Neurological Physiotherapy
Neurological Physiotherapy
This domain tests neurological examination, outcome-measure selection, and rehabilitation planning for stroke, Parkinson's disease, multiple sclerosis, spinal cord injury and Guillain-Barré syndrome. Questions reward knowing which measure answers which question.
Core rules
- Separate upper from lower motor neuron signs: hyperreflexia, spasticity and Babinski favour UMN; fasciculation, atrophy and areflexia favour LMN.
- Neuroplasticity follows task-specific, high-repetition, progressively challenging practice with active participation; passive handling alone does not drive it.
- Stroke: quantify impairment with Fugl-Meyer, balance with Berg Balance Scale, walking speed with the 10-metre walk test, and function with the modified Rankin Scale. Berg below 45/56 signals falls risk.
- Parkinson's: auditory and visual cueing, dual-task training and amplitude-based movement; refer for LSVT BIG where available.
- Multiple sclerosis: fatigue and heat sensitivity (Uhthoff phenomenon) require pacing, cooling and energy conservation.
- Spinal cord injury: classify with the ASIA Impairment Scale, then prioritise pressure care, respiratory management and transfer training.
Worked example
A 68-year-old man, three weeks after a left middle cerebral artery infarct, is Brunnstrom stage 3 with Berg 28/56 and stands with one-person assistance. Reasoning: stage 3 means movement is dominated by synergy, and Berg below 45 predicts falls. Plan: task-specific sit-to-stand practice, assisted gait training, constraint-based use of the affected arm, and falls education for the family. Reassess Berg at two to four weeks.
Traps
- Reinforcing flexor synergy instead of training task-specific movement.
- Prescribing bed rest for MS fatigue rather than pacing.
- Assuming a favourable Brunnstrom stage equals functional independence.
- Overlooking post-stroke depression and cognition, which limit carry-over.