Neurological Physiotherapy: Impairment, Function and Neuroplasticity
Linking lesion to movement
Neurological physiotherapy demands understanding of motor control, tone, sensation, coordination, and the principles of neuroplasticity. Candidates must know how to assess and interpret weakness, spasticity, ataxia, sensory loss, and postural control, and how these impairments translate into activity limitations and participation restrictions. Familiarity with outcome measures, such as the Berg Balance Scale, Trunk Impairment Scale, and functional independence measures, is expected, along with the ability to justify task-specific, repetitive, and meaningful practice. Neuroplasticity is driven by use, salience, repetition, intensity, and timing; rehabilitation should exploit these principles while respecting fatigue and safety.
Traps that catch candidates
A common trap is equating tone with strength or treating spasticity as always harmful. Spasticity may support function in some patients, so reducing it indiscriminately can worsen standing or transfers. Another trap is over-reliance on facilitation techniques without task specificity, or failing to recognise that a patient with pusher behaviour, neglect, or sensory loss needs assessment of perception and safety before mobility progression. Questions may also test when to withhold gait training, for example with unstable cardiovascular status or unsafe cognition without supervision.
Worked rule of thumb
Use the task-impairment link: identify the limiting impairment, choose a task that requires it, and grade the challenge so the patient succeeds with effort. For example, in a patient with mild post-stroke hemiparesis and adequate trunk control, practise reaching and stepping tasks with variable targets rather than passive facilitation alone, and measure change with a relevant balance or gait outcome.