Therapeutic Approaches

During the past century, we have seen the development of several therapeutic approaches for the treatment of adults with various neurological deficits. In the early to the middle part of the twentieth century, therapeutic approach for handling neurological conditions was largely orthopedic that emphasized on surgery, strengthening the weak muscles, and use of splints. By the late 1940s to early 1960s, a swing towards a neurological emphasis characterized by development of techniques based on neurophysiological and motor learning principles was observed. Approaches developed by Rood, Brunnström, Bobath and Bobath, and Knot and Voss were instances for the same. From the 1980s the emphasis moved away from the neurodevelopmental approaches towards non-neurodevelopmental approaches like motor relearning program and constraint-induced movement therapy and currently, the technological advancement has paved the way to novel concepts like the use of virtual reality, transcranial magnetic stimulation, and robotics in the field of neurological rehabilitation. As yet, there is no scientific evidence that clearly supports that any standalone approach is superior to another. The gamut of research including systematic and meta-analysis studies has shown minimal to moderate improvement for few approaches when delivered as a standalone treatment and for most the sample size or methodology was not rigorous enough to demand a change in practice. Therapists must have adequate knowledge, both theoretical and practical, about various therapeutic approaches to provide an eclectic treatment program. Since all these approaches have strengths and weaknesses of their own and collectively have the edge over a standalone, an eclectic approach makes it all the more meaningful to tackle most of the sensorimotor dysfunctions among patients. The author believes that the knowledge earned from each scientific therapeutic approach must serve as a reservoir from which a clinician can wisely choose the necessary tools to customize the eclectic treatment program to suit the specific needs of patients. Choosing the best treatment methods to address the patient’s sensorimotor issues must be the most rational approach when substantial evidence for the effectiveness of any single approach over the others is unavailable. Based on the patient’s abilities and requirements, the therapists need to carefully select the strategies that have the greatest chance of successfully remediating existing impairments and promoting functional recovery.