Neurological Physiotherapy
What you must understand
Know the levels of the nervous system and how lesions present: upper motor neuron signs (hyperreflexia, spasticity, Babinski sign, clasp-knife tone) versus lower motor neuron signs (flaccidity, fasciculation, atrophy, areflexia). Understand the International Classification of Functioning model, task-specific training, neuroplasticity principles (repetition, salience, intensity, specificity), and outcome tools such as the Berg Balance Scale, Trunk Impairment Scale, and Functional Independence Measure. Be familiar with tone management, positioning, transfers, and falls prevention.
Traps in questions
- Confusing cerebellar signs (ataxia, dysmetria, intention tremor) with basal ganglia signs (rigidity, bradykinesia, resting tremor).
- Assuming spasticity should always be reduced; function may depend on it.
- Choosing strengthening in isolation over task-specific, functional practice after stroke.
- Missing safety issues: neglect, pusher syndrome, hemianopia, and impulsivity.
Rule of thumb
For neurological rehabilitation questions, prefer high-repetition, task-specific, meaningful practice with appropriate challenge. Screen cognition, vision, and sensation before progressing balance work.
Worked example
A stroke patient can stand with assistance but leans strongly to the weaker side and ignores the left side. Before progressing gait, address pusher behaviour and neglect through midline cueing, visual scanning, and supported symmetrical stance.