Abstract
A physical therapist (PT) in a neuro-rehabilitation population is one who specializes in the evaluation and treatment of individuals with movement problems due to disease or injury of the nervous system in which the goal is to aid in recovery, minimize, and/or compensate for any residual functional alterations or deficits.
Unlike orthopedic injuries, neurological insult or injury can result in total body or global functional deficits. It is imperative for a neurologic PT to be able to perform a comprehensive clinical examination which includes review of past medical history (PMH), subjective reports, balance, transfer ability, gait, strength, range of motion (ROM), muscle tone, coordination, vision, vestibular, proprioceptive, posture, deep tendon reflexes (DTR), sensation and safety awareness. The PT must also consider any comorbidities, client age, and prior level of function. With the information obtained from the examination and evaluation, the PT will develop a customized and individualized plan of care, addressing and prioritizing the most debilitating deficits in a systematic and logical manner.
There is no “one-size fits all” recovery protocol for neurological injuries such as cerebrovascular accidents (CVA), aneurysm ruptures, or anoxic injuries like there would be for a total hip replacement. Although individuals who suffer a neurological injury can present with similar deficits such as pyramidal strength imbalances, it is the role of the PT to determine exactly how these deficits will affect the individual and the best approach to address them.
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References
Alhilali, L. M., Yaeger, K., Collins, M., & Fakhran, S. (2014). Detection of central white matter injury underlying vestibulopathy after mild traumatic brain injury. Radiology, 272(1), 224–232. https://doi.org/10.1148/radiol.14132670
Allison, L. (1999). Imbalance following traumatic brain injury in adults. Neurology Report, 23(1), 13–18. https://doi.org/10.1097/01253086-199923010-00010
Bellew, J. W., Michlovitz, S. L., & Nolan, T. P., Jr. (2016). Michlovitz’s modalities for therapeutic intervention. Philadelphia, PA: F.A. Davis Company.
Berg Balance Scale. (n.d.). Retrieved January 27, 2018, from https://www.sralab.org/rehabilitation-measures/berg-balance-scale#stroke
Bowden, M. G., Balasubramanian, C. K., Behrman, A. L., & Kautz, S. A. (2008). Validation of a speed-based classification system using quantitative measures of walking performance poststroke. Neurorehabilitation and Neural Repair, 22(6), 672–675. https://doi.org/10.1177/1545968308318837
Brunnstrom, S. (1966). Motor testing procedures in hemiplegia: Based on sequential recovery stages. Physical Therapy, 46(4), 357–375. https://doi.org/10.1093/ptj/46.4.357
Bunton, E. E., Pitney, W. A., Cappaert, T. A., & Kane, A. W. (1993). The role of limb torque, muscle action and proprioception during closed kinetic chain rehabilitation of the lower extremity. Journal of Athletic Training, 28(1), 10.
Callaghan, M. J., Mckie, S., Richardson, P., & Oldham, J. A. (2012). Effects of patellar taping on brain activity during knee joint proprioception tests using functional magnetic resonance imaging. Physical Therapy, 92(6), 821–830. https://doi.org/10.2522/ptj.20110209
Chen, H., Schultz, A. B., Ashton-Miller, J. A., Giordani, B., Alexander, N. B., & Guire, K. E. (1996). Stepping over obstacles: Dividing attention impairs performance of old more than young adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 51A(3), M116–M122. https://doi.org/10.1093/gerona/51a.3.m116
Cozean, C., Pease, W., & Hubbell, S. (1988). Biofeedback and functional electric stimulation in stroke rehabilitation [Abstract]. Archives of Physical Medicine and Rehabilitation, 69(6), 401–405. Retrieved December 14, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/3288172
DeLisa, J. A. (1998). Gait analysis in the science of rehabilitation. Washington, DC: Dept. of Veterans Affairs, Veterans Health Administration, Rehabilitation Research and Development Service, Scientific and Technical Publications Section.
Fell, D. W., Lunnen, K. Y., & Rauk, R. P. (2018). Lifespan neurorehabilitation: A patient-centered approach from examination to interventions and outcomes. Philadelphia, PA: F.A. Davis Company.
Fredericks, C. M., & Saladin, L. K. (1996). Pathophysiology of the motor systems: Principles and clinical presentations. Philadelphia, PA: F.A. Davis Company. ISBN 0-8036-0093-3.
Fulk, G. D., & Echternach, J. L. (2008). Test-retest reliability and minimal detectable change of gait speed in individuals undergoing rehabilitation after stroke. Journal of Neurologic Physical Therapy, 32(1), 8–13. https://doi.org/10.1097/npt0b013e31816593c0
Function in Sitting Test. (n.d.). Retrieved January 28, 2018, from https://www.sralab.org/rehabilitation-measures/function-sitting-test
Ghadieh, A. S., & Saab, B. (2015). Evidence for exercise training in the management of hypertension in adults. Canadian Family Physician, 61(3), 233–239.
