Neurophysiological physiotherapy


This topic is an additional page on our topic:

  • Physiotherapy / physiotherapy

Physiotherapy on a neurophysiological basis

We would like to go into the following neurophysiological therapy methods:

  • Neurophysiological therapy method according to Bobath
  • Neurophysiological therapy method according to Vojta
  • PNF

General Introduction

These treatment concepts are predominantly used in so-called Central movement disorders in children and adults used. The central movement disorder is a generic term for all disorders of posture and movement control that are based on a disease or damage to the brain. These can be both congenital and thus less often progressive (progressive) or acquired and more often take a progressive course.

Frequent clinical pictures with Children are the early childhood brain damagewhich is often due to a delay in the child's movement development and possibly also in intellectual early childhood development become symptomatic. The causes of delayed or impaired motor development include Muscle tension that is too high (hypertonic) or too low (hypotonic) and changes in reflex activity.
The effects can be barely noticeable Gait disorder up to severe physical and possibly also mental disabilities. Childlike effects on the nervous system can be equally severe Traumatic brain injury due to accidents.

in the Adult area are the most common areas of application for Physiotherapy on a neurophyiological basis the acquired damage to the brain and spinal cord (central nervous system) or the draining nerve pathways. As an example I would like to use the Stroke, traumatic brain injury, multiple sclerosis, Parkinson's disease, paraplegia or the Peroneal palsy (Paralysis of the foot e.g. after disc prolapse) or the Plexus palsy (Paralysis of the arm, e.g. after an accident). Even the so-called Muscular dystrophies (Muscle wasting) in children and adults require intensive and comprehensive physiotherapeutic treatment.

The general Goal setting the physiotherapeutic treatment of neurological diseases is the

  • Promote or restore as healthy as possible (physiological) Movement sequences
  • Support in the intellectual and social-emotional area
  • the training of substitute functions (if not otherwise possible)
  • handling aids (supports, rails, wheelchairs)
  • Delay of the progressive (progressive) course
  • Prevention of consequential damage (secondary damage).

Physiotherapy not only influences the musculoskeletal system, but also vegetative (breathing and blood circulation) and psychological functions. The mobility and productivity of those affected should be increased with the aim of achieving the greatest possible independence and integration into the family and society.

Especially when working in the neurology is the interdisciplinary cooperation with other medical specialties such as doctor, nursing, occupational therapist, speech therapist, orthopedic technician, psychologist and family absolutely necessary, as those affected almost always suffer complex damage.

Physiotherapy on a neurological basis according to Bobath

The Bobath concept was developed in the middle of the 20th century by the married couple Berta (physiotherapist) and Dr. Karel (neurologist) Bobath developed. The neurophysiological basic hypotheses on which the therapy was developed are outdated nowadays, but this does not diminish the success of the therapy in the treatment of neurologically diseased children and adults.

The treatment concept according to Bobath is based on the assumption that neurological disorders of the central nervous system, which often include express through changed muscle tension and abnormal movement patterns, can be influenced by repeatedly recurring sensitive stimuli and the provision of normal movement sequences in such a way that approximately normal movement development can be stimulated. The Bobath couple made use of plasticity (i.e. the brain's ability to reorganize) to learn or regain new functions by networking and activating other areas of the brain. In children with congenital neurological disorders who have not yet had any "previous movement experience", normal motor development from head control to upright gait serves as the basis for recognizing abnormal movement patterns and development deficits.

Adults with an acquired neurological disorder must be picked up and supported at the level of their current movement disorder, which can range from the loss of any movement functions to minor residual symptoms such as e.g. incomplete fine motor skills are sufficient. Stroke patients in particular often offer great potential for regaining motor and mental abilities.

Implementation of the Bobath therapy

From certain key points (e.g. shoulder and pelvis), the abnormal movement patterns are inhibited through the regulation of muscle tension and healthy movement sequences are repeatedly initiated ("ground in"). Essential techniques are the stimulation of active functional movements, posture and gait training, but also passive techniques such as positioning and mobilizing a paralyzed patient. If it is not possible to achieve physiological movement development, substitute functions are trained and the use of aids is accompanied. The starting positions in therapy range from treatment on the lap of babies to gait training for adults with hemiplegia.

The treatment successes like Regulation of muscle tension, improvement of joint mobility and personal activity are based on biomechanical changes such as muscle growth and strength.

