Advertisement

Physical and Occupational Approaches

  • Susan H. Pierson
Chapter
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Most approaches by physical and occupational therapists are founded in neurophysiologic, neurodevelopmental, or clinical principles. Unfortunately, there is little level I evidence to support any one of these therapeutic approaches. Yet most of the enduring approaches to spasticity management by therapists persist because they are felt to be effective. These therapeutic approaches have treatment goals that include the achievement of normal motor performance, orderly developmental sequences, and functional mobility. Gillette described each of these clinical approaches as being centered about one or more clinical phenomena occurring in the neurologically injured patient. These phenomena include righting reflexes, reciprocal inhibition, synergistic patterns of movement, and sensory functions such as proprioception, vision, and temperature perception (1). Physical therapy theory holds that any effective treatment program for spasticity also includes efforts aimed at enhancing normal motor control, ensuring optimal physical conditioning, and preventing deformity, skin breakdown, and other complications of spasticity. The treatment of spasticity must be cost-effective and allow for transition out of the medical model and towards resumption of daily life. Table 1 details the fundamental tenants in the management of spasticity that are central to the physical-therapeutic approach to every patient with spasticity.

Keywords

Motor Neuron Cerebral Palsy Functional Task Spastic Cerebral Palsy Therapeutic Exercise 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gillette, H. E. (1964) Recovery of motion following cerebral insult: an appraisal of current methods of management. Arch. Phys. Med. Rehabil. 8, 167–176.Google Scholar
  2. 2.
    Kraft, G. H., Fitts, S. S., and Hammond, M. C. (1992) Techniques to improve function of the hand and arm in chronic hemiplegia. Arch. Phys. Med. Rehabil. 73, 220–227.PubMedGoogle Scholar
  3. 3.
    Bobath, B. (1985) Abnormal Postural Reflex Activity Caused by Brain Lesions, 3rd ed. Aspen Publications, Rockville MD.Google Scholar
  4. 4.
    Mayer, N. H., Esquenazi, A., and Wannstedt, G. Surgical planning for upper motor neuron dysfunction: the role of motor control evaluation. J. Head Trauma Rehabil. 11, 37–56.Google Scholar
  5. 5.
    Keshner, E. A. (1981) Reevaluating the theoretical model underlying the neurodevelopmental theory: a literature review. Phys. Ther. 1035–1040.Google Scholar
  6. 6.
    Bly, L. (1991) A historical and current view of the basis of NDT. Pediatr. Phys. Ther. 3, 131–135.CrossRefGoogle Scholar
  7. 7.
    Walshe, F. M. R. (1946) On the Contribution of Clinical Study to the Physiology of the Cerebral Cortex. The Victor Horsley Memorial Lecture. E & S Livingstone, Edinburgh, p. 18.Google Scholar
  8. 8.
    Otis, J. C., Root, L., and Kroll, M. A. (1985) Measurement of plantar flexion spasticity during treatment with tone reducing casts. J. Pediatr. Orthop. 5, 682–686.PubMedCrossRefGoogle Scholar
  9. 9.
    Knott, M. and Voss, D. E. (1968) Proprioceptive Neuromuscular Facilitation: Patterns and Techniques, 2nd ed. Harper & Row, New York.Google Scholar
  10. 10.
    Ayres, J. A. (1972) Sensor Integration and Learning Disorders. Western Psychological Services, Los Angeles, CA.Google Scholar
  11. 11.
    Siev, E., Freishtat, B., and Zoltan, B. (1986) Perceptual and Cognitive Dysfunction in the Adult Stroke Patient: A Manual for Evaluation and Treatment. SLACK Inc., Thorofare, NJ.Google Scholar
  12. 12.
    Farber, S. D. and Huss, A. J. (1974) Sensorimotor Evaluation and Treatment Procedures for Allied Health Personnel. Indiana University Foundation, Indianapolis, IN.Google Scholar
  13. 13.
