As every year, we receive the training sessions of the Spanish Association of Therapists trained in the Bobath Concept (AETB).
At the beginning of the month of March, Saturday, September 9, the XXXII AETB Training Days will take place in Madrid. These conferences, open to members and non-members, aim to keep interested parties up-to-date regarding the Bobath Concept and neurological rehabilitation, whether in children or adults.
This year will be treated issues such as the treatment of patients with acquired brain damage, in the acute phase of the process that corresponds to the first 3 months after suffering a stroke. In this phase the intervention of physiotherapy is paramount since it is when more and better results are obtained, the progress and level of recovery in this phase, which is usually hospitable, is usually an indication of recovery in future phases of evolution (subacute and chronic).
After addressing this issue several lectures will be given by highly qualified professionals such as the speech therapist Elía Rodríguez, the physiotherapist and tutor Bobath Maria Angeles Tejedor and the physiotherapist and tutor Bobath Carlos Leite Martins who comes from Portugal.
This year prior to the days of the Bobath Concept, the Association promotes a monographic course of physiotherapy treatment for patients with acquired brain damage. The course will address issues related to critical aspects of the patient in the acute phase and clinical aspects of the medical and therapeutic intervention. They will also relate the sensory integration treatment techniques and the construction of the body’s median line and its symmetry as a requirement to ensure that the patient acquires stability at the time of getting up and standing upright.
The Neurorehabilitation Clinic from Barcelona always marks its presence to bring to the working group new ideas and updates in the treatment of physiotherapy and occupational therapy of patients with brain damage.
Este fin de semana he empezado una formación interesantísima de valoración y tratamiento de miofascial impartida por el fisioterapeuta y osteópata Ricard Tutusaus autor del recomendado libro: Sistema fascial, anatomía, valoración y tratamiento. Así que hoy he empezado a aplicar todo lo aprendido a mis pacientes y como no me parecía interesante compartir algunos conceptos interesantes sobre el tejido fascial que he refrescado y actualizado.
El tejido conjuntivo o fascial es un elemento de sostén y de relación conecta todo el cuerpo humano. Desarrolla tareas imprescindibles para la correcta función visceral y la coordinación neuromuscular. Sus principales funciones son:
– suspensión y conexión de estructuras viscerales;
– envoltura de vasos sanguíneos y estructuras nerviosas asegurando la vascularización e inervación;
– recubrimiento de músculos;
– adaptación a las fuerzas mecánicas y transmisión de movimientos;
– mantenimiento de la integridad postural;
– papel destacado en la propiocepción y en la recepción del dolor;
La evidencia científica demuestra que los pacientes con espasticidad, hipertonía o rigidez soportan tensiones continuas a nivel fascial lo que causa cambios estructurales permanentes en músculos y tejido conectivo. Una tensión mecánica prolongada sobre el tejido fascial estimula la formación de fibras de colágeno y causa una densificación que altera su capacidad elástica. Por otro lado, diversos autores afirman que el grosor de la fascia puede también incrementarse con la inmovilización muscular, que presentan por ejemplo los pacientes con imposibilidad de mover un segmento corporal tras un ictus.
Es por ello que en mis tratamientos incluyo técnicas de liberación miofascial con el objetivo de disminuir la espasticidad, favorecer la función fascial y muscular y mejorar la postura en sedestación y en bipedestación de mis pacientes.
Os dejo un estudio piloto que me ha parecido interesante y la referencia del libro de Ricard Tutusaus y Josep Maria Potau, que sin duda recomiendo leer.
Park DJ1, Hwang YI2. A pilot study of balance performance benefit of myofascial release, with a tennis ball, in chronic stroke patients. J Bodyw Mov Ther. 2016; 20(1):98-103
Ricard Tutusaus Homs, Josep María Potau Ginés. Sistema Fascial. Anatomía, valoración y tratamiento. Madrid: Panamericana; 2015.
The foot is an area of the body of extreme importance. It is seen as the base that sustains our whole body when we are standing or when we walk and an alteration in one or both feet induces alterations of postural control, that is, balance and consequently in gait.
In the neurological patient, Multiple Sclerosis, Friedreich’s Ataxia, stroke, among other pathologies of the nervous system, it is common to find alterations of the foot, such as:
- Structural alterations: loss of the plantar arch, claw toes, etc.
- Hypertonia or Spasticity: foot in equine or equine-varus
- Hipotonia: flat foot
- Joint instability:
- Sensitivity: hyperreflexia, hypesthesia, etc.
