Rehabilitation and Therapy

Physical Therapy (PT) is mainly concerned with movement. Using a variety of techniques, the PT team helps patients restore mobility that has been lost as a result of neurological injury or disease. Most physical therapy takes place in a hospital or rehabilitation center. Other locations can include community centers, nursing homes, schools and sports facilities. However, it can be done at home with assistance as well.

Many neurological rehabilitation patients need help performing the routine daily tasks that used to be second nature. Physical therapy helps patients re-train the neural pathways in the brain and spinal cord that facilitate Activities of Daily Living (ADLs). Examples include walking, sitting, standing, cooking, using the toilet, dressing and bathing.

In some cases, such as recovery from some kinds of injury, ADLs can be completely or nearly restored. In other cases, like patients with degenerative neurological diseases, physical therapy helps the patient slow the progression of symptoms and live as independently as possible for as long as possible.

In addition to improving ADLs, physical therapists can also help patients in a variety of other ways, including:

• Restoring balance
• Improving gait
• Providing targeted massage
• Administering heat and cold therapy
• Using assistive devices such as canes, crutches, walkers and wheelchairs
• Managing chronic pain
• Retraining specific muscles
• Improving cardiovascular conditioning
• Using prostheses and orthotics

Occupational Therapy (OT) focuses on helping patients regain as much independent functioning as possible as they go about daily life. Like Physical Therapy, OT can help patients perform activities of daily living better. But OT is concerned with a broader range of functioning, with emphasis on activities that are meaningful and purposeful.

OT can help patients improve skills that are both physical and cognitive (those that involve memory, problem-solving, thinking and reasoning). And it can have an impact on a patient's performance at work, home or in leisure or recreational activities.

An Occupational Therapy team works with the patient to evaluate the current level of functioning, set goals for specific performance improvements, and help with the physical and cognitive work to strengthen muscular and neurological performance. Some of the areas that can be addressed with OT include

• Physical skills: coordination and balance, muscle strengthening, expanding range of motion (especially in the arms and hands)
• Cognitive skills: altered perception and judgment, memory loss, reduced attention span

OT helps patients re-learn skills needed for the activities of daily living (ADLs) such as bathing, grooming, dressing, cooking, eating, toileting and cleaning. It can also assist patients as they learn (or re-learn) more complex tasks such as

• Driving a motor vehicle
• Adjusting to reduced vision or hearing
• Using adaptive devices such as braces, walkers, canes, and wheelchairs
• Avoiding injury through safety training

Speech and Language Therapy focuses on managing a narrow range of physical and cognitive problems resulting from damage to specific areas of the brain. These problems can make it difficult for a patient to communicate.

Because language is such a complex function, it involves physical and cognitive skills that must work together. Some patients have the cognitive skills to process information in their brains but may not be able to control the muscles needed to speak the words. Others have difficulty using words but can understand their meaning when others communicate with them. It is the job of a Speech and Language Therapist to help each patient work through their individual physical and cognitive challenges to help them communicate better.

Speech and Language Therapists generally work with patients who have one of several classifications of speech disorder.

• Aphasia results when the speech centers of the brain are damaged through injury, stroke or other cause. The condition makes it hard for a patient to use language. This includes forming and speaking words, understanding spoken words as well as reading and writing.
• Cognitive Linguistic Disorders arise when a patient has problems with memory, attention span, reasoning and problem-solving.
• Dysarthria results from weakness or lack of coordination in the muscles that control speech—the tongue, mouth or lips.
• Dyspraxia, also called Apraxia of Speech, makes it hard for patients to express themselves or produce sounds, syllables, words and sentences. This condition is sometimes the result of a brain tumor. In children, Developmental Apraxia of Speech is a neurological condition that starts at birth.
• Dysprosody affects a person's ability to speak. Patients with this condition have difficulty maintaining the usual rhythm, intensity, intonation, cadence and timing of spoken words. As a result the condition causes changes in speech patterns and accent.
• Dysphragia is difficulty swallowing, which offen occurs with stroke.

To overcome these challenges, Speech and Language Therapists customize exercises and programs for each patient. The exercises often include reading, writing, following instructions and repeating spoken words. In the process, the patient develops greater strength in the muscles that control speech and can often forge new neurological pathways in the brain. Some specific goals of patients undergoing Speech and Language Therapy include

• Improving articulation and voice control
• Cognitive training to improve memory, attention span and other functions
• Practicing the use of language
• Relearning muscle skills required for swallowing
• Learning to use computer-aided speech technologies and nonverbal communication