    Baker Nobles, L. and Bink, B. (1979) Sensory integration in the rehabilitation of blind adults. Am. J. Occup. Ther. 33, 559–564.Google Scholar
  14. 14.
    VanBenschoten R. A Sensory integration program for blind campers. Am. J. Occup. Ther. 29, 615–617.Google Scholar
  15. 15.
    Mateer C. (1997) Rehabilitation of individuals with frontal lobe impairment, in Neuropsychological Rehabilitation: Fundamentals, Innovations, and Directions ( Leon Carrington, J., ed.), St. Lucie Press, Delray Beach, FL.Google Scholar
  16. 16.
    Wolf, S. L., LeCraw, D. E., Barton, L. A., and Jann, B. B. (1989) Forced use of hemiplegic upper extremities to reverse the effect of learned non-use among chronic stroke and head injured patients. Exp. Neurol. 104, 125–132.PubMedCrossRefGoogle Scholar
  17. 17.
    Netz, J., Lammers, T., and Homberg, V. Reorganization of motor output in the non-affected hemisphere after stroke. Brain 120, 1579–1586.Google Scholar
  18. 18.
    Pritchard, J. W. and Brass, L. M. (1992) New Horizons in neurology: new anatomical and functional imaging methods. Ann. Neurol. 32, 395–400.CrossRefGoogle Scholar
  19. 19.
    Chollett, F., DiPiero, V., Wise, R. J., Brooks, D. J., and Dolan, R. J. et al. (1991) The functional anatomy of motor recovery after stroke in humans. A study with positron emission tomography. Ann. Neurol. 29, 63–71.CrossRefGoogle Scholar
  20. 20.
    Richards, C. L., Malouin, F., Wood-Dauphinee, S., Williams, J. I., Bouchard, J. P., and Brunet, D. (1993) Task specific physical therapy for optimization of gait recovery in acute stroke patients. Arch. Phys. Med. Rehabil. 74, 612–620.PubMedCrossRefGoogle Scholar
  21. 21.
    Fetters, L. and Kluzik, J. (1996) The effects of neurodevelopmental treatment versus practice on the reaching of children with spastic cerebral palsy. Phys. Ther. 76, 346–358.PubMedGoogle Scholar
  22. 22.
    Taub, E. (1994) Overcoming learned non-use: a new approach to treatment in physical medicine, in Clinical Applied Neurophysiology ( Carlson, J. G., Seifer, A. R., and Birnbaumer, N., eds.), Plenum, New York.Google Scholar
  23. 23.
    Giebler, K. B. (1990). Physical modalities, in The Practical Management of Spasticity in Children and Adults ( Glenn, M. B. and Whyte, J., eds.), Lea and Febinger, Philadelphia, pp. 118–148.Google Scholar
  24. 24.
    Kukulka, C. G., Fellows, W. A., Oehlertz, J. E., and Vanderwilt, S. G. (1985) Effect of tendon pressure on alpha motor neuron excitability. Phys. Ther. 65, 595–600.PubMedGoogle Scholar
  25. 25.
    Odeen, I. and Knuttson, E. (1981) Evaluation of the effects of muscle stretch and weight load in patients with spastic paraplegia. Scand. J. Rehabil. Med. 13, 117–121.PubMedGoogle Scholar
  26. 26.
    Otis, J. C., Root, L., and Kroll, M. A. (1985) Measurement of plantar flexor spasticity during treatment with toner reducing casts. J. Pediatr. Orthop. 5, 682–686.PubMedCrossRefGoogle Scholar
  27. 27.
    Patajan, J. H. (1990) Spasticity: effects of physical interventions. J. Neuro. Rehabil. 4, 219–225.Google Scholar
  28. 28.
    Stockmeyer, S.A. (1967) An interpretation of the approach of Rood to the treatment of neuromuscular dysfunction. Am. J. Phys. Med. 46, 900–956.PubMedGoogle Scholar
  29. 29.