By presenting alterations of the foot the patient can experience the reduction of balance reactions, known as ankle balance strategy, and therefore see their balance compromised. It is known that to improve the recruitment of these equilibrium reactions so necessary to standing posture, it is advisable to perform a structural preparation work such as:
- Liberation of amplitudes or joint ranges, often limited by spasticity and often called equine foot;
- Muscle recruitment and its potentiation, especially in the foot lift muscles;
- Reciprocal innervation and coordination between muscle groups of the foot,
- Among others
The preparation of the foot as a base of support and support of the body also includes a sensitive approach, that is, improving the sensitivity of the joint complex of the foot. The foot contact with the ground and therefore must present tactile or tactile capacity preserved. Kinesthesia, proprioception or deep sensitivity are also crucial to balance and gait. At all times we should be able to identify the weight that supports our joints of the feet and compare them to know if we are more or less inclined to one side or another, in front or behind.
Finally, the load. The ankle-foot joint complex is composed of large and strong joints, capable of receiving and supporting body weight. However, it is not just that the joints support the weight, but that the muscular system is able to keep them aligned in order to guarantee our balance in any situation (inside and outside the home, barefoot or with shoes, standing or moving, with light or low light, etc.).
As you can see, from the physiotherapy we have many tools to work the foot and improve the balance, either reducing spasticity and equine foot, strengthening the muscles that raise the foot or improving their sensitive perception.
Soon we will talk about how the foot behaves during walking and how physiotherapy can help patients with pathologies or neurological diseases.
Individuals with acquired neurological diseases (such as stroke, head trauma, spinal cord injury, etc.) suddenly see their lives limited by alterations and functional, motor, sensory, and cognitive problems, among others. In addition to these limitations that on their own lead to a disability, there are other affected areas such as family, work, social life and even sexuality.
The motor, sensory, emotional and cognitive disability of patients with neurological disorders interrupts the sexual life of those affected and their respective partners and spouses.
The therapists of the rehabilitation team of the Neurorehabilitation Clinic of Sant Cugat del Vallés (Barcelona) recommend that patients overcome the tabu, shyness, shame and talk about this issue with a doctor, neurologist, psychologist, physiotherapist and even social worker. Different professionals can help in the search of strategies and therapeutic options (pharmacological and non-pharmacological) to face problems related to sexual life (erection, ejaculation, fertility, orgasm, reproduction, etc.).
Neurological patients, whether due to brain or spinal cord disease, may experience different symptoms or alterations that affect sexual activity. For example, the sensitive alteration can affect aspects related to the excitement or pleasure sensation, the motor alteration can affect the aspects related to the erection or ejaculation and even emotional alterations can influence the sexual libido and behavior.
Communication can also be a limiting factor to address the issue. Patients with aphasia (comprehension, expression, mixed, others) may have difficulty expressing their concern about the sexual issue, either with rehabilitation professionals, or at home with their partners. In a similar way it happens at an emotional level. Patients usually see their life changed completely, their body is not the same, they feel useless, unwanted, insecure of their family role and their position as a couple. Thus, we must assume that any type of disability can lead to an interruption and limitation in your sex life.
Nowadays you can find several therapeutic strategies apart from the help and impulse that is received by the professionals (psychologist, occupational therapist, physiotherapist). Some of the best known options are sensory and sensory stimulation, neuroprosthetic implantation, sensitive substitution therapy, transcranial electrostimulation, vibro-stimulation among others.
There are strategies for men and women equalizing the importance of sexual life in both genders, at different ages and for people and couples with different needs.
With this, in the Neurorehabilitation Clinic, we do not forget that a patient is a person with needs and demands in different areas. One of the objectives as a therapeutic team is to help the individual and his family achieve a better quality of life.
Occupational therapy is a socio-sanitary discipline that focuses on the treatment of people who have a deficit in the performance of their daily activities and occupations, from the most basic such as grooming or clothing, to more complex tasks such as money management or the care of the home. Its purpose is to improve the autonomy of the person, and improve the quality of life.
An intervention from occupational therapy at home allows us to transfer to daily life all the objectives that are worked on in physiotherapy, neuropsychology and speech therapy sessions. In each person’s own environment it will be possible to adapt to the individual and personal needs of each one.
At home we analyze the activities that are carried out in order to detect difficulties or abilities and skills. We also analyze the current role that each one develops in their environment. Many times after suffering a brain damage the person changes the roles of home and happens to depend on a third person to perform their daily activities. These roles, instead of adapting to advances in rehabilitation, tend to become chronic and family members adopt the role of caregiver and the patient has a more passive role in the basic activities of cleanliness and self-care and in household chores.