Giles, S. M. (2015). PTEXAM: The complete study guide. Scarborough, ME: Scorebuilders.
Giza, C. C., Kutcher, J. S., Ashwal, S., Barth, J., Getchius, T. S., Gioia, G. A., … Zafonte, R. (2013). Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology, 80(24), 2250–2257. https://doi.org/10.1212/wnl.0b013e31828d57dd
Heilman, K. M. (2010). Apraxia. Continuum, 16, 86–108. https://doi.org/10.1212/01.con.0000368262.53662.08
Hemiparesis. (2015, November 17). Retrieved July 12, 2018, from http://www.stroke.org/we-can-help/survivors/stroke-recovery/post-stroke-conditions/physical/hemiparesis
Joint Commission on Accreditation of Healthcare Organizations. (1996). Environmental safety and equipment management. In: Comprehensive Accreditation Manual for Home Care. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations.
Kessner, S. S., Bingel, U., & Thomalla, G. (2016). Somatosensory deficits after stroke: A scoping review. Topics in Stroke Rehabilitation, 23(2), 136–146. https://doi.org/10.1080/10749357.2015.1116822
Khadilkar, A., & Phillips, K. (2006). Ottawa panel evidence-based clinical practice guidelines for post-stroke rehabilitation. Topics in Stroke Rehabilitation, 13(2), 1–269. https://doi.org/10.1310/3tkx-7xec-2dtg-xqkh
Langhorne, P., Coupar, F., & Pollock, A. (2009). Motor recovery after stroke: A systematic review. The Lancet Neurology, 8(8), 741–754. https://doi.org/10.1016/s1474-4422(09)70150-4
Luque-Moreno, C., Ferragut-Garcías, A., Rodríguez-Blanco, C., Heredia-Rizo, A. M., Oliva-Pascual-Vaca, J., Kiper, P., & Oliva-Pascual-Vaca, Á. (2015). A decade of progress using virtual reality for post-stroke lower extremity rehabilitation: Systematic review of the intervention methods. BioMed Research International, 2015, 1–7. https://doi.org/10.1155/2015/342529
Mackintosh, S. F., Goldie, P., & Hill, K. (2005). Falls incidence and factors associated with falling in older, community-dwelling, chronic stroke survivors (1 year after stroke) and matched controls. Aging Clinical and Experimental Research, 17(2), 74–81. https://doi.org/10.1007/bf03324577
MayoClinic (n.d.). Acupuncture. Retrieved June 4, 2018, from https://www.mayoclinic.org/tests-procedures/acupuncture/about/pac-20392763
Mccrory, P., Meeuwisse, W., Aubry, M., Cantu, B., Dvořák, J., Echemendia, R., … Turner, M. (2013). Consensus statement on Concussion in Sport—The 4th International Conference on Concussion in Sport held in Zurich, November 2012. Physical Therapy in Sport, 14(2), e1–e13. https://doi.org/10.1016/j.ptsp.2013.03.002
Mccrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M., Molloy, M., & Cantu, R. (2009). Consensus Statement on Concussion in Sport—The Third International Conference on Concussion in Sport Held in Zurich, November 2008. The Physician and Sportsmedicine, 37(2), 141–159. https://doi.org/10.3810/psm.2009.06.1721
Middleton, A., Fritz, S. L., & Lusardi, M. (2015). Walking speed: The functional vital sign. Journal of Aging and Physical Activity, 23(2), 314–322. https://doi.org/10.1123/japa.23.2.314
Mong, Y., Teo, T. W., & Ng, S. S. (2010). 5-Repetition sit-to-stand test in subjects with chronic stroke: Reliability and validity. Archives of Physical Medicine and Rehabilitation, 91(3), 407–413. https://doi.org/10.1016/j.apmr.2009.10.030
Moreland, J., & Thomson, M. A. (1994). Efficacy of electromyographic biofeedback compared with conventional physical therapy for upper-extremity function in patients following stroke: A research overview and meta-analysis. Physical Therapy, 74(6), 534–543. https://doi.org/10.1093/ptj/74.6.534
Moreland, J. D., Thomson, M. A., & Fuoco, A. R. (1998). Electromyographic biofeedback to improve lower extremity function after stroke: A meta-analysis. Archives of Physical Medicine and Rehabilitation, 79(2), 134–140. https://doi.org/10.1016/s0003-9993(98)90289-1
O’Sullivan, S. B., Schmitz, T. J., & Fulk, G. (2014). Physical rehabilitation. Philadelphia, PA: F.A. Davis Company.
Paoloni, M., Mangone, M., Scettri, P., Procaccianti, R., Cometa, A., & Santilli, V. (2009). Segmental muscle vibration improves walking in chronic stroke patients with foot drop: A randomized controlled trial. Neurorehabilitation and Neural Repair, 24(3), 254–262. https://doi.org/10.1177/1545968309349940
Pierson, F. M., & Fairchild, S. L. (2008). Principles & techniques of patient care (4th ed.). St. Louis, MO: Saunders Elsevier.