    Ayres, J. (1972) Sensory Integration and Learning Disorders. Western Psychological Services, Los Angeles, CA.Google Scholar
  30. 30.
    Bishop, B. (1977) Spasticity: its pathophysiology and management. Part IV: current and projected treatment procedures for spasticity. Phys. Ther. 57, 396–401.PubMedGoogle Scholar
  31. 31.
    Griffin, J. W. (1974) Use of proprioceptive stimuli in therapeutic exercise. Phys. Ther. 54, 1072–1079.PubMedGoogle Scholar
  32. 32.
    Knuttson, E. and Mattsson, E. (1969) Effects of local cooling on monosynaptic reflexes in man. Scand. J. Rehabil. Med. 1, 126–132.Google Scholar
  33. 33.
    Stockmeyer, S.A. (1967). An interpretation of the approach of Rood to the treatment of neuromuscular dysfunction. Am. J. Phys. Med. 46, 900–956.PubMedGoogle Scholar
  34. 34.
    Wells, H. S. (1947) Temperature equalization for the relief of pain. Arch. Phys. Med. Rehabil. 38, 135–139.Google Scholar
  35. 35.
    Benton, L. S., Baker, L. L., Bowman, B. R., and Waters, R. L. (1981) Functional Electrical Stimulation. A Practical Clinical Guide, 2nd ed. Professional Staff Association of the Rancho Los Amigos Hospital, Downey, CA.Google Scholar
  36. 36.
    Fulbright, J. S. (1984) Electrical stimulation to reduce chronic toe flexor hypertonicity. Phys. Ther. 64, 523–525.PubMedGoogle Scholar
  37. 37.
    Petajan, J. H. Sural Nerve stimulation and motor control of tibialis anterior muscle in spastic paresis. Neurology 37, 47–52.Google Scholar
  38. 38.
    Kraft, G. H., Fitts, S. S., and Hammond, M. C. (1992) Techniques to improve function of the arm and hand in chronic hemiplegia. Arch. Phys. Med. Rehabil. 73, 220–227.PubMedGoogle Scholar
  39. 39.
    Han, J. S., Chen, X. H., Yuan, Y., and Yan, S. C. (1994) Transcutaneous electrical nerve stimulation for treatment of spinal spasticity. Chin. Med. J. 107, 6–11.PubMedGoogle Scholar
  40. 40.
    Barry, M. J. (1996) Physical therapy interventions for patients with movement disorders due to cerebral palsy. J. Child. Neurol. (Suppl. 1)11, S51 - S60.Google Scholar
  41. 41.
    Gottlieb, G. L., Myklebust, Bm., Stefoski, D., Groth, K., Kroin, J., and Penn, R. D. (1985) Evaluation of cervical stimulation for chronic treatment of spasticity. Neurology 35, 699–704.PubMedCrossRefGoogle Scholar
  42. 42.
    Barolat, G., Myklebust, J. B., and Wenninger, W. Effects of spinal cord stimulation on spasticity and spasms secondary to myelopathy. Appl. Neurophysiol. 51, 29–44.Google Scholar
  43. 43.
    Kraft, G. H. (1993) Hemiplegia: evaluation and rehabilitation of motor control disorders. Phys. Med. Rehabil. Clin. North Am. 4, 687–705.Google Scholar
  44. 44.
    Basmajian, J. V. (1981) Biofeedback in rehabilitation: a review of principles and practices. Arch. Phys. Med. Rehabil. 62, 469–475.PubMedGoogle Scholar
  45. 45.
    Rinehart, M. A. (1990) Strategies for improving motor performance, in Rehabilitation of the Adult and Child With Traumatic Brain Injury, 2nd ed. ( Rosenthal, M., Griffith, E. R., Bond, M. R., Miller, J. D., eds.), F.A. Davis, Philadelphia, pp. 331–350.Google Scholar
  46. 46.
