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Developing Neurological Physiotherapy: Opening up the black box
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Developing Neurological Physiotherapy: Opening up the black box P C Siemonsma Stroke Research Unit, City Hospital, Hucknall Road, Nottingham NG5 1PB
A T Lettinga Human Movement Sciences, State University Groningen, Bloemsingel 10,9712 KZ Groningen, Netherlands Current discussions about development of physiotherapy tend to focus on arguments as to t h e appropriate source of this development; should it start from clinical practice or from theory? However it is results rather than means of development that actually matter; we should thus start exploring the content of approaches and open up the ‘black box’ called physiotherapy. Our strategy for this is to compare approaches in neurological physiotherapy in detail in order to learn from their similarities and differences (Lettinga et al, 1997). This comparison does not set out to judge approaches in terms of scientific body of knowledge or clinical applicability, it merely provides a detailed insight into the elements of physiotherapy.
We present observations on the relationship between theory and practice. Theory and clinical practice are intertwined and should not be judged separately. Some clinical techniques, such as a physiotherapist moving a n affected arm, might look similar at first, but in fact are not. A therapist moving a patient’s arm can in fact be inhibiting tone, facilitating normal movement, guiding, controlling degrees of freedom or passive movement. Even if it can be agreed t h a t some of the techniques a r e similar, they may be derived from different theoretical backgrounds and their use rated differently. In the example of passive movement of the arm, this can be supported by theories about perceptual integration and neurophysiological theories as well as learning theories, biomechanics and muscle biology. We conclude t h a t content analysis can give valuable insight into t h e elements which comprise physiotherapy approaches. Opening up the ‘black box’ through content analysis and detailed comparison of approaches can facilitate the development of individual approaches a s it can provide a base for discussion, insight into strengths, weaknesses or gaps, and can guide future research. Based on: Siemonsma, P C, Lettinga, A T, and Schoemaker, M M; ‘Ontwikkelingvanuit theorie of praktijk? Een analyse van twee behandelmethoden voor CVA patienten’ (thesis in Human Movement Sciences, State University Groningen, Netherlands).
The handbooks of two treatment approaches for adult stroke patients are compared using content analysis. This qualitative research method was used to explore the goals, treatment techniques and theories embodied i n t h e approaches. The handbooks of Davies (1985, 1990) were analysed a s a n example of a treatment which started its development mainly from practice: t h e Bobath approach. The handbook and articles of Carr and Shepherd (1987) were analysed as an example of a n approach that mainly started in theory: the motor relearning program.
References Carr, J H and Shepherd, R B (1987). A Motor Relearning Programme for Stroke, Heinemann, London, 2nd edn. Davies, P M (1985). Steps to Follow: A guide to the treatment of adult hemiplegia, Springer-Verlag,Berlin. Davies, P M (1990). Right in the Middle: Selective trunk acfivities for the treatment of ad& hemiplegia, Springer-Verlag, Berlin. Lettinga, A T, Mot, A , Helders, P J M and Rispens, P (1997). ‘Differentiationas a qualitative research strategy: A comparative study of Bobath and Brunnstrom approaches to treatment of stroke patients’, Physiotherapy, 83,10, 538-546.
Change in Gait Parameters of Young Adults with Learning Disabilities
have little to indicate the cause or time of onset of the problem. There a r e no published data on gait parameter measurements for adults with learning disabilities with which to make comparison.
J Rennie
This study aimed to create a database of gait measurements for adults with learning disabilities which would include:
F Bell
Department o f Physiotherapy, Podiatry and Radiography, Glasgow Caledonian University G4 OBA
J Robb Department of Orthopaedic Surgery, Princess Margaret Rose Hospital, Edinburgh EHlO 7ED The most frequent reasons for referrals of adults to the Physiotherapy Community Outreach Service of the Learning Disability Directorate of Edinburgh Healthcare NHS Trust are assessment and re-education of walking. Many of the adults have not required physiotherapy i n childhood and adult medical records
1. Establishing t h e earliest time and age t h a t any changes occur in gait parameter measurements after pupils leave Lothian special schools / classes. 2. Investigating possible causes of change. 3. Measuring differences between gait parameters of young adults with learning disabilities and subjects in the same age range with no known disabilities.
