Patients recovering from stroke usually go through a number of stereotyped stages of “motor recovery”. Although initially flaccid and with no active movement, the limb later becomes stiff with tension in the muscles when the joints are moved passively. After this stage, active movement may return but patients may not be able to localize it to a single joint, resulting in movement that is dominated by “synergies”. Slowly synergies are overcome but the recovery of the capacity for rapid, complex movement with normal timing, coordination, strength, and endurance may require significant rehabilitation time and effort.
A variety of stroke treatment approaches have evolved historically and are currently in use. Traditionally a therapist identifies which movement patients have difficulties with these forming the basis for rehabilitative exercises. By the early 1950′s a variety of treatment approaches specifically designed to address neurological disability came into being called “Neuro-developmental” therapies. These had a theoretical basis in neurophysiology and focused on reducing tone, overcoming abnormal muscle patterns, and substituting normal patterns to facilitate functional and voluntary movements.
The preferred practice style of physiotherapists has generally reflected the philosophy of the educational institution where they received their training resulting in variations in practice patterns. Over the past forty or so years these differences in treatment philosophy have been studied scientifically in the interest of improving patient care.To date there have been twelve studies that have compared particular therapy approaches. A total of about 1000 patients have been studied, at different time points in the course of their recovery (from about 3 days to several years). Eight of the twelve studies have compared NDT with one or more other therapies. Most of the therapy was conducted at least three days per week and lasted up to six months.
Of the twelve studies, nine found that either therapies was effective in improving function, while only two found that the comparison treatment was more effective. In only one study was NDT treatment found to be the more effective treatment. Although research is ongoing the results of investigations so far conducted indicate that physiotherapists trained in a number of treatment approaches can help patients can make meaningful improvements in function.
by Max Kovler, M.Sc. Rehab Science, Reg PT (ON) for Mobile Physio
Basmajian, J. V., Gowland, C. A., Finlayson, M. A., Hall, A. L., Swanson, L. R., Stratford, P. W., Trotter, J. E., &Brandstater, M. E. (1987). Stroke treatment: comparison of integrated behavioral-physical therapy vs traditional physical therapy programs.Arch.Phys.Med.Rehabil., 68(5 Pt 1), 267-272
Dickstein, R., Hocherman, S., Pillar, T., &Shaham, R. (1986). Stroke rehabilitation. Three exercise therapy approaches. Phys.Ther., 66(8), 1233-1238
Gelber, D. A., Good, D. C., Dromerick, A., Sergay, S., & Richardson, M. (2001).Open-label dose-titration safety and efficacy study of tizanidine hydrochloride in the treatment of spasticity associated with chronic stroke. Stroke, 32(8), 1841-1846.
Hafsteinsdóttir, T. B., Algra, A., Kappelle, L. J., &Grypdonck, M. H. (2005). Neurodevelopmental treatment after stroke: a comparative study.J.Neurol.Neurosurg.Psychiatry, 76(6), 788-792.
Hafsteinsdóttir, T. B., Kappelle, J., Grypdonck, M. H., &Algra, A. (2007).Effects of Bobath-based therapy on depression, shoulder pain and health-related quality of life in patients after stroke.
Journal of Rehabilitation Medicine, 39(8), 627-632.
Langhammer, B., &Stanghelle, J. K. (2000).Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study. Clin.Rehabil., 14(4), 361-369.
Logigian, M. K., Samuels, M. A., Falconer, J., &Zagar, R. (1983).Clinical exercise trial for stroke patients.
Arch.Phys.Med.Rehabil., 64(8), 364-367.
Lord, J. P., & Hall, K. (1986). Neuromuscular reeducation versus traditional programs for stroke rehabilitation.Arch.Phys.Med.Rehabil., 67(2), 88-91.
Platz, T., Kim, I. H., Engel, U., Pinkowski, C., Eickhof, C., &Kutzner, M. (2005). Amphetamine fails to facilitate motor performance and to enhance motor recovery among stroke patients with mild arm paresis: interim analysis and termination of a double blind, randomised, placebo-controlled trial.
Restor.Neurol.Neurosci., 23(5-6), 271-280.
Platz, T., van, K. S., Mehrholz, J., Leidner, O., Eickhof, C., & Pohl, M. (2009). Best conventional therapy versus modular impairment-oriented training for arm paresis after stroke: a single-blind, multicenter randomized controlled trial. Neurorehabil.Neural Repair, 23(7), 706-716.
Platz T, van Kaick S, Moller L, Freund S, Winter T, Kim IH. Impairment oriented training and adaptive motor cortex reorganisation after stroke: afTMS study. J Neurol. 2005;252:1363-1371
van der Lee, J. H., Wagenaar, R. C., Lankhorst, G. J., Vogelaar, T. W., Deville, W. L., &Bouter, L. M. (1999). Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke, 30(11), 2369-2375.
vanVliet, P. M., Lincoln, N. B., &Foxall, A. (2005). Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial. J.Neurol.Neurosurg.Psychiatry, 76(4), 503-508.
vanVliet, P. M., Lincoln, N. B., &Foxall, A. (2005). Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial. J.Neurol.Neurosurg.Psychiatry, 76(4), 503-508
Wagenaar, R. C., Meijer, O. G., van Wieringen, P. C., Kuik, D. J., Hazenberg, G. J., Lindeboom, J., Wichers, F., & Rijswijk, H. (1990).The functional recovery of stroke: a comparison between neuro-developmental treatment and the Brunnstrom method. Scand.J.Rehabil.Med., 22(1), 1-8.
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