How Neuro Physical Therapy Helps Stroke Patients

Physical impairments post stroke are debilitating and can affect simple tasks of daily living that seem overwhelming. Neuro physical therapists are responsible for understanding the neurological deficits from the brain in causing the physical impairments and then drawing protocols to restore them to effectively return to a functionally independent lifestyle.

Key Focus Areas of Neuro Physical Therapy

Assessment and evaluation:The brain is a complex structure that is responsible for micro and macro management of the complete functional output of an individual. Different parts of the brain are responsible for controlling different functions of the body. An NPT must first evaluate and assess the physical parameters based on the following:

Type of stroke (Ischemic or hemorrhagic)
Complete self and family history of the individual
Sensory deficits
Motor deficits
Disturbance in balance and coordination
Gait disturbances

Sensorimotor integration: For each movement (responsibility of motor system) that we make, there is a signal (responsibility of sensory system) that comes from the brain. This relay is impaired post stroke which causes muscle weakness and subsequent functional impairments. It is important to restore the sensorimotor system to achieve any improvement in the physical functioning of the body by the use of the following techniques:

Proprioceptive Neuromuscular Stimulation: To improve orientation of the body position and movement by the use of icing, brushing and therapeutic hammer techniques.
Positioning: Various round the clock positioning techniques are done to restore the correct muscle synergy patterns.
Electrical Stimulation: Therapeutic galvanic currents are used to restore the relay of sensory signals from the brain to the muscles .

Strength training: Restoring correct sensory signals from the brain induces movement in the muscles for various functions of the body. Targeted approach to movement improves the range of motion and subsequently the strength in the upper and lower limb along with the trunk. Neuro physical therapists uses the following techniques to improve strength:

Functional electrical stimulation (FES): These are low level therapeutic currents which mimics the electrical signals from the brain to the muscle to contract and move. Repetitive FES improves the gradual strength in the muscle.
Hydrotherapy: Portable exercise therapy pool uses movement against the pressure of the water to induce strength in the muscles. It is a low impact exercise which reduces stiffness and prevents spasticity post stroke.
Graded exercise program: These exercises range from simple forms to increase internal strength of the muscles to resistive techniques with the use of Thera bands, Thera tubes and weight cuffs.

Functional Training: Restoring correct functional patterns of movement is very important for the Neuro physical therapist to focus as the brain is in a re learning stage. Any wrong movement learnt or practiced at this stage leads to permanent impairments and restrictions in movements. The following aspects are covered in functional training

Balance and coordination: These exercises focus on improving stability and preventing risk of fall using a body weight balance system.
Constraint induced movement therapy: Preventing the non-affected part from moving and focusing the affected part to be used for targets helps improve functioning of the affected part. This is especially effective for rehabilitation for fine movements of the hand.
Gait training: Practicing walking patterns is the key part in stroke rehabilitation program.