Problem solving in neurological physiotherapy – setting the scene

A therapist using a problem-solving approach to the management of neurological patients prior to the 1940s may have asked: How can I train the person to use their unaffected body parts to compensate for the affected parts, and how can I prevent deformity? The result was a strong emphasis on orthopaedic intervention with various types of splints, strengthening exercises and surgical intervention. However, in the 1940s several other ideas emerged, the most popular being the Bobath approach. Bobath (1985) with others, such as Peto (Forrai 1999), Kabat & Knott (1954), Voss (1967) and Rood (1954), pioneered the neurological approach to these disorders, recognising that patients with neurological impairment, in particular stroke patients, had potential for functional recovery of their affected body parts. For the child with a neurodevelopmental disorder, the approach was based on the idea that each child’s development could be guided by the therapist, to maximise their potential for functional independence and minimise contractures and deformities. While the Bobath approach is one of the most used and accepted in the UK, little has been written about it in recent years, and there is no robust evidence for its efficacy (Davidson & Waters 2000). In the last few years there has been a further progression in the neurorehabilitation field, with increasing interest in different models of central nervous system (CNS) function, skill acquisition and training. For example, for some therapists, the emphasis for retraining of the neurologically CHAPTER CONTENTS