Neurological Physiotherapy
Domain focus
This domain covers adult and paediatric neurorehabilitation. The exam tests lesion localisation, prognosis, tone and movement analysis, task-specific training, and safe management of impairments such as weakness, spasticity, ataxia and neglect. Paediatric questions expect developmental and family-centred reasoning rather than adult protocols applied to children.
Core rules and concepts
- Recovery combines spontaneous neurological recovery, compensation and learning-dependent neuroplasticity. Task-specific, repetitive and meaningful practice drives functional change.
- Tone is not the same as strength. Spasticity is velocity-dependent; rigidity is lead-pipe and non-velocity-dependent. Treat tone only when it limits function, care or comfort.
- Adults after stroke need early mobilisation when medically stable, sitting balance, transfer practice, gait training and upper-limb task practice. Shoulder pain and subluxation require careful handling.
- Paediatric rehabilitation uses developmental trajectories, play-based tasks and family-centred goals. Cerebral palsy classification includes GMFCS, and function is influenced by environment and participation.
- Cognitive and perceptual deficits affect safety and learning. Neglect, impulsivity and apraxia change how you teach a task.
- Outcome measures should capture activity and participation, not only impairment.
Worked example
A 62-year-old has a right middle cerebral artery stroke with left hemiparesis, left neglect and poor trunk control. Reasoning: the right hemisphere lesion explains left-sided weakness and neglect; safety awareness is reduced. Begin with supported sitting, weight shift to the left, visual scanning and simple reach tasks. Progress to sit-to-stand with cueing and a left-sided approach. Do not start unsupervised standing or walking because neglect may cause falls and pushing. Reassess trunk control and neglect before changing the plan.
Traps that cost marks
Assuming a plateau without reviewing practice intensity, environment or goals; reducing tone without a functional aim; applying adult strengthening rules to young children without developmental context; and ignoring cognitive, perceptual or communication barriers. Another trap is measuring only tone or range while missing participation.
Key points
- Use task-specific, repetitive practice.
- Treat tone only when it limits function or care.
- Paediatric goals are family-centred and developmental.
- Neglect and cognition change safety and teaching.
- Measure activity and participation, not impairment alone.