Ramesh debur

Understanding of the brain functioning Gives a direction to treatment Ability to understand concepts in

practice Deeper understanding of treatment

and effects Ability to detect change in status early

Theoretical concepts that help CNS functions

To some extent based on practical knowledge

Understanding morphology using physiology

Brain recovers the way it developed from birth

Informed assumption to established facts

Muscle Re-education Approach (1920s) Neurodevelopmental Approaches (1940-70s)

Sensorimotor Approach (Rood, 1940s) Movement Therapy Approach (Brunnstrom, 1950s) NDT Approach (Bobath, 1960-70s)

PNF Approach (Knot and Voss, 1960-70s) Motor Relearning Program for Stroke (1980s) Contemporary Task-Oriented Approach

(1990s)

Hirerchial theory Top to bottom approach Normalization of muscle tone

Mobilizers and stabilizers

Voluntary movement based on reflexes and uses reflexes to augment motor response

Development cephalocaudal

therefore treatment is

◦ toe to head

◦ flexors >extensors> abductors > adductors

Movement is towards function

Repetition is necessary

TLR and labyrinthine responses can affect sensory stimulation

TThree basic observations

◦ Stimulation of receptors - Homeostatic response via ANS

◦ Reflexive and protective response via brainstem, ANS and Spinal circuits

◦ Adaptive response that require greater integration of higher levels of CNS

1. fast brief stimulus – large synchronous motor output

2. fast repetitive – maintained response

3. maintained sensory – maintained motor response

4. slow rhythmical sensory – deactivates body and mind

PNF :

Steady joint

compression

Stretch

Light touch moving

Fast brusing

Icing

Resistance

Vestibular

stimulation :

positioning etc

Intrinsic stretch

Secondary ending

stretch

Stretch pressure

Normal warmth

Gentle shaking or walking

Slow stroking

Slow icing

Uses Uses

Modulate muscle tone

Re educate movements

Pure sensory feed back

Make patient aware “aware” of the joints

Alter reflex patterns

Slow rolling

Light joint compression

Tendionus pressure

Maintained stretch

AdvantagesAdvantages Strong reactions ( if used properly) Transient responses Does not require the cooperation of

the patient as the responses are automatic

Easy to apply Immediate outcome

Disadvantages Disadvantages No responses under altered conditions No Long term effects Very less evidence in support Change of thinking Change of knowledge base has

outdated this method as a standalone therapy

SummarySummary Elementary method of treatment Uses body responses to cause change Action - Reaction principle Can be used in the initial phases of

recovery