(Español) FORMACIÓN ON-LINE: Razonamiento clínico aplicado a al abordaje de la persona con patología neurológica

We adapt our training proposals to the insecurity experienced during the coronavirus pandemic (COVID-19). Our specific training aimed at physiotherapists, occupational therapists, speech therapists and psychologists who are dedicated to the field of neurorehabilitation and treatment of neurological patients, return in online format.

We present a live on-line training, with theoretical and practical content and very affordable, with the lowest price in the market thinking of those economically affected by the pandemic.

7 reasons to try aquatic therapy

Do you know that there is a specialized treatment for neurological patients that is performed in water? Aquatic therapy is a way of using a different medium, such as water, to achieve your goals, taking advantage of all the physical properties that it offers and all the benefits of therapeutic exercise.
Surely you are already undergoing a rehabilitation treatment and you are wondering what do I gain by getting into the pool?

Here are 7 reasons to try it:
1- Improve your safety when moving: sometimes it is difficult to try new things for fear of falling. In the water everything happens more slowly and, therefore, we have more time to think and react. Working in the pool has shown that we can significantly reduce the risk of falls.
2- Work the gait: water is a natural support for the body, so that we can practice the way you walk, with less muscular effort and with greater independence, since it will not be necessary to use poles or walkers. In addition, without these supports, you will have your hands free to carry out other activities.
3- Improve balance: overcoming the instability that water provides us will make you work the necessary adjustments to keep your posture upright.
4- Get active relaxation: this is the term we use when you are able to move according to the demands of the task, that is, staying active and, at the same time, feeling that the movement is fluid.
5- Improve your body perception: water is a constant stimulus on our body that causes the somatosensory areas of the brain to be activated. This is especially important when there are sensitivity problems in both the upper and lower limbs.
6- Increase your cardiopulmonary function and stimulate neuroplasticity: these are the benefits you get when performing aerobic exercise in the aquatic environment, an exercise of low or medium intensity that is maintained for a long time.
7- Have fun and get motivated: beyond all these technical aspects, we know how important it is to have fun to learn. Aquatic therapy can become a source of motivation where the results obtained can be seen in your day to day.
If you are a water lover and want to try a different experience in a different environment, at the Neurorehabilitation Clinic we can help you. Elisa is currently in charge of the aquatic therapy area and is trained in the Halliwick Concept, one of the current approaches to the treatment of neurological injuries in water.


Elisa Lara

Fisioterapeuta Colegiada número 14047

Bettina Paeth

On World Physiotherapy Day, we paid tribute to an influential physiotherapist in the Neurological Physiotherapy. Bettina Paeth, German physiotherapist who introduced the Bobath Concept to Spain.

In her 40 years of assisting trajectòria has always advised the maximum potential of all patients. At the docent level, he has been a source of inspiration for hundreds of professionals physiotherapists, occupational therapists as speech therapist, to dedicate and train in the field of neurological rehabilitation.

For all that, the therapists of the Neurorehabilitation Clinic, we appreciate Bettina, founder of the Clinic, all the learned during these years with she.


Neuropsychological rehabilitation is one that focuses on the treatment of disorders that affect any cognitive domain: attention, memory, perceptual-motor processes, executive functions (planning, inhibition, working memory, etc.), emotion and behavior. Cognitive functioning can be altered by different causes, one of these being Acquired Brain Damage (DCA). When we talk about DCA, we are referring to a sudden brain injury that has had normal development so far. This can be due to different causes: strokes or strokes, traumatic brain injuries, brain tumors, infections, anoxia, etc. Whatever the cause, the DCA has as its main consequence the loss of previously developed functions. These losses can be physical, cognitive and emotional, causing, in most cases, a loss of functional independence.

Neuropsychological rehabilitation, as mentioned above, is the one that focuses on the improvement of cognitive, behavioral and emotional functions. Cognitive deficits can range from mild to severe, where, for example, the person only notices a little difficulty when performing tasks, such as absent-mindedness, slowness or slight forgetfulness; or, in more serious cases, where the person is unable to remember what they did that morning, follow the thread of a conversation or prepare breakfast. It can also happen that the family perceives that the person has changed, that he is no longer the same as before; and that the patient does not realize their difficulties.

It is important to carry out a complete neuropsychological evaluation to be able to determine the damaged or altered functions, as well as those that are preserved, since the latter will be the basis of the rehabilitation process. You must also take into account how the person was before, his tastes and hobbies, so that the process is as motivating as possible and with significant objectives for him or her. The purpose of all this is to ensure that the person is as functional as possible in their day to day. This is done both with the patient and with the family, giving them information about the relative’s difficulties, orientation, guidelines and emotional support; among many others.

