Physical Therapy For

Neurological Disorders

By
Muskan Ahuja

Summer Project -1
In Partial Fulfilment of the requirement for the degree
Bachelor of Physiotherapy
Under the guidance of- Dr. Pooja Sharma (PT)

Amity Institute of Physiotherapy

Noida Uttar Pradesh
2019

DECLARATION
I hereby declare that this Summer Project-I entitled “Physical Therapy for
neurological disorder” is a bonafide and genuine work carried out by me under the
guidance of Dr. Pooja sharma(PT), Amity Institute of Physiotherapy, Amity University,
Noida.

Date- Signature of
the student

PLACE- Noida Muskan

Ahuja

A1106
618136

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FACULTY GUIDE APPROVAL

This is to certify that Summer Project-I entitled “PHYSICAL THERAPY FOR
NEUROLOGICAL DISORDER” is a bonafied work done by Muskan, in partial fulfillment
of the requirement for the degree of Bachelors of Physiotherapy from Amity Institute of
Physiotherapy, Noida.

Guide Dr. Pooja Sharma (PT)

Amity Institute of Physiotherapy

AMITY UNIVERSITY

Date:
Place: NOIDA

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ACKNOWLEDGEMENT
I express my deep sense of gratitude to my respected guide for her valuable
help and guidance, I am thankful to for the encouragement she have given
me in completing the project.
I am also thankful to all the other faculty & staff members of
our department for their kind co-operation and help and I came to know
about so many new thing.

Secondly I would also like to thank my parents and friends who helped me
a lot in finalizing this project within the limited time frame .

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INDEX
S.No TOPIC Page No
Declaration ii
Faculty Guide Approval iii
Acknowledgement Iv
1. Introduction
2. Anatomy
2.1 Brain 1
2.2 Arterial blood supply
3. Types
Alzheimer’s disease 5
3.1 Stroke
Parkinson
3.2
3.3
4. Examination 8
5. Case study 9
6. Reference 10

1. INTRODUCTION
Brain, spinal cord, and nerves together makes up nervous system. They control the
workings of our body. With increasing age, individuals are facing age-related
neurological disorders that affects activities of daily living which is called ADL , Also
general function such as gait and balance are affected thereby the well being is
disturbed . Hence, protection of brain, muscle, and neuromuscular function is crucial in
maintaining health and to enhance quality of life.

There are over 500 neurological disorders which is seen among the people of different
age group . Although neurological disorder mainly occur in ageing brain that is old aged
people .

Types of neurological disorders are -

Spina bifida ,
Parkinson's disease ,
Alzheimer's disease,
 Stroke,
Injuries to the spinal cord and brain
Cancer, such as brain tumors

Patient are treated focusing mainly on motor learning because the structural and
functional alterations in the brain of old people is increasing

The role of physiotherapist in neurological disorder mainly is to enhance the motor

activities thereby enhancing the functional ability of the brain

2. ANATOMY
2.1 Brain Anatomy

Part Function

1. Frontal lobe Motor function ,problem solving decision

making , social behaviour

2.  Parietal lobe
Processing language and mathematics and
sensory information

3. Occipital lobe Visualization

Organization of temporary input and

processing
4. Temporal lobe

Coordination and control

5. Cerebellum

Breathing , heart rate and balance

6. Brain stem

222222222 2
 Part Function

Maintaining the body status

7. Hypothalamus

Control heart rate , respiratory

8.Medulla Oblongata
movements, act of swallowing
and secretion of saliva

9. Pineal Gland Produces melanin

10.Pituary Gland Control release of hormones of

endocrine gland

Monitors the involuntary

11. Pons actions

3
2.2 Arterial Supply to brain

Internal carotid arteries supply 80% of the brain and all the vertebral arteries
contribute the remaining 20 % .

After entering the brain the internal carotid artery splits into two that is anterior
cerebral artery and middle cerebral artery anterior cerebral artery supply the medial ,
frontal and parietal lobes and they are connecting by the anterior communicating artery

Middle cerebral artery supplies most of the lateral surface of cerebral hemisphere

Before splitting into the middle and anterior cerebral arteries internal carotids gives
rise to internal choroidal artery which supplies no of different structures and the
posterior communicating artery which connects the internal carotid artery to posterior
cerebral arteries

The vertebral arteries gives rise to the posterior inferior cerebellar artery (PICA)which
supplies the inferior part of the cerebellum

The vertebral artery and the anterior spinal artery forms the basilar artery .the basilar
artery gives rise to anterior inferior cerebral arteries and superior cerebellar arteries
which supplies the rest of the cerebellar surface

And then at the mid brain the basillar artery splits into two posterior cerebral

The anterior cerebral arteries, internal carotid arteries and posterior cerebral arteries
are all connected known as circle of willis this interconnection allows blood to flow.

