Neurological Physical Therapy: A Comprehensive Guide
Neurological Physical Therapy or “Neuro PT” is physical therapy for individuals with problems or dysfunctions related to the nervous system.
The central nervous system includes the brain, spinal cord, and a complex network of nerves called neurons. The job of the nervous system is to communicate and coordinate messaging from your brain to and from the rest of your body. These nerve cells called neurons can grow, reorganize, and change the way they do their work through a concept called neuroplasticity. The nerve cells can make new connections, as well as strengthen older connections, in order to "rewire" the brain. These changes in connection within your brain happen throughout the lifespan.
As a physical therapist, our role is to improve the way you move and we can do this by also getting your brain "active". The role of the physical therapist does not change, but a Neuro PT will have an improved understanding and optimal treatment plan for your specific neurological diagnosis. Like any physical therapy, we want to know what your goals are and what is important to you!
What diagnoses can be treated by Neuro PT?
Some common neurological diagnoses or problems related to the nervous system that are treated by Neuro PT may include:
Stroke
Parkinson’s disease
Multiple Sclerosis
Brain injury (including concussion)
Vestibular dysfunction and Vertigo or dizziness
Neuropathy
Brain Tumor
Spinal Cord Injury
Balance dysfunction
For a comprehensive list of neurological diagnoses/injuries we treat, visit our website.
How do patients benefit from Neuro PT?
Over the years, I have found that among many other treatments, most patients coming for neurological physical therapy will benefit from balance training, motor control training, aerobic exercise, and resistance training.
So how do we do that?
First we want to make sure we are considering factors that improve neuroplasticity or the “re-wiring of the brain” with each exercise type.
Some main factors of the exercise that influence the ability for the brain to make these changes and connections include:
Repetition: practice, practice, practice!
Task-specificity: practice the specific movement or task you want to improve on
Variability: change up how you do the activity such as improving walking by practicing forward, side, and backwards walking
Intensity: "turn up the heat" and increase the cardio challenge
Uniqueness: practice things that are important to you and bring you joy!
So regardless of the type of training we use, these factors are variables throughout treatment and exercise. I’ll go into a little more detail of what balance training, motor control training, and overall aerobic and strength would look like below.
What type of exercises/training might be prescribed?
Balance Training:
Balance is our ability to stay upright and steady. There are 3 main systems for balance.
Visual system (eyes)
Vestibular system (inner ear consisting of cochlea for hearing and semicircular canals and vestibule for balance)
Sensory system (helps you sense position and movement of your body in space)
All of these systems need to work together with the brain and communicate effectively in order to maintain your balance. In addition, we need adequate strength especially in our core, legs, and ankles to help us stay upright.
So we can modify these systems by taking one away (eyes closed) or adding more challenge to one (unloved surface) to force your brain to use the “weaker” system.
Motor Control Training:
Motor control involves the nervous system being able to create purposeful and coordinated movements and to regulate these movements. Motor learning is the process of obtaining a new skill and improving how well you can do that movement.
I often utilize the OPTIMAL (Optimizing Performance through Intrinsic Motivation and Attention for Learning theory of motor learning) from Wulf et. al, 2016 to guide how I think about motor control exercise. I found this research fascinating while in PT school and was able to meet the authors during a continuing education course.
They highlight the importance of motivation and attention in learning. Within motivation, autonomy and enhanced expectancies are important. Autonomy means that you have some control and independence with the situation and enhanced expectancy meaning you are told that you will do well and given positive feedback.
Within attention, they highlight the importance of external cues. This means instead of always focusing internally on your body try to consider using a target outside of your own body. For example, in patients with Parkinson’s Disease it is very helpful to use external cues such as a laser light on the floor or obstacles to step over to improve walking instead of having the patient focus on specifically moving their ankle joint more.
Aerobic Exercise and Resistance Training:
We also know that research really highlights the role of aerobic exercise and resistance exercise in brain health. Aerobic exercise often referred to as “cardio” is any type of workout that gets your heart pumping. It improves the strength of your heart and lungs.
The American Heart Association recommends adults get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both. Additionally, moderate- to high-intensity muscle-strengthening activity (such as resistance or weights) on at least 2 days per week.
Aerobic exercise increases certain chemicals in your brain that help to improve nerve function and health. Research shows that physical exercise and activity can help to improve neuroplasticity and brain function.
Many neurodegenerative diagnoses such as Parkinson’s Disease or Dementia can have improvements in progression of the disease through aerobic and higher intensity exercise.
What to expect at your Neuro PT appointment.
At On The Move, the 55-minute initial evaluation is a chance for the therapist to get to know you, identify your goals, and observe how you move. Your physical therapist will be a neurologic clinical specialist, meaning they have done advanced training and practice in the area of neurological physical therapy. Based on the evaluation, we will give you exercises and strategies on day one to improve the way you move and function in your daily life.
Follow-up visits will likely be recommended to continue to progress towards your goals and come up with a treatment plan to improve function, quality of life, and overall wellness. This can include treatments to improve balance, motor control, aerobic fitness, strength, flexibility, posture, walking, and mobility in your daily life or activities. The treatment and exercises will be tailored to meet your individual needs.
At the end of the day, we want you to feel confident and in control of your own body and health!
- Ellese Miller, PT, DPT, NCS