Approaches to Neuro Physio

Question 1

Compensatory vs Restorative

Answer 1

• compensatory approach
  
  • teaching pts new skill, including using non-affected side
  • adaptive, one-handed, improve ADLs
• Restorative approach
  
  • focus on traditional therapy exercise, facilitation, resistance to enhance motor recovery

Question 2

Bobath

Answer 2

• nervous system is capable of change (neuroplasticity) and that rehabilitation should focus on facilitating normal movement patterns while inhibiting abnormal ones
• Emphasizes the importance of postural control and alignment.
• Aims to normalize tone and improve the quality of movement.
• Involves hands-on techniques to guide and support the patient through movement, promoting more normal movement patterns.
• Focuses on the whole body and encourages the integration of movements into functional tasks.
• Application: Therapists use techniques such as positioning, handling, and sensory stimulation to help patients relearn normal movement patterns.

Question 3

Motor Relearning Program (Carr-Shepherd)

Answer 3

• It is grounded in motor learning theory and emphasizes the relearning of motor control through practice and repetition in a task-specific context.
• Emphasizes task-oriented training and the practice of specific functional activities.
• Encourages active participation from the patient in their rehabilitation.
• Focuses on improving motor control by breaking down complex activities into simpler components and then practicing them in a meaningful context.
• Uses principles of feedback and motor learning to enhance performance and adaptation.
• Application: MRP involves repetitive practice of functional tasks, with an emphasis on motor planning, feedback, and adaptation.

Question 4

Key Differences between Bobath & MRP

Answer 4

1) Focus of Treatment:
- Bobath: Focuses on normalizing tone and facilitating normal movement patterns using hands-on techniques.
- MRP: Focuses on task-specific practice and motor learning to improve functional independence.

2)Therapist’s Role:
- Bobath: The therapist often takes a more hands-on approach, guiding the patient through movements.
- MRP: The therapist encourages more active participation from the patient, providing feedback and guidance as needed.

3) Theoretical Basis:
- Bobath: Based on neurodevelopmental and neurophysiological principles.
- MRP: Based on motor learning theory and the principles of motor control.

4) Application:
- Bobath: Often used for a wide range of neurological conditions, focusing on overall movement patterns.
- MRP: More specifically used for functional retraining, especially in stroke rehabilitation.

Question 5

Key Principles of MRP

Answer 5

1. Task-Oriented Training: - The MRP emphasizes the importance of practicing functional tasks that are meaningful to the patient, such as walking, reaching, or dressing. The idea is that by repeatedly practicing these tasks, the brain can reorganize and improve motor control.
2. Motor Learning: - Motor learning involves the process of acquiring or re-acquiring motor skills through practice and experience. The MRP incorporates principles of motor learning, such as providing feedback, varying practice conditions, and gradually increasing task difficulty.
3. Problem-Solving Approach: - Therapists work with patients to identify and solve movement problems, such as difficulty with balance or coordination. The aim is to help patients develop strategies to overcome these challenges.
4. Use of Feedback: - Feedback is critical in the MRP. Therapists provide verbal and tactile cues to help patients correct their movements. This feedback is gradually reduced as the patient becomes more proficient.
5. Encouraging Normal Movement Patterns: - Similar to the Bobath concept, the MRP emphasizes the importance of promoting normal movement patterns and avoiding compensatory strategies that could lead to abnormal postures or movements.
6. Repetition and Practice: - Repetition is key in the MRP. Patients are encouraged to practice functional tasks frequently to reinforce motor patterns and promote recovery.

Question 6

Stages of MRP

Answer 6

1. Analysis of Task: - The first step involves breaking down a functional task into its component parts to understand what the patient needs to do to perform it successfully.
2. Practice of Missing Components: - The patient practices the specific components of the task that they struggle with. For example, if a patient has difficulty with the initial phase of walking, they would practice weight shifting and stepping.
3. Practice of the Whole Task: - After mastering the individual components, the patient practices the entire task in a functional context.
4. Transfer of Training: - Finally, the patient is encouraged to practice the task in different environments and situations to ensure that the skills learned can be applied in real-life settings.

Question 7

Structuring Neuro Rehab Session (MRP)

Answer 7

Consider:
* Initial position (alignment & symmetry)
* Loading (how COM is moving in terms of BOS & postural control)
* Movement (selection of best movement with gravity and friction)
* Functional task practice (consider task & environment)