Rehabilitation Methods for Motor Function
Modern medical practice is evidence based. In other words, ideally guided by what has been shown to be best practice. Having best evidence to support or refute the value of particular types of treatment is obviously important. Unfortunately high quality evidence of treatment value is not always available or can be hard to obtain. In rehabilitation, simply the variability of the condition and the lack of ability to control all of the influences that could potentially affect recovery, make it difficult to accumulate strong research evidence.
When it comes to therapy to restore motor function you might be surprised that there are a wide range of approaches, mostly not backed by strong research evidence. So what does this tell us abou the best approaches?
The major approaches are as follows:-
- “Traditional” therapy
- Proprioceptive Neuromuscular Facilitation (PNF)
- Bobath Approach – Neurodevelopmental technique (NDT)
- Brunnstrum (Movement) Approach
- Sensorimotor Approach
- Motor Relearning Programme
- Behavioural Approaches
We are not going to describe all of these - just a couple.
In the UK overall, the Bobath approach is probably most commonly used. The goal is to normalise tone, to inhibit primitive patterns of movement and facilitate automatic, voluntary reactions and subsequent, normal, movement patterns. This is based on the concept that pathologic movement patterns (the limb synergies and primitive reflexes) must not be used for training because it is believed that continuous use of these pathologic pathways make them too readily available to use at the expense of the normal pathways. The Bobath approach in other words inhibits abnormal patterns of movement.
Interestingly, this is opposite to the Brunnstrom approach, which makes use of (encourages) the primitive synergistic patterns in training to improve motor control.
The problem therefore is we have advocates of seemingly conflicting paradigms.
Tailwind as such is not treatment. It is exercise equipment that can be used intelligently to improve motor function damaged by stroke (for example).
So the question is, how should this be used for best effect.
The availability of some forward motion at the shoulder is perhaps the best indicator of the potential to use Tailwind. However we have had users who initially did not have such shoulder motion as a common synergy pattern was blocking forward movement. By setting the Tailwind arms at an angle we encouraged the user to work with the movement pattern they did have and develop it (as suggested by Brunnstrom). As this movement developed further and spasticity reduced it became possible to start to work in a forward direction.
On occasion, users have focused on working with one arm only. Putting all their attention into moving the affected arm rhythmically. A helper can gently support the elbow in the initial stages until the user develops the fluidity to increase the repetitions and the range of motion.
Working with Tailwind is taxing and most users need encouragement and support to progress. When we go to the gym and use a personal trainer we tend to make faster progress to our goals and so it is with Tailwind. As we are not working against resistance it is safe to build up and do lots of repetitions. Progress depends on it.
