Essay About Standing Position And Substantial Amount Of Research

Physiotherapy – Early Rehabilitation of a Stroke
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Early Rehabilitation of a Stroke
Patient (1)
PAULETTE VAN VLIET
Introduction
A substantial amount of research now exists which is relevant to the treatment
of neurological patients, and it is important that physiotherapy treatment
is based on this research. This chapter will therefore draw on current
research from the sciences relevant to physiotherapy, as well as the results
of pragmatic trials of treatment in a clinical setting.
There is no evidence at present that one overall approach is superior to
another. The approaches that have been compared for efficacy in controlled
trials include the Bobath, proprioceptive neuromuscular facilitation, and
functional (traditional) approaches (Dickstein et al., 1986 A; Loggigian et
al., 1983 A; Lord and Hall, 1986 A). These trials have some problems in their
design. For example, the study of Loggigian et al. was the only one of the
three that randomized adequately, and all three studies arguably had insufficient
power to detect differences, owing to small numbers. A single-case
design was used by Wagenaar et al. (1990 A) to compare neuro-developmental
(a modernized version of Bobath) and Brunnström methods of
treatment, and also found no substantial differences. It is possible that
differences do exist between the effectiveness of these approaches, but
were not demonstrated in these studies.
Elements of treatment packages have been investigated with more
success. In randomized controlled trials, training of weight distribution via
auditory feedback has improved symmetry of body-weight distribution in
sit-to-stand (Enghardt et al., 1993 A), and visual feedback about weightbearing
in the standing position has improved standing balance (Sackley
and Lincoln, 1997 A). EMG biofeedback has been shown to facilitate
recovery of arm function (Crow et al., 1989 A). In another randomized
controlled trial, repeated pressing movements