For the best possible therapy success, all those involved in the care of the patient - especially the relatives - should join the so-called Handling (Storing, carrying, moving, etc.) of the patient. For the success of the therapy, it is crucial that the movement sequences offered over and over again relate to everyday abilities and skills (everyday life = therapy), as this can immensely increase the learning success and the patient's motivation. Successes such as reaching a toy, turning over in bed, putting on clothes independently or regaining the ability to walk are more beneficial for the person concerned than a complicated exercise created in therapy.

For the performance of physiotherapy on a neurophysiological basis according to Bobath in children and adults, an additional qualification of the therapist is necessary.

Physiotherapy on a neurophysiological basis according to Vojta

The Vojta therapy was carried out by neurologists in the 50/60 years of the last century Dr. Vaclav Vojta Developed through long-term studies of children's motor development and through the observation of recurring reaction patterns to certain external stimuli in different body positions.
These reaction patterns affect not only the entire muscle activity with regard to automatic posture adjustment and targeted movements of the body against gravity, but also breathing, circulation and digestion. The implementation of Vojta therapy is possible in both children and adult patients, but in practice it is mainly prescribed for child development disorders.

Implementation of therapy according to Vojta

Before the therapy, there is an assessment of the quantitative and qualitative movement and development behavior of the child or adult. For diagnostics, Dr. Vojta the so-called posture reactions (only possible with children), which make statements about the level of uprightness and the quality of the child's movement patterns.

The treatment takes place in defined starting positions (e.g. supine position, prone position, side position) via targeted muscle stretching and periosteum stimuli on specific trigger zones on the extremities and trunk. As a reaction = stimulus response there is a complex activation of entire muscle chainsthat are necessary for automatic basic motor movements such as “reflex crawling and reflex turning”. These basic skills such as position control, Erection against the Gravity, (Seat and stand) Mobility and balance form the basis for the development of locomotion (walking, running).

In contrast to many other treatment approaches, Vojta therapy does not want to achieve arbitrary, consciously triggered movements, but instead creates a positive change in posture, movement and economy through automated muscle activity. For this reason, the treatment is usually carried out non-verbally, and verbal prompts are also possible for adults. The attempt is made to break up the recurring “wrong” stereotypes of movement and to prevent the “establishment” of substitute functions.

Repeated therapy in everyday life by previously trained assistants are important for the best possible treatment success. Adult patients are often able to independently call up the movement patterns they have learned in different starting positions and in this way carry out targeted muscle activation.

An additional qualification of the physiotherapist is required for the implementation of physiotherapy treatment according to Vojta.

Physiotherapy treatment on a neurophysiological basis according to PNF

The Proprioceptive Neuromuscular F.Azilitation (movement trajectory via the functional unit of nerves and muscles) was developed in America in the middle of the 20th century by the neurophysiologist Hermann Kabat and the physiotherapist Maggie Knott. The starting point of your research was the frequent occurrence of the poliomyelitis (poliomyelitis), which was associated with symptoms of paralysis in approx. 2% of the cases.

The difference to the treatment methods of that time, which mainly focused on the isolated, one-dimensional movement of Musculature limited, was the three-dimensionality of the developed movement patterns, which are based on the spiral structure of the muscle chains and the multiple functions of individual muscles. We find these movement patterns, empirically tested at the time, in our everyday movement sequences (inconspicuous to the untrained eye) e.g. are trained in the leg patterns stance and free leg phase for the normal course of walking. The PNF method makes use of the fact that the brain remembers complex movement sequences, even if the patient is currently unable to perform them actively and independently.

Implementation of therapy (PNF)

The Initiation of the different movement patterns takes place via the summation of external (exteroceptive) and internal (proprioceptive) stimuli. Exteroceptive stimuli are set through the skin through touch, through the eye through eye contact and through the hearing through commands, muscle activity is intensified through propioceptive stimuli on the body's own perception system (activation of the muscle spindles, tension and pressure on joints).

Synergistic (working together) muscle groups are pre-stretched (= stretch / restretch) by the therapist from different starting positions from the supine position to the standing position and then activated against dynamic resistance. The selection of movement patterns and the use of the various techniques depends on the clinical picture, the individual movement findings and the objectives for the respective patient.

The desired sequence of movements in the brain is automated by repeating the three-dimensional movement patterns (patterns), which are composed of bending / stretching, spreading / spreading and turning movements; Regulation of muscle tension, muscle strength, endurance, coordination and stability is promoted.

In this therapy, too, the transfer of the learned movement patterns into everyday life is important for the patient's motivation and independence.

An additional qualification of the physiotherapist is required for performing physiotherapy according to the PNF method.