Finally, it should be noted that throughout the rehabilitation process it is necessary to work in an interdisciplinary way since, as mentioned at the beginning, the alterations that persist after a DCA are of a different nature, requiring the joint and coordinated participation of a team from different professionals.

Gilma Acosta Llopart



Quite a few patients have consulted me by phone during the confinement since they have suffered some episode of pain. A pain that in many cases had no apparent cause or justification, hence its anguish and bewilderment.

We often associate pain with injury, but is there always a correlation?

In other words, whenever there is an injury do we feel pain? And vice versa, whenever there is pain does it mean that we have been injured? The answer is no.

Furthermore, when faced with consummate damage, the intensity of the pain we feel does not always coincide with the actual damage to the tissues, for example, when we cut the fingertip with a sheet of paper (Has this never happened to you? It hurts!!!).

Let’s start at the beginning … what is pain?

Pain is a perception of alert linked to the defense system that, as defined by the IASP (International Association of Study of Pain), “… notifies us of the existence of current or potential tissue damage or that it is experienced as such damage “

Therefore, tissue damage is not necessary for its appearance, it is enough that it is interpreted that there may be.

And who makes such an interpretation? The boss, our central nervous system (or in other words, the brain).

A perception (in the case at hand, pain) is a brain hypothesis of what is happening outside our body, through information that comes from the environment to the central nervous system through information from the senses . And our brain faces the challenge of building a story as rational as possible.

Specifically, the Nociceptive System (I will discuss it in more detail in the next publication) is in charge of detecting a state of current or potential tissue damage and informing the central nervous system so that the latter produces a modulation of the response.

All perception has its function and pain tries to protect us (yes, in fact, on many occasions we have to be very grateful to it) and promote healing. Pain has been evolutionarily promoted and selected to modulate our behavior in periods of adversity: discomfort, exploratory inhibition and apathy (little desire to move and do new things), and the lowering of the pain threshold (we feel pain more ease) are preservation behaviors that appear with such behavioral modulation.

The curious thing is that consummate damage is not necessary for such modulation of behavior to be activated, since the simple expectation of damage is sufficient to activate such behaviors.

The brain is always responsible for making the final decision about whether something (however small and insignificant it is) is dangerous to the tissues and integrity of the individual, and whether action is required (project pain into consciousness to stop of using a body part or deciding not to take a potentially dangerous action).

As human beings we have the capabilities to plan an event, to quickly learn from an experience and to use logic to predict the future (the brain is predictive, not reactive). Therefore, we can identify a situation / context / scenario as potentially dangerous long before the information reaches our tissues.

In short, although painful stimuli have nothing to do with tissues, if our brain considers them dangerous, they may be enough to evoke pain.

With the current situation that we have had to live, we have been locked up at home for many hours, thinking and watching the news, and receiving an informative bombardment of constant alarm. Our nervous system has been in a constant nociceptive alert situation, focusing our attention towards the body and towards an expectation of symptoms in order to act as quickly as possible at the slightest sign of danger (in this case, the symptoms of Covid-19 ), and therefore our sensitivity has increased to raise alarms at the slightest suspicion.

As a consequence, stimuli or bodily states that prior to confinement were asymptomatic or silent, have now become conscious and perceived.

Our nervous system has increased its sensitivity and effectiveness to protect us better, but as in any great computer program, there is always a mistake. I explain myself better with a very illustrative example:

Imagine that you are the owners of an industrial warehouse, and you have the bad luck that one night thieves enter to steal. Obviously, your work is very important to you and you do not want this to happen again, and you decide that you are going to invest in the best infrared security system so that thieves never enter without alarms and you can catch them with your hands. in the mass.

Perfect! Now your business is protected and you can rest easy.

At midnight they call you on the phone, it is the company in charge of the security system, the alarms have gone off! How can it be?

You get up running and go straight to your computer to check the security cameras to see if you see what has happened, and what is your surprise when you see a couple of very cute little mice hanging around your company!!!

Infrared rays are sure to detect thieves, but they are so highly sensitive that they set off alarms with something that is harmless to your company… little mice!”

We have a wonderful organism, which is capable of remembering events that we ourselves do not know are stored in some corner of our memory, and if it detects that there is an alarm signal similar to the stored memory and that it could be dangerous for our physical integrity, it sets in motion all the machinery necessary to protect us, and if we have to feel pain with it, it will make sure we feel it.

Author of the entry: Anna Canet. Physiotherapist specializing in the musculoskeletal system


  • Butler D, Moseley G. Explicando el dolor. Adelaide: Noigroup; 2016.

  • Goicoechea A. Depresión y dolor. Enero 2020.