Pumpa, L. U., Cahill, L. S., & Carey, L. M. (2015). Somatosensory assessment and treatment after stroke: An evidence-practice gap. Australian Occupational Therapy Journal, 62(2), 93–104. https://doi.org/10.1111/1440-1630.12170
Rayegani, S. M., Raeissadat, S. A., Sedighipour, L., Rezazadeh, I. M., Bahrami, M. H., Eliaspour, D., & Khosrawi, S. (2014). Effect of neurofeedback and electromyographic-biofeedback therapy on improving hand function in stroke patients. Topics in Stroke Rehabilitation, 21(2), 137–151. https://doi.org/10.1310/tsr2102-137
Reece, A. C., & Simpson, J. M. (1996). Preparing older people to cope after a fall. Physiotherapy, 82(4), 227–235. https://doi.org/10.1016/s0031-9406(05)66877-0
Salbach, N. M., Obrien, K., Brooks, D., Irvin, E., Martino, R., Takhar, P., … Howe, J. (2014). Speed and distance requirements for community ambulation: A systematic review. Archives of Physical Medicine and Rehabilitation, 95(1), 117–128.e11. https://doi.org/10.1016/j.apmr.2013.06.017
Scherr, J., Wolfarth, B., Christle, J. W., Pressler, A., Wagenpfeil, S., & Halle, M. (2012). Associations between Borg’s rating of perceived exertion and physiological measures of exercise intensity. European Journal of Applied Physiology, 113(1), 147–155. https://doi.org/10.1007/s00421-012-2421-x
Schleenbaker, R. E., & Mainous, A. G. (1993). Electromyographic biofeedback for neuromuscular reeducation in the hemiplegic stroke patient: A meta-analysis. Archives of Physical Medicine and Rehabilitation, 74(12), 1301–1304. https://doi.org/10.1016/0003-9993(93)90083-m
Schmid, A., Duncan, P. W., Studenski, S., Lai, S. M., Richards, L., Perera, S., & Wu, S. S. (2007). Improvements in speed-based gait classifications are meaningful. Stroke, 38(7), 2096.
Shetty A (2016) Yoga as Physical Therapy Intervention and Future Direction for Yoga Research. J Yoga Phys Ther 6:e122. doi:10.4172/2157-7595.1000e122
Shumway-Cook, A., & Woollacott, M. H. (2012). Motor control: Translating research into clinical practice. Philadelphia, PA: Wolters Kluwer Health, Lippincott Williams & Wilkins.
Stanford Medicine. (n.d.). Gait abnormalities. Retrieved July 12, 2018, from https://stanfordmedicine25.stanford.edu/the25/gait.html
Stanton, R., Ada, L., Dean, C. M., & Preston, E. (2011). Biofeedback improves activities of the lower limb after stroke: A systematic review. Journal of Physiotherapy, 57(3), 145–155. https://doi.org/10.1016/s1836-9553(11)70035-2
Steyvers, M., Levin, O., Baelen, M. V., & Swinnen, S. P. (2003). Corticospinal excitability changes following prolonged muscle tendon vibration. Neuroreport, 14(15), 2001–2004. https://doi.org/10.1097/00001756-200310270-00004
Teasell, R., McRae, M., Foley, N., & Bharadwaj, A. (2002). The incidence and consequences of falls in stroke patients during inpatient rehabilitation: Factors associated with high risk. Archives of Physical Medicine and Rehabilitation, 83, 329–333.
Thomas, B. (2015, September 5). Geriatrics. Retrieved July 12, 2018, from http://rehab-insider.advanceweb.com/teaching-fall-recovery-skills-to-the-elderly/
Timed Up and Go. (n.d.). Retrieved January 27, 2018, from https://www.sralab.org/rehabilitation-measures/timed-and-go
Tuba Tulay Koca, Hilmi Ataseven. (2015). What is Hippotherapy? The indications and effectiveness of Hippotherapy. North Clin Istanb.; 2(3): 247–252
Voss, D. E., Ionta, M. K., & Myers, B. J. (1985). Proprioceptive neuromuscular facilitation patterns and techniques. Philadelphia, PA: Harper & Row.
Wong, A. M., Su, T. Y., Tang, F. T., Cheng, P. T., & Liaw, M. Y. (1999). Clinical trial of electrical acupuncture on hemiplegic stroke patients. American Journal of Physical Medicine & Rehabilitation, 78(2), 117–122.
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Murray, K., Aquino, N., Nugent, J. (2019). The Role of the Physical Therapist on the Neuro-Rehabilitation Team. In: Elbaum, J. (eds) Acquired Brain Injury. Springer, Cham. https://doi.org/10.1007/978-3-030-16613-7_8
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