Neurological problems

Neurological problems stem from a wide range of conditions relating to defects in the function of the brain, spinal cord, muscles or nerves. Neurological problems may manifest themselves in inability to walk, abnormal muscle tone, poor coordination, decreased sensation, perceptual problems and a host of other symptoms, depending on the nature and scope of the problem. Neurological problems are most often seen in cerebrovascular accident, spinal cord injury and in cerebral palsy. This article looks at a few of these problems that are addressed by physiotherapy.

Cerebrovascular accident (commonly called stroke) is one of the reasons that many people end up in the emergency room and ultimately in a physiotherapy clinic. Loss of motor function and hemiparesis (weakness on one side of the body) are the major problems a stroke patient may bring to the clinic. The goals of physiotherapy will be to help the individual return to his prior level of function as far as possible. Therapy will involve a thorough examination to determine the extent of the illness and formulate a treatment plan. The person's occupation and goals for post recovery will be considered.

If the patient's lower extremity is still weak or unstable, he/she may have to be trained in the use of an assistive device such as a walker or cane. In severe cases, the patient may have to use a wheelchair or other mobility aid such as a powered wheelchair or scooter. ADL and IADL retraining (driving, cooking, shopping etc.) form a major part of rehabilitation and these may be addressed by an occupational therapist.

Safety with transfers is an issue with patients suffering from neurological problems. Because of lower extremity weakness, instability or perceptual problems, many people fall when getting in or out of bed, or getting in or out of a wheelchair. There are many aids on the market that a person can be trained in using to make transfer safe and easy.

Neurological problems are also seen in spinal cord injury. This type of injury may result from motor vehicle accidents, gunshot wounds, falls and sports accidents. Damage is usually permanent, however early partial to full return of a movement function can be seen. Spinal cord injury may result in paralysis of all four limbs (quadriplegia) as well as the trunk, depending on the level of injury. Physiotherapy addresses passive range-of-motion to prevent contractures, strengthening exercises and gross motor skills with the help of braces, walkers and wheelchairs.

Incoordination and unsteady gait are often seen in persons suffering from cerebral palsy. Physiotherapy can help by having the patient fitted with a brace and training the person to don, doff and use the brace. A program of strengthening exercises, transfer training and ambulation will help reduce the incoordination and promote safety with ambulation.