3. TYPES OF NEUROLOGICAL DISORDERS

 3.1 Alzheimer’s disease

It is also known as AD . It attacks the brain function and affects the memory, language,
behaviour and thinking .Most people diagnosed it with 65 or above although the onset
of disease can occur early

Cause- It is a neurodegenerative disease that is the cell in the brain die cause can be
genetic or environmental factors

Symptoms-Symptoms of Alzheimer have 7 stages

Stage 1 – No impairment
The patient do not experience memory loss
Stage 2-Mild cognitive Decline
Mild changes which are the earliest signs of Alzheimer
Stage3-Early confusional
ADL can be disturbed problems may include organization and planning .Also there is
mood change person may become depressed anxious ,moody at times
At this stage diagnosed can be done .
Stage 4- Moderate cognitive decline
Reduce memory of personal history become isolated still indentifies known
Stage 5- Moderately severe cognitive decline
Cannot remember details of personal history
Stage 6- Severe cognitive decline
Memory continues to deteriorate required assistance in daily activities
Stage 7- Very severe cognitive decline
During this stage the person stops responding to their environment cannot speak
eventually no movement
TREATMENT –Due to the immobilisation of the muscles both antagonist and agonist
become stiff and rigid
1. Rocking technique
Stimulates the vestibular thereby providing the relaxation
2. Rhythmic initiation
Passive assisted, active assisted movements and resisted exercises
Physiological effects -It increases mobility and the strength of the muscles . Decreases
aggression and improves mood.  Maintain activities of daily living (ADLs). Also slows
the loss of memory.
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3.2 Stroke
It is a life threatening condition it is the interruption to the blood flow to the brain or
brainstem for more than 24 hours when there is interruption to the blood flow for less
than 24 hour called the transient ischemic stroke
Stroke can be of 2 types ischemic stroke and haemorrhage and ischemic ,in ischemic
stroke there is a plaque in the internal carotid artery but in haemorrhage there is
rupture of blood vessels

Indications
Numbness
Loss the ability to pronounce words
Gait (reduce ability to walk in straight line)
Migraine

Treatment
Right Positioning –to reduce the pain and swelling and provide comfort

Early Mobilisation -increase in blood circulation and oxygen supply to the brain

GAIT-improves the walking and standing so that to walk independently

Treadmill training –Improves the aerobic function also provide opportunity for
gaining improvements in speed and endurance

Hydrotherapy –increase musculoskeletal extensibility

3.3 Parkinson’s disease

It is also known shaking palsy Parkinson is the disorder of the brain that leads to
shaking and difficulty with walking , movement, and coordination it occurs due to the
not normal functioning of the basal ganglia of the brain

Cause
This disease is caused by the progressive impairment or deterioration of neurons
(brain cells) in the area of brain can due to proteins miscoding aggregation and toxicity
Mitochondrial dysfunction
Oxidative stress

Symptoms
Tremors
Rigidity
Postural instability
Reduction in facial expressions
Blurred vision

Treatment
1. Relaxation exercise –gentle rocking and slow rhythmic rotations movements
2 Flexibility exercise – range of motion exercise passive stretching passive positioning
3. Strengthening exercise - hydrotherapy
4. Balance training
5. Locomotors training
6 Postural interventions

4.Examination

4.1 Dynamic Gait Index 

It is developed as clinical implement used to assess balance and fall risk. It involves not
only usual steady-state walking, but also walking during challenging tasks. People
usually who are aged diagnose with stroke or have vestibular disorders

Method
The functional walking tests normally 8 test are performed and grading system is
used out of 1-3 ,3 grade be the lowest
Also there are in total of 24 category score is given in each category 24 is the total
individual score possible. The individual who scores 19 or less is likely increase
incidence of falls.

Completion time -15 minutes

4.2 10 Metre Walk Test

It is a performance method used to examine the walking speed in metres per second
for a short distance. Also it can be used to determine functional mobility, gait, and
vestibular function. People with brain injury is most likely to examine with this test
Therapist mark the at the 2 m and 8 m also time should be noted by the therapist
with help of the stop watch .

Method
Ask the patient to walk in straight line and patient can use assistive device if needed

Completion time – 10 minutes

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5. Case study

Patient name – Krishna Gupta Age/gender- 80/F

Examination- BP-110/70mmHg
Temp-Normal
Chest- Clear
Dressing-no soakage

Known Allergies- No Known allergies

Significant Past History- Bronchial asthma

Diagnosis –Intracerebral haemorrhage

Surgery Performed – Craniotomy

Treatment and advice- Neurophysiotherapy

MRI Report – Attached below :-

6. References

1. Books- Principles For neurology

 Neurology in clinical practice
2. https://www.physio-pedia.com/Category:Neurological_Conditions
3. https://www.disabled-world.com/health/neurology/disorders-list.phpp
4. Action balaji institute report

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