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Theoretical basis of stroke rehab


dreinke

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And we wonder why there are so many stroke forums and websites set up by survivors trying to understand stroke rehabilitation.

 

http://informahealthcare.com/doi/abs/10.3109/09593989409036399

 

As in the Swedish study, although the respondents were able to describe their treatment choices, they had difficulty explaining the underlying theoretical basis for their choice. Difficulty providing a scientific and rational explanation for intervention may have implications for the future development of physiotherapy as a clinical science.

 

In a survey of Swedish physiotherapists working in neurology, the treatment of individuals following stroke was found to be essentially praxis-oriented (What?)(Nilsson and Nordholm, 1992). The present study replicated the Swedish survey in order to compare the responses of Australian physiotherapists with those of their Swedish colleagues. The questionnaire, designed to establish choice of treatment, factors influencing and theoretical bases for the choice of treatment, and attitudes towards new methods, was sent to the 331 members of the Neurology Special Interest Group of the Australian Physiotherapy Association. The response rate was 72%. Respondents viewed experience working with patients as the most important factor influencing current choice of treatment. As in the Swedish study, although the respondents were able to describe their treatment choices, they had difficulty explaining the underlying theoretical basis for their choice. Difficulty providing a scientific and rational explanation for intervention may have implications for the future development of physiotherapy as a clinical science.

 

 

And I bet I have a better understanding of the theoretical basis of stroke rehab than those physiotherapists. Read my posting on What my doctor should have told me about stroke recovery

http://oc1dean.blogspot.com/2010/08/what-my-doctor-should-have-told-me.html

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Dean, If they had difficulty explaining the basis for their theory they're certainly not to be relied on. Some things, even if they are not 100% effective, have proven to be successful (such as constraint therapy, as you mention in your blog). By the way, nice blog.

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Hi Dean,

Excellent blog and excellent articles. I just finished reading the article about Brunnstrom vs Bobath. So interesting! I am a PT who went through the bobath training for treating adult hemiplegia. My sister died of a stroke at 20, and my Dad had a stroke this year, so it is something on my mind. I think that there are some really good PTs and really poor PTs out there (sounds like you agree??). I think that of a therapists cant comprehensively discuss the treatment rationale for their approach then that raises a red flag, and you should request someone else. I also think that while one treatment approach works for one person, it might not be the best fit for another, and you (being the PT) should be flexible to each situation. I am sad to hear that you had such a poor experience with the bobath (NDT) approach, sounded harsh! In my training I never learned to tell a client "no, that is the wrong movement". That usually meant that I was doing something wrong in the set up or facilitation of the exercise! I also believe that the bobath method relies on "massed practice", from my course they explained that it requires thousands of repetitions to get the other parts of the brain to recover (neuroplasticity), and they advised up to 5 hours a day of this type of treatment! Thats great if you have the personal funds to hire a PT for that, but clearly the insurance companies dont support this type of rehab. So I feel discouraged that there may be a treatment out there to treat hemiplegia, but there is no access to it. I am so curious to find out what "worked"for you?? It would be a learning experience for me to find out. I have never seen a stroke recovery patient so well versed in stroke rehab!! You should give a lecture!!!

I hope your recovery is going well.

kind regards,

Sara

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