    Farber, S. D. and Huss, A. J. (1974) Sensorimotor Evaluation and Treatment Procedures for Allied Health Personnel, 2nd ed. Indiana University Foundation, Indianapolis, IN, pp. 88–97.Google Scholar
  47. 47.
    Mills, V. (1984) Electromyographic results of inhibitory splinting. Phys. Ther. 64, 190–193.PubMedGoogle Scholar
  48. 48.
    Mathiowetz, V., Bolding, D., and Trombly, C. (1983) Immediate effects of positioning devices on the normal and spastic hand measured by electromyography. Am. J. Occup. Ther. 37, 247–254.PubMedCrossRefGoogle Scholar
  49. 49.
    McPherson, J. and Becker, A. (1985) Dynamic splint to reduce the passive component of hypertonicity. Arch. Phys. Med. Rehabil. 66, 249–252.PubMedCrossRefGoogle Scholar
  50. 50.
    Warren, C. G., Lehmann, J. F., and Koblanski, J. N. (1976) Heat and stretch procedures: an evaluation using rat tail tendon. Arch. Phys. Med. Rehabil. 57, 122–126.PubMedGoogle Scholar
  51. 51.
    MacKay-Lyons, M. (1989) Low-load prolonged stretch in treatment of elbow flexion contractors secondary to head trauma: a case report. Phys. Ther. 69, 50–54.Google Scholar
  52. 52.
    Orest, M. (1993) Casting protocol. P.T. Magazine, pp. 51–55.Google Scholar
  53. 53.
    Lehmkuhl, L. D., Thoi, L. L., Baize, C., Kelley, C. J., and Krawczyk, L., et al. (1990) Multimodality treatment of joint contractures in patients with severe brain injury: cost, effectiveness, and integration of therapies in the application of serial/inhibitive casts. J. Head Trauma Rehabil. 5, 23–42.CrossRefGoogle Scholar
  54. 54.
    Hinderer, K. A., Harris, S. R., Purdy, A. H., et al. (1988) Effects of “tone reducing” vs. standard plaster casts on gait improvement in children with cerebral palsy. Dey. Med. Child. Neurol. 30, 37–77.Google Scholar
  55. 55.
    Zablotny, C., Andric, M. F., and Gowland, C. (1987) Serial casting: clinical applications for the adult head injured patient. J. Head Trauma Rehabil. 2, 46–52.CrossRefGoogle Scholar
  56. 56.
    Lehmkuhl, L. D., Thoi, L. L., Baize, C., Kelley, C. J., Krawczyk, L., et al. (1990) Multimodality treatment of joint contractures in patients with severe brain injury: cost, effectiveness, and integration of therapies in the application of serial/inhibitive casts. J. Head Trauma Rehabil. 5, 23–42.CrossRefGoogle Scholar
  57. 57.
    Hallenborg, S. C. (1990) Positioning, in The Practical Management of Spasticity in Children and Adults ( Glenn, M. B. and Whyte, J., eds.), Lea and Febinger, Philadelphia, pp. 97–117.Google Scholar
  58. 58.
    Naeser, M. A., Alexander, M. P., Stiassny-Eder, D., Galler, V., Hobbs, J., and Bachman, D. (1993) Real versus sham acupuncture in the treatment of paralysis in acute stroke patients: a CT scan lesion study. J. Neurol. Rehabil. 6, 163–173.Google Scholar
  59. 59.
    Yu, Y. H., Wang, H. C., and Wang, Z. J. (1995) The effect of acupuncture on spinal motor neuron excitability in stroke patients. Chung Hua I Hsueh Tsa Chih 56, 258–263.PubMedGoogle Scholar
  60. 60.
    Kjendahl, A., Sallstrom, S., Osten, P. E., Stanghelle, J. K., and Borchgrevink, C. F. (1998) Acupuncture in stroke. Tidsskr Nor Laegeforen 118, 1362–1366.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Susan H. Pierson

There are no affiliations available

Personalised recommendations