Neuro treatment techniques - notes by 2nd year physiotherapy student PDF

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Summary

positioning, stretching...

Description

Neurological treatment techniques Aims of positioning

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Encouraging comfort and avoidance of pain Maintenance of soft tissue length and avoid contractures Promote hydration and nutrition Promote orienttation for the patient Avoid aspiration - aspiration pneumonia Avoid subluxation or pain of the UL Maintain appropriate skin integrity

Get her seated more upright, sitting on the bum and not how the weight is on her trunk/back/spine. Look at arm positioning.

Shoulder pain

- Shoulder pain can affect 16-27% of -

people following a stroke (Walsh, 2001) The patient experiences pain, hampers recovery and leads to higher level of disability Multi casual - soft tissue damage and muscle weakness, spasticity Education throughout the team regarding appropriate handling and positioning are key to prevent/ management shoulder pain

Stretching

- Physiotherapists undertake stretching -

during physiotherapy treatment sessions We can teach carers and family members to stretch as part of a home exercise programme (HEP) We can use stretching within

Get her seated more upright, lower the armrests, or elevating her so that she can rest her arms. Look at arm/hand positioning.

positioning programs

- Physiotherapist can also use Serial casting for a sustained stretch - Splints can be used to maintain range of movement - Orthoses can also be used (NICE, 2013 LL orthoses should be considered for foot clearance during walking)

Stretching - debate

- Stretch for the treatment and prevention of contractures Lisa A Harvey et al., (2017) Cochrane systematic -

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Review - 49 RCTT, 2135 patients - stroke, SCI, ABI, arthritis Quality of the evidence - there was high-quality evidence that stretch does not have clinically important short-term effects on joint mobility in people with neurological or non-neurological conditions. There was high quality evidence that stretch does not have clinically important short-term effects on pain, and moderate-quality evidence that stretch does not have clinically important short-term effects on quality of life in people with non-neurological conditions Conclusion - stretch is not effective for the treatment and prevention of contractures and does not have short-term effects on quality of life and pain in people with non-neurological conditions. The short-term effects of stretch on quality of life and pain in people with neurological conditions, and the short-term effects of stretch on activity limitations and participation restrictions for people with and without neurological conditions are uncertain. Benefits in traumatic brain injury particularly in the LL, however, were not maintained once intervention crease No studies looked at stretching over a longer period of time not known

COT ACPIN

- There is a need for high quality research to explore who (age, pathology), the ‘what?’ (response to stretch across different muscles or tendons) and the ‘how?’ (dosage, intensity, joint position) of splinting for contracture management. As one part of a comprehensive goal directed rehabilitation or management programme where the aim is to use gains or maintenance of range in movement for passive or active function (ACPIN 1998, RCP 2009)

ACPIN COT guidelines (2015)

- It is suggested that ankle casts are used at end of range (for people with ABI and stroke) for improving range of movement at the ankle joint

- It is suggested that splints should not be used routinely for the correction of range of movement but may be beneficial in selected cases (in people with stroke and ABI)

- Individuals at risk of contracture or loss of joint range should receive interventions (e.g. splints, casts or -

positioning) to provide passive stretch of sufficient duration and intensity when there is still potential for reversibility. Moderate evidence Task-practice training (repetitive practice) should be considered when improvement in activity performance and motor control are the target or goal of treatment. Moderate evidence

Repeated task practice

- Task specificity - Practice/intensity

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Feedback Generalisability or transferability Modelling Mental practice...