Perspective of Neuro Therapeutic Approaches Preferred for Stroke Rehabilitation by Physiotherapists

There are various neurophysiological approaches like Proprioceptive neuromuscular facilitation technique i.e. PNF, Bobath's neurodevelopmental approach i.e. NDT, Brunnstrom's technique and Rood's approach. But there is a lot of variation of use of these approaches depending on the therapists. We wanted to find the what approach is used the most, what was the reason behind the selection, and were the physiotherapists trained in it.

It is questionnaire based survey, validated by 3 clinical experts, created using Google docs and was emailed to more than 2000 therapists across India. Out of which 412 therapists willingly participated in the survey. Ten incomplete questionnaires were excluded. Final sample size was 402. The questionnaire was based on the neuro therapeutic approaches. Physiotherapists holding BPTh and MPTh degrees were included in the study. After the reception of responses the data was analyzed through descriptive analysis.

Out of all the respondents, 15% of them were on-going masters students while rest all of them were clinicians. This included 39% from south and west region each and 13% from north and 9% from east region of India. The study shows that 96% therapist show good awareness about the approaches, despite this 73% faced difficulty practicing it. Although PNF, sensory integration, CIMT, MRP are found to be most commonly taught at graduation level followed by Rood, NDT/Bobath and Brunnstorm, PNF and CIMT are most commonly preferred and practiced approaches, followed by NDT/Bobath and Brunnstorm. The least preferred and practiced approaches were found to be Roods and Motor Relearning Program. It was found that the therapists misunderstood sensory integration with sensory re-education. PNF and CIMT were more preferred because they are easy to learn and practice and are also evidence based. Only 13% of therapists were found to have received training in some approaches. Surprisingly, 90% of them were found to be interested in attending additional training in these approaches.

96% of therapists are well aware of neuro approaches, but face difficulty practicing them. PNF and CIMT are most commonly preferred and practiced approaches, followed by NDT and Brunnstorm and Roods and MRP. There is a mix pattern of practice of traditional approaches such as PNF, Brunnstorm and NDT and the task specific training such as CIMT. This study suggests that the physiotherapists are still practicing more of traditional approaches than task specific approaches such as CIMT and MRP. The study further shows that majority of the therapists i.e.87% have not had any additional training and that 90% are keen on acquiring additional knowledge about these approaches through some workshop or a seminar.