Contemporary neurological physiotherapy: what is in the toolkit?

Abstract

One of the key roles of the physiotherapist working in neurology is to help the patient experience and relearn optimal movement, and function. Physiotherapists are not only interested in which functional activities clients/patients can or cannot perform, but also in how the patient moves to execute functional activities (Lennon ＆ Bassile, 2018).

 

Key questions are raised in this presentation about the guiding principles underlying contemporary neurological physiotherapy. Understanding our theoretical framework is critical, as theory provides the explanation for our clinical reasoning influencing how we select and deliver interventions leading to the development of new treatment strategies. Ten key principles are proposed to guide neurological physiotherapy： the International Classification of Functioning, Disability and Health (ICF, WH0 2001), team work, person-centred care, prediction, neural plasticity, systems model of motor control, functional movement re-education, skill acquisition, self-management (self-efficacy) and health promotion (Lennon ＆ Bassile 2018).

 

Neurological physiotherapy is a complex intervention, it is crucial to unpack the black box of physiotherapy by exploring the tools in our toolkit (components) that are applied in the clinic. Current research suggests that therapy components should be evidence-based, task specific, repetitive, meaningful (goal oriented), and challenging. Examples of key techniques/variables applied in Australia will be explored： tele-rehab, emerging technologies (virtual reality, robotics, apps), task-specific training, ballistic strength training, clinical simulation and physical fitness and physical activity. Increasing dose/intensity in people with neurological conditions is a hot topic achieved by focusing on empowering our clients through group activities, semi-supervised practice and home exercise programs moving the focus of physiotherapy from an impairment/activity focus to living well with their condition and community integration.

 

Implications for practice

The beliefs that therapists subscribe to determine the therapy that is offered. These beliefs need to be science-driven, and evidence-based. There needs to be more emphasis on what participants do outside therapy. Named treatment approaches which promote a guru mentality should be discarded in favour of evaluating the array of tools in our toolkit. Physiotherapists also need to focus on other key variables such as behavior change to drive neural plasticity besides repetition, and task-specific practice. Physiotherapists need to consider how they can promote self-efficacy and enhance their patients’ self-management skills. What is in the black box of neurological physiotherapy? Further research is required to evaluate the systematic manipulation of treatment components within complex therapy interventions.

 

Biology

Emeritus Professor Sheila Lennon, Foundation Chair of physiotherapy at Flinders University in Adelaide, Australia, has worked internationally in Canada, Switzerland, the UK, and Australia in a physiotherapy career that has spanned over 40 years. Sheila qualified as a physiotherapist at McGill University in Canada in 1979. Her PhD explored the impact of gait reeducation based on the Bobath Concept in acute stroke. She is the author/editor of 60 peer reviewed papers, and two international textbooks for Elsevier Science on neurological physiotherapy, and the physical management of neurological conditions.

 

Sheila holds a statutory appointment as practitioner-member for South Australia with the Physiotherapy Board of Australia. She works clinically for the MS Society of South Australia. She is on the executive board of the International Neurological Physiotherapy Association (INPA) of World Physiotherapy.

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