A prospective study was undertaken to measure changes in the velocity and spatial parameters of gait over one year. Step length, stride length, base width and foot angle were measured from footprints made
Physiotherapy, December 1997, vol 83, no 12
Developing Neurological Physiotherapy: Opening up the black box P C Siemonsma Stroke Research Unit, City Hospital, Hucknall Road, Nottingham NG5 1PB
A T Lettinga Human Movement Sciences, State University Groningen, Bloemsingel 10,9712 KZ Groningen, Netherlands Current discussions about development of physiotherapy tend to focus on arguments as to t h e appropriate source of this development; should it start from clinical practice or from theory? However it is results rather than means of development that actually matter; we should thus start exploring the content of approaches and open up the ‘black box’ called physiotherapy. Our strategy for this is to compare approaches in neurological physiotherapy in detail in order to learn from their similarities and differences (Lettinga et al, 1997). This comparison does not set out to judge approaches in terms of scientific body of knowledge or clinical applicability, it merely provides a detailed insight into the elements of physiotherapy.
We present observations on the relationship between theory and practice. Theory and clinical practice are intertwined and should not be judged separately. Some clinical techniques, such as a physiotherapist moving a n affected arm, might look similar at first, but in fact are not. A therapist moving a patient’s arm can in fact be inhibiting tone, facilitating normal movement, guiding, controlling degrees of freedom or passive movement. Even if it can be agreed t h a t some of the techniques a r e similar, they may be derived from different theoretical backgrounds and their use rated differently. In the example of passive movement of the arm, this can be supported by theories about perceptual integration and neurophysiological theories as well as learning theories, biomechanics and muscle biology. We conclude t h a t content analysis can give valuable insight into t h e elements which comprise physiotherapy approaches. Opening up the ‘black box’ through content analysis and detailed comparison of approaches can facilitate the development of individual approaches a s it can provide a base for discussion, insight into strengths, weaknesses or gaps, and can guide future research. Based on: Siemonsma, P C, Lettinga, A T, and Schoemaker, M M; ‘Ontwikkelingvanuit theorie of praktijk? Een analyse van twee behandelmethoden voor CVA patienten’ (thesis in Human Movement Sciences, State University Groningen, Netherlands).
The handbooks of two treatment approaches for adult stroke patients are compared using content analysis. This qualitative research method was used to explore the goals, treatment techniques and theories embodied i n t h e approaches. The handbooks of Davies (1985, 1990) were analysed a s a n example of a treatment which started its development mainly from practice: t h e Bobath approach. The handbook and articles of Carr and Shepherd (1987) were analysed as an example of a n approach that mainly started in theory: the motor relearning program.
References Carr, J H and Shepherd, R B (1987). A Motor Relearning Programme for Stroke, Heinemann, London, 2nd edn. Davies, P M (1985). Steps to Follow: A guide to the treatment of adult hemiplegia, Springer-Verlag,Berlin. Davies, P M (1990). Right in the Middle: Selective trunk acfivities for the treatment of ad& hemiplegia, Springer-Verlag, Berlin. Lettinga, A T, Mot, A , Helders, P J M and Rispens, P (1997). ‘Differentiationas a qualitative research strategy: A comparative study of Bobath and Brunnstrom approaches to treatment of stroke patients’, Physiotherapy, 83,10, 538-546.
Change in Gait Parameters of Young Adults with Learning Disabilities
have little to indicate the cause or time of onset of the problem. There a r e no published data on gait parameter measurements for adults with learning disabilities with which to make comparison.
J Rennie
This study aimed to create a database of gait measurements for adults with learning disabilities which would include:
F Bell
Department o f Physiotherapy, Podiatry and Radiography, Glasgow Caledonian University G4 OBA
J Robb Department of Orthopaedic Surgery, Princess Margaret Rose Hospital, Edinburgh EHlO 7ED The most frequent reasons for referrals of adults to the Physiotherapy Community Outreach Service of the Learning Disability Directorate of Edinburgh Healthcare NHS Trust are assessment and re-education of walking. Many of the adults have not required physiotherapy i n childhood and adult medical records
1. Establishing t h e earliest time and age t h a t any changes occur in gait parameter measurements after pupils leave Lothian special schools / classes. 2. Investigating possible causes of change. 3. Measuring differences between gait parameters of young adults with learning disabilities and subjects in the same age range with no known disabilities.
A prospective study was undertaken to measure changes in the velocity and spatial parameters of gait over one year. Step length, stride length, base width and foot angle were measured from footprints made
Physiotherapy, December 1997, vol 83, no 12