Neurological Physiotherapy
Neurological physiotherapy tests lesion localisation, recovery mechanisms, and task-specific rehabilitation for stroke, spinal cord injury, Parkinson disease, and peripheral neuropathy.
Core rules and concepts
- Upper motor neuron lesions cause spasticity, hyperreflexia, and weakness; lower motor neuron lesions cause flaccidity, fasciculation, and atrophy.
- Neuroplasticity underpins recovery; repetition, task specificity, salience, and intensity matter.
- Stroke rehabilitation addresses tone, positioning, sitting and standing balance, gait, and upper-limb function.
- Spinal cord injury is classified by the ASIA examination: motor and sensory levels, sacral sparing, and complete versus incomplete.
- Autonomic dysreflexia is a medical emergency in lesions above T6: hypertension, bradycardia, headache, and sweating.
Worked example
A patient with a C5 ASIA A injury has deltoid and biceps function but no wrist extension. Reasoning: C5 supplies deltoid and biceps; wrist extensors are C6. Sacral sparing is absent, so the injury is complete. Functionally, the patient may use a power wheelchair and need assistance with transfers, but can assist with feeding using biceps function. Respiratory monitoring remains important because higher lesions impair cough and ventilation.
Traps that cost marks
- Confusing spinal shock with complete injury; spinal shock is temporary loss of reflexes.
- Missing autonomic dysreflexia and treating it as anxiety.
- Assuming spasticity is always harmful; it can support standing or transfers.
- Overfatiguing patients with Guillain–Barré syndrome during progression.