Monday Medical: The power of neurological rehabilitation
For Steamboat Pilot & Today
STEAMBOAT SPRINGS — Neurological rehabilitation can be a powerful tool for helping patients with injuries and diseases of the brain and spinal cord.
Those issues may stem from a degenerative disease, such as Parkinson’s disease, multiple sclerosis or A.L.S., or from an acute injury, such as a stroke or head injury.
Patty Bobryk, a neurologic physical therapist at UCHealth SportsMed Clinic, outlines things to know about neurological rehabilitation below.
Team work is key
Neurological physical therapists work as part of a team that includes occupational therapists and speech pathologists to help address a patient’s needs.
“We each evaluate a patient, then we have biweekly team meetings to determine the best strategies for helping a patient reach their goals,” Bobryk said. “Team meetings give us the opportunity to say, ‘I’m going to help with this, so you can work on that.’ We divide and conquer to help meet all of a patient’s needs.”
A patient’s family is also a crucial part of the team.
“We work in collaboration with the patient and their family,” Bobryk said. “Family involvement is a key element in working with an individual with a neurological disorder.”
Every patient is different
A strategy or exercise that worked well for one patient may not work well for another, so therapy programs are always tailored to the individual.
Plus, every patient has different goals.
“Someone may live in a two-story house and have trouble climbing stairs,” Bobryk said. “But maybe they never go upstairs, and the thing that’s most important to them is being able to get up and down from the floor to play with their grandkids. We have a comprehensive interview process to delve into what the patient’s desires are. They’re always at the center of the care.”
It’s all about small steps
In a therapy session, larger tasks are often broken down into smaller tasks.
A patient who can’t climb the stairs may work on placing their foot on a 1-inch step first. Or a patient struggling with balance issues may work on balancing in a static position, then in more challenging positions, such as with their feet together, and progress maintaining this balance while also turning their head.
“Eventually, we work up to doing those movements on uneven surfaces, such as grass, curbs, gravel,” Bobryk said. “We take a skill down to its most basic level and work on it in small pieces. As you master those, we layer on more difficulty.”
When the brain has been injured, recovery isn’t just about regaining use of the injured area but also about encouraging other parts of the brain to take over some of the damaged functions.
Research shows that aerobic activity releases a chemical — brain derived neurotropic factor or BDNF — that helps.
“You can almost think of it as ‘brain fertilizer,’” Bobryk said. “When that chemical is floating around in your brain, you have the best opportunity to access new parts of your brain and learn new skills. That’s why we often do aerobic activity first, then work on skill acquisition.”
There’s always hope
Even with more serious injuries or degenerative diseases, there is always something a rehabilitation therapist can help with.
“My personal philosophy, and my philosophy with neurologic care, is that there’s always hope, there’s always something we can do,” Bobryk said. “Seeing someone with a spinal cord injury, we don’t have a magic wand that’s going to help them walk again. But maybe we find they’re uncomfortable in their wheelchair, or need to be stretched out — those changes can have a huge impact on their quality of life. And I do see recovery, sometimes when it’s not expected. So I never say ‘never.’”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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