A CLOSER LOOK AT THE ROLE OF PHYSICAL THERAPY IN TREATING PATIENTS WITH NEUROLOGIC PROBLEMS.

INTRODUCTION

The use of exercise and rehabilitative techniques to prevent and treat disease and trauma is an ancient concept. It's a well-known fact that physical activity is a key component of improving, as well as sustaining, good health. In this age of managed care, the goal is to regain and maintain good health. For this reason, all healthcare providers must work together efficiently to produce optimal functional results for their patients in a timely and cost-effective manner.

For the individual with a nervous system insult or with a neuromuscular disease, therapeutic intervention is crucial to restoring function. Research suggests that specific physical neurological intervention can produce phenomenal results in coordination with medical advisement.

Many conditions can cause neurologic and balance disorders, including Parkinson's disease; Meniere's disease; Lou Gehrig's disease (ALS); diabetic neuropathy; stroke; chronic ear, nose and throat conditions that damage the vestibular system; Cerebral Vascular Accident; neuropathy; myopathy; Multiple Sclerosis; slow-growing tumors on the nerve that leads from the inner ear to the brain; insufficient blood flow to the vestibular system high doses or long-term use of certain antibiotics (such as aminoglycosieds); the use of aspirin, caffeine, nicotine, marijuana or medications (such as certain oral contraceptives, sedatives or tranquilizers); orthopedic problems; and motion sickness caused by exposure to unusual or conflicting visual or surface orientation references.

This Physician Alert will focus primarily upon physical therapy for neurological difficulties.

ASSESSMENT

Most physical therapy treatment is provided on referral by a primary care physician, and therapy is typically covered by insurance.

When a client is referred for physical therapy, a physical therapist who is specially trained in neurologic and balance disorders will assess eye reflex functions as they relate to the inner ear function, determine how well the client's senses are interacting, and assess the client's position sense, motor responses and balance skills as they affect daily activities. The same physical therapist will also perform a home assessment to determine if changes are needed to prevent fall injuries.

After these studies, a recommended program of treatment is customized to the client's specific needs and is provided to the referring physician. Working together, the client and therapist then formulate component goals that allow the client to understand and fully participate in the treatment process. Throughout therapy, the client's progress is reported regularly to the referring physician.

TREATMENT GOALS

There are two main goals in the treatment of neurologic and balance disorders: inhibition and facilitation. The goal of inhibition is to stop or alter the abnormal muscle tone or movement. The goal of facilitation is to encourage or direct normal movement.

THE HANDS-ON THERAPY APPROACH

Initially, the physical therapist may utilize a "hands-on or hand placement" approach throughout the execution of all movements. Hands-on therapy means that the therapists' hands are purposefully placed on the client's body in a preplanned sequence throughout therapy to guide, direct and stabilize joints and muscles, to facilitate proper motion, initiate weight shifts and to ensure client safety.

CEREBRAL VASCULAR ACCIDENT

For many years it was thought that the greatest physical strides after a Cerebral Vascular Accident (CVA) would be experienced within the first six months post-stroke. It is now thought that the evolution of regaining function is lifelong -- providing that the individual is motivated, able and willing to follow directions.

Plasticity of the Central Nervous System (CNS) varies among individuals, as does the extent of damage incurred. The key to improving motor control is found in the treatment.