Case studies in neurological physiotherapy

CHAPTER SIX Case studies in neurological physiotherapy






Introduction


Neurological physiotherapy covers a broad area of practice spanning intensive care, acute, rehabilitative and community services. New ways of working have seen an increase in physiotherapists working in community and primary care settings, a number of case studies presented touch upon the differences experienced when working in these areas. The case studies based in acute settings highlight transferable skills which may impact on the approach to treatment of the patient with neurological impairment.


Physiotherapy practice in neurology can be focussed on prevention, maintenance, restoration, prevention or in palliative care. The case studies presented in this chapter aim to touch upon each of these areas, highlighting the role of the physiotherapist, the need to develop an underpinning knowledge of the pathophysiology of a condition in order to set appropriate goals and the need to work as part of a multi/inter disciplinary team.


In neurological physiotherapy the evidence base for treatment interventions is a developing one (Pomeroy & Tallis 2002). Moves have been made by a number of researchers to identify what constitutes neurological physiotherapy. Studies by Ballinger et al (1999), Davidson & Waters (2000), Lennon & Ashburn (2000) and Lennon (2003), have begun to address this issue mainly in the form of surveys and focus groups. These studies have sought to isolate the components of neurological physiotherapy treatment and what concept of treatment physiotherapist’s professed to use. Previous studies by Nilsson & Nordholm (1992), Carr et al (1994), and Sackley & Lincoln (1996) as cited in Davidson & Waters (2000), identified that the main approach used by physiotherapists in the United Kingdom, although eclectic in nature, was based on the Bobath concept. This was supported by Davidson & Waters (2000) who reported that the majority of physiotherapists questioned (88%), professed to use the Bobath approach, although the majority of these also used other approaches in the treatment of their clients. The second most popular approach was identified as the Motor Re-learning Programme (MRP), though this was practised by only 4% of the respondents.


Much of the evidence available informing neurological physiotherapy practice supports the MRP as an effective treatment approach in the management of neurological conditions. However, given the low numbers of physiotherapists reported to be practising MRP in the UK and the eclectic approach reported, a similar approach has been taken when compiling this chapter. It is therefore suggested that any preparation for a new area of clinical practice should include familiarisation with the approach adopted in that area.



CASE STUDY 1 Acute stroke






CASE STUDY 2 Stroke rehabilitation, upper limb hypotonicity






CASE STUDY 3 Stroke rehabilitation, gait disturbance






CASE STUDY 4 Head injury, acute phase


The following patient is on intensive care following admission via A&E 2 weeks ago.






CASE STUDY 5 Head injury, long-term rehabilitation


You have been asked to see the following patient in the community. She suffered a head injury 4 years ago and is seeking advice on exercise and social activity, having previously been discharged from physiotherapy 2 years ago.



Subjective assessment










CASE STUDY 6 Spinal cord injury at C3


The following gentleman was discharged 4/52 ago from a regional spinal unit. He has 24-hour care provided at home by a dedicated nursing team. You have been asked to see him by the lead nurse in the team due to difficulties with positioning.



Subjective assessment








Objective assessment


You are asked to focus your attention on seating and positioning difficulties.







CASE STUDY 7 Spinal cord injury at T5


The following patient has recently been transferred to a rehabilitation unit following a period of care for a spinal fracture at T5. Surgical intervention was required to stabilise the fracture site and decompress the spinal cord. The patient is now wearing a brace, which is due to be reviewed in the next few weeks.



Subjective assessment










CASE STUDY 8 Multiple sclerosis, relapsing–remitting


You have been asked to see the following lady in an out-patient setting by the multiple sclerosis (MS) specialist nurse following a recent relapse.



Subjective assessment









Objective assessment


Arrives for therapy session mobilising with husband, reports ‘linking’ as feels unsafe mobilising outside own home independently. Husband reports that his wife has been maintaining her balance by holding on to furniture while walking around the home.







CASE STUDY 9 Multiple sclerosis, secondary progressive


You have been asked to see the following gentleman at home by the home care team, who have reported increasing difficulty with transfers on visits to assist with personal care.









Objective assessment






CASE STUDY 10 Parkinson’s disease


You are asked to see the following gentleman at his home by the Parkinson’s disease specialist nurse who reviewed him at her clinic 1 week ago. He has been finding transfers increasingly difficult. His medication has been changed, but increasingly difficult home circumstances have triggered an urgent referral.



Subjective assessment








Objective assessment







Mar 17, 2017 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on Case studies in neurological physiotherapy

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