Neurological Disorders Treated with Physical Therapy

Neurological Disorders are diseases of the brain, spinal cord, and the connecting nerves. There are six hundred diseases of the nervous system affecting one in six of the world's population suffers from a neurological disorder. Physical therapy helps improve mobility, independence, and several other beneficial skills; therefore, physical therapy is one of the best way to treat and manage a neurological disorder.    “A neurologically trained physical therapist will evaluate and treat people with movement problems related to disease or injury of the nervous system”.

A therapist has the chance to help a patient regain some if not most of the functions that were lost because of an injury; therefore, enabling the patient to live independently again . Patients who at some point in their life suffered from a neurological disease or injury; it is extremely important for the patients to participate in physical therapy . However, if physical therapy is not done after a neurological injury patients may lose many functions, may be unable to perform certain activities, or may lose their independence .    Physical therapy is a key role in rehabilitating patients with diagnosed neurological disorders.

According to the American Physical Therapy Association, neurological physical therapy has become a subspecialty . Research has shown that physical therapy can prevent neurological problems from progressing. Patients at different stages of their neurological disorder. For example patients that start having symptoms or motor loss therapy can maintain mobility, and minimizing symptoms, or prevent the onset of symptoms. When patients have an onset of symptoms, therapy can help regain movement. Finally, after their symptoms have subsided, therapy can preserve their skills and abilities (Alterg). A ten to fifteen minute exercise routine creates an awakening in the brain .

Physical therapy gives a patient the opportunity to return back to his independent life or as close as he can get to his old life.One neurological disease is a stroke. In stroke rehabilitation the average therapy session is between one and eight minutes to treat the upper limbs; resulting in an average of thirty-two repetitions of task oriented movements per session . Therapist use practice to address target behaviors such as the following: identifying suitable patients for exercises with a screening tool, provision of supplementary self directed exercises, including family, and monitoring adherence to the exercises . Practise is a paper based tool kit and meeting between the research and therapy team to ensure the tool kit is embedded into routine practice . Patients are categorized with a flowchart as green, amber, or red based on their initial assessment . Green patients have upper limb impairment and active movement and would safely be able to complete self directed exercises independently. Next amber patients have upper limb impairment and active movement but require assistance in exercises. Finally, red patients have either no impairment of active movement in their upper limbs and are not suitable for exercise .

Parkinson’s disease is a progressive disease of the nervous system that is marked by tremor, muscular rigidity, and slow, imprecise movement, it chiefly affecting middle-aged and elderly people. It is associated with degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine. Physical therapist manage gait disorders with three key elements . The first element involves teaching the person how to move more easily and to maintain postural stability by using cognitive strategies . The second element helps with management of secondary sequelae affecting the musculoskeletal and cardiorespiratory systems that occur as a result of deconditioning, reduced physical therapy activity, advanced age, and combination conditions. Finally, the third element is the promotion of physical activities that assist the person in making lifelong changes in exercise and physical activities habits as well as preventing falls .

Physical therapy for people with mild to moderate disease could incorporate practice daily up to three weeks, until the motor skill is acquired (par.9). Burst of therapy then could be provided two to three times per year to promote retention of training . Physical therapists should therefore consider taking different approaches to strategy training according to their disease severity.Traumatic brain injury occurs as a result of forces exerted on brain tissue. Common causes of TBI are falls, car accidents, blows to the head, and battlefield injuries . A closed injury is movement of the brain that causes damage even though the skull is in tact . A penetrating injury is damage caused by a wound that breaks through the skull such as a gunshot wound or a puncture by a sharp object. A few physical symptoms are weakness or difficulty moving the arms, legs, body, and head . The affected person may have difficulty sitting, standing, balancing, walking, lying down, and/or changing position in bed .

Physical therapists help people with TBI regain their physical function, relearn daily tasks, and restore their fitness and wellness. If a TBI has occurred, doctors conduct imaging studies to determine the parts of the brain that are injured or if  there is any bleeding or fluid build-up that could be pressing on the brain tissue .  The physical therapist works with the patient, family, and other health care providers to develop goals and and individualized treatment plan to address the challenged and functional limitations associated with the injury . The factors to consider when planning a treatment plan are the patient’s level of consciousness and the injuries from which the patient has suffered . There are different level of consciousness in which a patient can be . In a vegetative state, a patient has some basic brain functions, such as eye opening, a regular sleep cycle, and breathing and digestive functions; however, the patients are unaware of their surrounding activity.

During this phase the physical therapist helps with positioning the patient and uses equipment that will ensure proper posture and flexibility therefore reducing the likelihood of bed sores, and encourage responsiveness to the environment. In a minimally conscious state the patient starts showing beginning signs of awareness, but the responses are often not steady . During this phase the physical therapist helps with stretching,and positioning, while working with the patient to increase consistent responses to commands for movement and communications . As the patient becomes more conscious and able to more actively participate in physical therapy, the therapist will use a combination of exercise task specific training, patient and family education, and different types of equipment to help the patient improve . 

If limitation prevent the return to preinjury activities, a physical therapist can help improve and master the use of equipment such as an ankle brace, a walker, or a wheelchair . Cerebral palsy is a condition marked by impaired coordination and/or other disabilities, typically caused by damage to the brain before or at birth. CP symptoms will appear by early childhood, and they include exaggerated reflexes, floppy or rigid limbs, and involuntary motions. Physical therapy can improve motor skills and can prevent movement problems from getting worse over time; therefore, implements strength and flexibility exercises, heat treatment, and special equipment can give children with cerebral palsy more independence . In order the keep the body strong and flexible therapy is used to improve mobility to prevent future issues such as contractured and joint dislocations . Therefore, therapy can improve the following coordination, balance, strength, flexibility, endurance, pain management, posture, gait, and overall health. Exercises vary each having its own benefit for each type of cerebral palsy.

For spastic cerebral palsy therapy can reduce muscle tension and jerky movements, and stretching can even relieve stiffness over time (par.5). For athetoid cerebral palsy therapy can increase muscle tone and gain control over their movements. Finally, ataxic cerebral palsy therapy can improve balance problems . There is also tailor treatment based on the location of the movement issue. A therapist has to evaluate the child’s movement problems to create a treatment plan, then a combination of exercises, muscle relaxing techniques, and special equipment is used to improve movement .  Exercises are geared toward treating either high or low muscle tone . High muscle tone causes stiffness and spasticity, and low muscle tone causes to much flexibility and weakness in the muscles . Strength training exercises are used to increase muscle tone in people with athetoid cerebral palsy . Then, flexibility exercises and massages are used with spastic cerebral palsy to help improve mobility and prevent painful muscle tightening that could require surgical correction .

Special exercises are also used to help with walking, posture, transitional movements, and sensory impairments . Therapy changes with the patient’s needs; for example, therapy for toddlers focuses on playtime; this helps them overcome the reluctance to touch their face or practice certain movements that are necessary for learning and physical development . Young children ages five to twelve receive therapy help ensure they grow in a way that is conducive to their motor function and instills healthy habits and a proactive mindset . People suffering from a neurological disorder look to physical therapy to treat and manage their disorder while also improving their mobility, independence, and flexibility. Physical therapists will use several exercises to treat and manage neurological disorders. Stroke, Parkinson’s disease, traumatic brain injury, and cerebral palsy limit a patient’s life by affecting the body’s nervous system. Therapy can ease patient’s life and help them regain some of their independence.

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