge of

understanding the physiology that helps CNS

function.

Neurophysiological approaches utilizes CNS

plasticity, it contributes to the adaptation and

reorganization of CNS function.

Correct and repeated stimulation through

neurophysiological approaches can lead to non

involved part of the brain functionally compensating

for the affected area of the brain.

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Muscle Re-education Approach (1920s) Neurodevelopmental Approaches (1940-70s)

◦ Sensorimotor Approach (Rood, 1940s) ◦ Movement Therapy Approach (Brunnstrom, 1950s) ◦ NDT Approach (Bobath, 1960-70s) ◦ PNF Approach (Knot and Voss, 1960-70s)

Motor Control & Relearning (1980s) Sensory integration (Jenn Ayers1920 -1989) Contemporary Task-Oriented Approach (1990s)

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Muscle re-education and muscle testing, basically the

principles of neuromuscular physiology are applied

clinically in the treatment of paresis and paralysis ◦ It is the phase of therapeutic exercises developed to the

development, or the recovery of voluntary control of skeletal

muscles

◦ The use of physical therapeutic exercises to restore muscle

tone and strength after injury or disease

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Application of proper/ controlled sensory stimuli to

the appropriate sensory receptors as it is utilised in

normal sequential development

The controlled input can be◦ Facilitatory light moving touch, fast brushing , icing etc

◦ Inhibitory gentle shaking / rocking, slow stroking, slow rolling

etc

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Rood theory ◦ Normalize tone

◦ Treatment begin at developmental level of functioning (

Hierarchical)

◦ Movement is directed towards functional goals

◦ Repetition is necessary for re-education of muscular response

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Emphasises the synergic pattern of movement

which develops during recovery from hemiplegia.

This approach encourages development of flexor and

extensor synergies during early recovery, with the

intention that synergic activation of muscles will,

with training, transit into voluntary activation of

movements.

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Brunnstrom (1966, 1970) and Sawner (1992) also described the process of recovery following stroke-induced hemiplegia. The process was divided into a number of stages

Flaccidity (immediately after the onset)

No "voluntary" movements on the affected side can be initiated

Spasticity appears

Basic synergy patterns appear

Minimal voluntary movements may be present

Patient gains voluntary control over synergies

Increase in spasticity

Some movement patterns out of synergy are mastered (synergy patterns still predominate)

Decrease in spasticity

If progress continues, more complex movement combinations are learned as the basic synergies lose their dominance over motor acts

Further decrease in spasticity

Disappearance of spasticity

Individual joint movements become possible and coordination approaches normal

Normal function is restored

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Aims to inhibit spasticity and synergies, using

inhibitory postures and movements, and to

facilitate normal autonomic responses that are

involved in voluntary movement control.

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Relies on quick stretching and manual resistance of

muscle activation of the limbs in functional directions,

which often are spiral and diagonal in direction.

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Incorporates functional training for key motor tasks such as sitting, standing, standing up, or walking.

The therapist analyses each task, determines which component of the task cannot be performed,

Trains the patient in those components of the task, and

Ensures carryover of this training during daily activities

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Sensory integration provides internal representations of the environment that informs and guides motor responses

These sensory representations provides the foundation on which motor programs for purposeful movements are planned, coordinated and implemented.

Motor learning and performance is inextricably linked to sensation, the individuals learns to anticipate – feedforward or correct or modify –feedback movement based on sensory inputs organised and integrated by the CNS

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Based on systems model of motor control and contemporary motor learning theories

Emphasizes that effective therapeutic intervention depends on identification of the system that is critical to controlling the occupational performance at a specific time

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