For this reason, in the Neurorehabilitation Clinic we believe that it is very important to be able to make a TO intervention to encourage, help and train the different tasks and daily activities, to improve the autonomy and to change the role of the affected person to be more active and participative. Advice and recommendations are given on changes and adaptations that facilitate accessibility and mobility within the home. An example of a TO session at home could be participating in the kitchen. From choosing the dinner looking at what is in the fridge, prepare the food (clean, cut food and cook) all training the use and management of devices that facilitate the realization of the activity (as would be a kitchen table for hemiplegia) . Throughout this process the person works on motor, neuropsychological aspects (such as remembering the steps to be taken, preventing what we need to cook, being alert to unexpected events or organizing time and space), aspects of speech therapy (oral language, reading, comprehension) of language) and emotional aspects. Other examples would be to put and empty the dishwasher or the washing machine and even leave home alone and be able to move around the neighborhood (on foot or in a wheelchair) autonomously and safely.
Current video games have developed a technological evolution that allows their use, not only in the field of leisure, but also for therapeutic purposes.
Thanks to the capture of movements by the Kinect system allows users to control and interact with the console without having to have physical contact with a traditional video game controller, through a natural user interface that recognizes gestures, voice commands and objects and images. The video game offers a virtual reality that allows you to create an avatar of the person who introduces you to the game and stimulates it physically, cognitively and sensorially.
In the field of motor rehabilitation, several studies have been carried out that show favorable results in neurological affectations.
The latest-generation video consoles (Nintendo Wii ®, Kinect for Microsoft Xbox ®) allow you to work on balance, gait, functionality and upper-extremity activity and tolerance to effort. These mechanisms allow us to perform objective assessments of equilibrium, postural control, and upper extremity mobility.
The advantages of these systems is that combined with the conventional rehabilitation allows to base the therapy in the principles of motor learning: active participation of the patient physically and cognitively, repetitions of functional movements, to give a feedback visual, auditory and constant proprioceptive of the movements performed and maintain an interest and motivation while performing the tasks.
One drawback of the game consoles is the level of difficulty that often involves the neurological patient, by implementing specific software for cognitive or motor neurorehabilitation. Several examples of these software are: Neuroathome®, Biotrak®, VirtualRehab®, SONRIE®, Neurorehabilitation Training Toolkit® o Rehabcity.
Recently, we have made an interesting discovery for the treatment of patients with Parkinson’s. It is an exercise program called LSVT (Lee Silverman Voice Treatment). Created initially with the aim of improving motor disorders related to speech (LSVT LOUD), recently it has been extended to address the treatment of limbs (LSVT BIG) of patients with Parkinson’s.
The objectives of the therapy are:
- Increase the range of movement: volume at the level of speech and wider movements at the level of the extremities (arms and legs).
- Sensory Recalibration: to help patients recognize movements with greater amplitude as normal.
- Exercises can be performed autonomously and allow attention to action to be trained, which facilitates the long-term maintenance of the treatment results.
- The intensity in which this therapy is performed drives the mechanisms of neuroplasticity and motor learning.
In the following link you can see an example of LSGT BIG exercises.
Whether you are therapists or patients, if you are interested in receiving training in LSVT therapy for the treatment of motor symptoms of Parkinson’s do not hesitate to contact the Neurorehabilitation Clinic.
Virtual reality is a technological system that has gained ground in neurological rehabilitation in recent years, although it has begun to develop in the 60s. Virtual Reality is used to artificially create sensory information from an interactive virtual environment being perceived as real and thus favoring exploration, commitment, curiosity and motivation.
In the neurological clinic of physiotherapy in Sant Cugat del Valles, we integrate Virtual Reality systems in neurorehabilitation of patients with stroke, spinal cord injury, multiple sclerosis and other neurological diseases. The objective of their integration is to increase the effectiveness of the treatment according to the scientific evidence, to increase the adherence of the treatment by the users and to provide opportunities and sensations not achieved by conventional methods.
In the field of the rehabilitation of diseases and especially of the deficits caused by the injuries of the nervous system, an important development of different systems and tools is observed. Many of these tools are focused on the treatment of the cognitive system (example: alteration of memory), motor system (example: leg movement) and sensory system (example: neuropathic pain).
An example of the application of Virtual Reality systems in the rehabilitation of patients in this neurological center is in alteration of balance. The alteration of balance can lead to a reduction in the practice of physical and ambulatory activity, limiting participation in activities of daily life and deterioration of the quality of life. With a virtual reality system, the therapist can provide the patient with the right environment for the work of balance without exposing him to risks. In this case activating the visuo-vestibular system involved in the maintenance of balance, gait etc.
There are several published studies that conclude that interventions based on Virtual Reality are effective in the treatment of balance and gait deficit after the Cerebral Vascular Accident or Stroke. However, intervention protocols can not be constructed since the therapist has the fundamental role of assessing and developing the most appropriate therapeutic plan for each patient.