Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Tuesday, October 19, 2010

Brunnstrom vs. Bobath(NDT) stroke rehab

I was involved in a stroke research trial and therapy students were running the experiment. I asked one of them, Which model of therapy are you taught? Bobath or Brunnstrom? He said he didn't know. My PT at the time was assisting the professor in teaching the class and I asked her about it. She said they were taught the difference but they were mainly ortho PTs rather than neuro PTs. I laughingly told her that she had better prepare them for patients like me that know more than they do. For those of you interested in this you can read this: Diversity in Neurological Physiotherapy: A
Content Analysis of the Brunnstrom/ Bobath
Controversy
http://en.scientificcommons.org/26409679
Well this article used to be here free in PDF form and I was able to read it - http://www.informaworld.com/smpp/content~db=all~content=a713795658

And another comparison study of Motor Relearning Program vs. Bobath:
http://cre.sagepub.com/content/14/4/361.short
Objective: To examine whether two different physiotherapy regimes caused any differences in outcome in rehabilitation after acute stroke.
Design: A double-blind study of patients with acute first-ever stroke. Sixty-one patients were consecutively included, block randomized into two groups, and stratified according to gender and hemiplegic site. Group 1 (33 patients) and group 2 (28 patients) had physiotherapy according to Motor Relearning Programme (MRP) and Bobath, respectively. The supplemental treatment did not differ in the two groups.
Main outcome measures: The Motor Assessment Scale (MAS), the Sødring Motor Evaluation Scale (SMES), the Barthel ADL Index and the Nottingham Health Profile (NHP) were used. The following parameters were also registered: length of stay in the hospital, use of assistive devices for mobility, and the patient's accommodation after discharge from the hospital.
Results: Patients treated according to MRP stayed fewer days in hospital than those treated according to Bobath (mean 21 days versus 34 days, p = 0.008). Both groups improved in MAS and SMES, but the improvement in motor function was significantly better in the MRP group. The two groups improved in Barthel ADL Index without significant differences between the groups. However, women treated by MRP improved more in ADL than women treated by Bobath. There were no differences between the groups in the life quality test (NHP), use of assistive devices or accommodation after discharge from the hospital.
Conclusion: The present study indicates that physiotherapy treatment using the MRP is preferable to that using the Bobath programme in the acute rehabilitation of stroke patients.


This was my response to a PT blogging about using clinical experience vs. evidence. NDT has wonderful clincal experience but is not supported by the evidence.
From Tonis' blog
http://community.advanceweb.com/blogs/pt_2/archive/2010/09/14/too-much-evidence.aspx
I'll give you my take on NDT(neuro Development treatment - the Bobath approach). My OT was trained in it and if you look at what I acheived with it you would say that it worked. I however think that any clinical experience with it hasn't split out the spontaneous recovery of the penumbra from what can be acheived with the therapy. Now that I have done lots more reading I prefer the Brunnstrom theory vs Bobath. The reason behind that is that NDT requires a therapist standing next to you telling you NO all the time. Brunnstrom allows you to use any movement possible. As a patient it is much more satisfying to be congratulated on some movement rather than constantly being told that what I am doing is wrong. And since I am now on the do-it-yourself model I am not going to be telling myself, No you are using muscles you are not supposed to. If it doesn't look good I will change it later whenever I neuroplastically get the dead brain functions moved.

And here is Peter Levines take on NDT:
http://recoverfromstroke.blogspot.com/2009/05/sonotthecase.html

1 comment:

  1. dean you are really great. you have got so much of information and you read so much. you have lot to share with public. i am a neuro therapist practicing 1o years. if you need any help please do contact. all the best to u. i hope your thoughts should reach to masses.

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