Current research in neurologic physical therapy and its impact on clinical practice.
Wednesday, July 24, 2013
Neurologic PTs are trained to understand that sedentary behavior is not an inevitable consequence of most neurological conditions. PTs are uniquely positioned to intervene at the primary and secondary prevention levels to those living with neurologic conditions. Unfortunately, we allow the structure of our third party payor system and the facilities at which we work dictate the type of care that we provide. Many of our clients are discharged from insurance-reimbursed care and left to fend for themselves in search for health, reduction of disability, and options for physical activity and exercise. Rather than leading the charge to be part of the solution to this problem, the PT community appears willing to tacitly accept as inevitable the pervasiveness of the sedentary lifestyle due to neurologic dysfunction and its deleterious consequences.
Do you provide prevention and wellness services in your practice area? If so, please respond and tell the group what group you work with (diagnosis?), where your care is delivered, how participants are referred to you, and how the services are funded. What have been your successes and failures and what are the barriers to this kind of care in your community?
How do you advocate for prevention and wellness care? Are you involved with non-profit patient advocacy groups or do you serve on local, state, or federal government institutions that fund this type of care?
Wednesday, November 21, 2012
Dizziness is a common symptom reported within the population of patients with TBI. In addition, this patient population often reports vertigo, gaze instability, motion intolerance, and other symptoms consistent with peripheral vestibular pathology. Whether the patient is a member of the military and suffered a blast exposure or is a teenager recovering from a MVA, physical therapists have a difficult job determining the cause of these symptoms and how to treat them. Clinical evidence of vestibular damage using techniques such as the Dix-Hallpike, head impulse test, oculomotor exam, or head shake nystagmus can provide some measure of confidence in knowing if the vestibular end organ or central pathways are damaged. What tests do you use to distinguish between peripheral and central vestibular dysfunction in people with TBI, and what differences are there in your interventions between the two?
Thursday, August 16, 2012
There is much debate in clinical circles regarding whether physical therapy interventions should focus on teaching people with disability to do whatever is required to accomplish a task (compensation) versus promoting the neuroplasticity needed to activate the neuromuscular system in a way that allows the task to be accomplished as
non-disabled person would do it. In the short term, teaching
compensatory strategies is the fast, cheap way to get a person to a level of independent function. There are several drawbacks to this approach however. Among the drawbacks is that, as compensatory strategies become habits, they are difficult to unlearn as all learning, even that associated with compensatory strategies, is accompanied by neuroplasticity changes that make it more difficult to “unlearn” these strategies. Another drawback is that compensatory
approaches are less efficient in the long term as the strategies are often inflexible, such that they cannot be generalized to other tasks. As an example, a person with deficits of hand function might use a compensatory strategy of sliding a card to the edge of the table in order to pick it up, rather than using a more typical pinch grasp. The compensatory strategy, while fine for picking up a card, cannot be transferred to turning the pages of a book. On the other hand, one might argue that in the early stages after stroke or spinal cord injury, the nervous system is not ready to learn recovery-based approaches, and therefore, given the need to prepare for discharge, it is necessary to teach compensatory strategies
Monday, June 4, 2012
The numbers and forms of technology available to assist with rehabilitation is growing exponentially. New tools are purported to help with everything from tracking movements and activity levels to robotically assist with the performance of functional tasks. At the same time that more and more devices are becoming widely available the monies to support these technologies is shrinking. As therapists how can we balance the use of new innovative tools with shrinking resources?
Sunday, April 1, 2012
Neuroscience and rehabilitation literature are converging to strongly support the idea that extended, task-specific practice is critical for producing lasting changes in motor system networks, motor learning, and motor function. Presumably, people with neurological disorders must undergo large amounts of task-specific practice in order to achieve optimal outcomes. Our laboratory has recently been investigating this issue in people post stroke (Lang et al. 2007; Lang et al. 2009; Birkenmeier et al. 2010). The amount of practice that is needed to achieve the best outcomes in individual patients is unknown.
At the same time that our science is suggesting that more practice may be better, physical therapists are feeling the pressure of reduced time for therapy services in many neurologic practice settings. How do you measure the amount of practice you provide? How do you decide how much practice to provide for individual patients? How and why do you prioritize practice of some activities/actions over others? Do you employ methods to increase practice outside of the therapy sessions, such as task-specific home exercise programs or special devices? What other innovative ways do you use to increase practice?