Physiotherapy - Early Rehabilitation of a Stroke

Early Rehabilitation of a Stroke

Patient (1)

PAULETTE VAN VLIET

Introduction

A substantial amount of research now exists which is relevant to the treatment

of neurological patients, and it is important that physiotherapy treatment

is based on this research. This chapter will therefore draw on current

research from the sciences relevant to physiotherapy, as well as the results

of pragmatic trials of treatment in a clinical setting.

There is no evidence at present that one overall approach is superior to

another. The approaches that have been compared for efficacy in controlled

trials include the Bobath, proprioceptive neuromuscular facilitation, and

functional (traditional) approaches (Dickstein et al., 1986 A; Loggigian et

al., 1983 A; Lord and Hall, 1986 A). These trials have some problems in their

design. For example, the study of Loggigian et al. was the only one of the

three that randomized adequately, and all three studies arguably had insufficient

power to detect differences, owing to small numbers. A single-case

design was used by Wagenaar et al. (1990 A) to compare neuro-developmental

(a modernized version of Bobath) and Brunnström methods of

treatment, and also found no substantial differences. It is possible that

differences do exist between the effectiveness of these approaches, but

were not demonstrated in these studies.

Elements of treatment packages have been investigated with more

success. In randomized controlled trials, training of weight distribution via

auditory feedback has improved symmetry of body-weight distribution in

sit-to-stand (Enghardt et al., 1993 A), and visual feedback about weightbearing

in the standing position has improved standing balance (Sackley

and Lincoln, 1997 A). EMG biofeedback has been shown to facilitate

recovery of arm function (Crow et al., 1989 A). In another randomized

controlled trial, repeated pressing movements