Neurological Physiotherapy
Neurolife offers a Bobath Neurological Physiotherapy Approach, with all physiotherapists trained in Bobath methods. Neurolife Physiotherapists assess a client’s current movement and potential to move.
The brain will naturally problem solve and compensate for a neurological injury. For example, in order to sit, instead of trying to recruit the small efficient postural muscles at the base of the spine which may be weak, the brain will compensate quickly by using the large muscles at the front of the hips. Large muscles are designed to work hard for short bursts. When they are used to hold your body up against gravity for long periods they “hold or fixate” and get tired. This inappropriate muscle activity becomes learnt or “a bad habit” and limits the smaller muscles’ normal stabilisation and balance reactions. Fear of falling becomes a problem that is a factor that feeds into these compensatory movement patterns. Although achieving a task in the short term, these learned compensatory patterns can limit natural balance and movement potential. Many clients are not aware of this and believe they move the way they move because of their stroke or “the MS is getting worse”.
The Neurolife neurological physiotherapy approach is to view the person’s movement as a result of the brain’s compensation to a neurological injury and we work to optimise the central nervous system’s function. The aim of our approach to Bobath neurological physiotherapy is to reduce the compensation that is occurring, and show the brain a more efficient way of stabilising the body. These may be familiar to the brain or new. The smaller postural muscles, which are designed to work efficiently for long periods, can then have the opportunity to regain function, allowing balance reactions and more efficient movement. When these smaller muscles begin to function again, the larger muscles, which have often become fixated or “spastic” are then able to relax as it is no longer necessary for them to work so hard.
Analysis and treatment is based on The Bobath Concept.
The Bobath Concept involves intensive post graduate training that offers a deeper analysis of movement and handling skills to apply appropriate sensory input, which stimulate muscle activation. The Bobath Concept is supported by emerging neurophysiological evidence and is distinguished from other therapies by its emphasis on postural control, sensory-motor processing and handling skills.
The Bobath concept aims to provide opportunities for strengthening and practice that does not just strengthen the use of compensatory muscles without changing the movement pattern. Recent research is now showing stretches for neurological problems to be ineffective at maintaining increased range. We need to understand why muscles are becoming tight in the first place. Often muscles are not short but are “on” (the brain is actively contracting the muscle) because this is the person’s learned way of attempting to hold themselves up against gravity. Lying down and stretching is not beneficial if the muscle just contracts again the next time the person sits up against gravity. More information on the Bobath Concept can be found at www.ibita.org
The systems of the brain and spinal cord have a large capacity for “plasticity”.
There is many “parallel wiring” of the nerve pathways from the brain to the spinal cord. The postural stabilisation pathways and goal directed movement pathways summate in the spinal cord to produce a smooth goal directed movement. In any given treatment, the neurological physiotherapist constantly works to manipulate their handling, the task, client alignment and client position with the aim of triggering a familiar automatic movement pattern or balance response.
The neurological physiotherapy treatment is “hands on” in order to manipulate the very close relationship between sensation and muscle activation.
Neurolife Physiotherapy believes that if you could move differently, you would. Strengthening exercises usually get you using the muscles you are already over using. In order to change the recruitment pattern your brain uses and move differently, you need a different sensory input into the nervous system. Not only does improving sensation improve muscle activation but, more importantly, improving muscle activation, increases sensation which in turn increases muscle activation. Neurolife Physiotherapists use their hands to stimulate muscle activation that in turn gives the brain sensory information to encourage more efficient movement. The aim is that the person feels a new movement.
Treatment is guided by the person’s individual characteristics.
Movement varies greatly between individuals depending on the person’s life time of experiences, sport, leisure activities, vocation, posture, mood, personality etc. The best way to stimulate appropriate muscle activity will depend on all of these individual factors and also the learning style of the person.
Dedication to therapist training is essential.
Neurolife Physiotherapists are trained and experienced in movement analysis and facilitation (handling skills). All our staff are supported to attend Neurological Physiotherapy courses in relevant areas.
A person’s arm can improve movement and use after a stroke.
Some possible reasons why the arm does not recover as well as the leg during hospital neuro rehabilitation can be summarised as follows:
1) Arms do not get the amount of therapy that legs and walking does.
2) Hand function is the result of a very complex relationship between head alignment, eye stabilisation and motor control of the hand.
3) We can manage with the other arm in a lot of functions so the necessity to use it is not as strong a drive for brain plasticity.
However, given there are similar pathways and centres of control in the brain for the arm as there is for the leg, we can expect plasticity and recovery to occur.
There are a large number of treatment options for the upper limb and a large number of intermediate steps and goals to achieve before reaching is achieved. Some of the methods of improving arm movement and use are by;
1) Regaining postural control of the trunk and often hip, lower limb and foot, which then allows the arm to relax and not have to tense up and perform an inappropriate balancing fixation role. It also provides the background or stable base for the arm to move away from.
2) Regaining alignment of the upper limb muscles and joints.
3) Regaining the postural muscle activation of the upper limb in various positions, especially standing.
4) Hands on specific facilitation of muscle activation in the upper limb.
5) Hand sensory stimulation.
6) Integration of activity into functional goal orientated reaching tasks or bilateral tasks.
Knowledge of the latest neurophysiological research is essential to treatment.
Neurolife Physiotherapists’ treatment is based on understanding the neurophysiology of how sensation and movement is processed. This knowledge assists to determine what sensory information the person needs to change the way they move. Using this knowledge to formulate what we do in treatment is an extremely exciting part of the job.