Different approaches to treatment

On my neurology placement I am working with many patients who have hemiplegia due to stroke. I find myself employing some techniques we leant at uni, some learnt in tutorials and continuing education sessions on clinic and sometimes an adaptation or a combination of techniques is appropriate for a particular patient. I’m pretty sure the treatment techniques we learnt at uni and those employed in the facility are a combination of treatment approaches. However I often hear people mention specific approaches and wondered if at this stage, my choice of treatment techniques would be any different if I was using a specific neurological treatment approach to guide my reasoning and intervention choices.

I was doing an exercise with a patient who has left hemiplegia. The patient was perched asymmetrically (almost sideways) on the plinth so that the left foot was in contact with the ground and right was not. With my hands on the pelvis providing and downwards pressure on the left and an upward pressure on the right, I was asking the patient to “stand” on the left leg and “straighten the left knee.” I chose this intervention because the patient was not weight bearing on the left leg during sit to stand, standing and walking.

If I was a Rood therapist I suppose I could do the same exercise in order to activate normal postural responses through sensory input. If I was coming from a Bobath point of view I suppose I could do a similar thing because I was facilitating a normal pattern of movement using the pelvis as a central key point. If I was coming from a motor learning point of view I could also do the same exercise as I was getting the patient to simplify the functional task and do part practice.

So there we go – the same exercise could be used for the same patient to improve the same function even if the therapist was thinking along the lines of a different approach. I think now that using a combination of approaches is probably effective as long as the therapist is clear about their reasons for choosing the technique. For me this highlights the importance of continual assessment and reassessment of the patient to ensure that the intended outcome is being achieved.