Physiotherapy after stroke: define, divide and conquer
- 1Sobell Department of Movement Neurosciences, Institute of Neurology, Queen Square, London WC1, UK
- 2Regional Neurological Rehabilitation Unit, Homerton Hospital, London E9, and Acute Brain Injury Service, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1, UK
- Correspondence to: Dr R J Greenwood RNRU, Homerton University Hospital, Homerton Row, London E9 6SR, UK; richard.greenwoodhomerton.nhs.uk
Assessment of physiotherapy is difficult because of the complexity of the interventions
When rehabilitating people after stroke, physiotherapists often favour a particular “approach”. An “approach” is a theoretical construct based on a series of ideas and hypotheses about the retraining of movement that influences the content, structure, and aims of a therapy session.1 In this edition of the journal (see pp 503–8), van Vliet et al2 compare two approaches, “motor re-learning” and the “Bobath concept”, the latter presently being the preferred approach within the United Kingdom.1 The emphasis of “motor re-learning” is on context specific functional training using principles derived from motor learning theory, while that of the Bobath concept is on observational analysis and facilitation of normal movement using principles derived from neurodevelopmental and neurophysiological theory.
van Vliet and colleagues have previously shown that therapy using these two approaches differs, for example in the degree and type of feedback provided and extent to which everyday objects are used during the treatment session.3 Their single blind randomised …
