Neurological Physiotherapy: Stroke, Spinal Cord Injury, TBI, Neurodegenerative Disease and Vestibular Rehabilitation
What the exam tests
Stroke, spinal cord injury, traumatic brain injury, neurodegenerative disease, and vestibular rehabilitation: assessment, neuroplasticity-based training, and safety.
Core rules and concepts
- Neuroplasticity: use task-specific, repetitive, meaningful practice; intensity, salience, and feedback drive learning.
- Stroke: screen for neglect, dysphagia, and shoulder subluxation; train sit-to-stand and gait early; avoid overhead pulleys in a flaccid shoulder.
- Spinal cord injury: the ASIA Impairment Scale and neurological level guide goals. Monitor autonomic dysreflexia: hypertension, bradycardia, headache, and sweating. Sit the patient up and remove the stimulus.
- TBI: Rancho Los Amigos levels guide arousal and behaviour; avoid overstimulation at low arousal.
- Vestibular rehabilitation: Dix–Hallpike identifies posterior canal BPPV; Epley canalith repositioning is the treatment. Central signs such as diplopia, dysarthria, and ataxia require urgent referral.
Worked example
A patient reports brief positional vertigo when rolling over. Dix–Hallpike reproduces torsional nystagmus with latency and fatigue. Reasoning: posterior canal BPPV. Perform Epley, teach post-treatment precautions, and reassess. If central signs appear, stop and refer.
Traps that cost marks
Treating spasticity with prolonged stretch alone; missing autonomic dysreflexia; performing vestibular repositioning without screening for central pathology; overfacilitating a patient in low-arousal TBI; ignoring neglect during gait training.