What Is Neurological Physical Therapy?

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Neurological physical therapy is aimed at restoring functional mobility, strength, balance, and coordination in people with neurological conditions that affect their quality of life and ability to move. Neurological physical therapy can help people recover from neurological injuries or prevent the progression and worsening of chronic neurological conditions. 

physical therapist assisting elderly woman walking in parallel bars

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Uses

Neurological physical therapy is geared toward treating patients with conditions affecting the brain and spinal cord, such as stroke, spinal cord injury, and Parkinson's disease, to help them function as best as possible. Neurological physical therapy is performed in hospitals, private practice physical therapy clinics, doctors’ offices, rehabilitation facilities, or at home.

Process

If you need neurological physical therapy, you may be treated either on an inpatient or outpatient basis. Inpatient therapy takes place in a facility such as a hospital or rehabilitation center, where you will stay overnight. Outpatient treatment is typically performed at physical therapy clinics or at an outpatient rehabilitation center at a hospital.

Whether you need inpatient or outpatient physical therapy will depend on the severity of your neurological condition. 

Newly acquired neurological conditions such as strokes or traumas like spinal cord injuries and traumatic brain injuries (TBI) often require inpatient rehabilitation. Once the patient gains enough strength, coordination, and independence with movements like standing and walking, they can progress to outpatient physical therapy.

After your physical therapist has gathered enough information about your medical history during your initial evaluation, you will undergo a physical exam. The therapist will check your muscle strength, coordination, range of motion, reflexes, and the muscle tone of your arms and legs.

Your general level of attention, cognition, and sensation will be assessed as well to determine if these areas have been affected by your neurological condition.

Your physical therapist will then assess your ability to perform movements called transfers, which are transitions to and from different positions such as from lying down to sitting up or from standing up to sitting. The therapist will note if you can perform these movements on your own or if you need assistance.

Your initial evaluation will also include an assessment of your balance, quality of gait (how you walk), and whether you need assistance from your physical therapist. Your therapist may provide you with—or recommend that you purchase—an assistive device to help with walking, depending on the severity of your neurological condition. 

Your physical therapist may also perform neurological tests to examine your coordination, such as following moving objects with your eyes, touching your finger to your nose, and rapidly alternating movements.

Physical Therapy for Dizziness or Vertigo

If you have been experiencing dizziness or have been diagnosed with vertigo (the sensation that you or your surroundings are moving or spinning), you may be referred to a vestibular specialist, who will provide you with vestibular therapy. Your body's vetibular system includes parts of your inner ear and brain that help you control your balance and eye movements.

Your treatment plan will differ from other forms of neurological physical therapy as the treatment will focus on reducing your dizziness and vertigo symptoms and improving your tolerance of certain positions and activities that normally make your symptoms worse.

During your neurological physical therapy sessions, you may receive the following interventions:

  • Gait training to improve your ability to walk, including proper instruction on the use of assistive devices such as crutches, canes, and walkers
  • Balance training to improve your static (stationary) and dynamic (while moving) balance, both sitting unsupported to improve your core control and standing upright with or without using handheld support
  • Therapeutic activities to improve independence with bed mobility skills like rolling and sitting up from lying down, and transfers on and off beds, chairs, and toilets
  • Therapeutic exercises for stretching and strengthening muscles and improving coordination and motor control
  • Endurance training with cardiovascular equipment like treadmills, stationary bicycles, and ellipticals
  • Vestibular therapy interventions to improve control of eye movements, balance exercises with head movements, and exercises to treat a common cause of dizziness (Dix-Hallpike and Epley maneuvers)

Conditions Treated

Neurological physical therapy can treat a variety of conditions, whether recently acquired or chronic. Some neurological conditions are progressive, getting worse over time, and require regular physical therapy and at-home exercises to maintain optimal well-being.

Neurological conditions that can be treated with physical therapy include:

  • Strokes (loss of blood supply to the brain)
  • Spinal cord injuries (damage to part of the central nervous system resulting in loss of movement and control)
  • Traumatic brain injuries (such as concussion)
  • Multiple sclerosis (a disabling disease of the brain and spinal cord)
  • Parkinson’s disease (a progressive nervous system disorder)
  • Cerebral palsy (a group of disorders affecting movement, balance, and posture)
  • Amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease)
  • Guillain-Barre syndrome (an autoimmune disease attacking the nerves)
  • Polyneuropathies (damage to the peripheral nerves)
  • Vertigo, including benign paroxysmal positional vertigo (BPPV)

Frequently Asked Questions

How does physical therapy help with neurological problems?

Physical therapy helps people with neurological problems by increasing their use of muscles that are weak; improving their motor control, coordination, and balance; and facilitating their independence with daily tasks and movements.

Why would someone need neurological physical therapy?

A person would need neurological physical therapy after an injury or illness affecting the brain and spinal cord. Physical therapy helps people recover, regain their strength and movement, and improve their abilities to perform daily tasks as they recover or as their illness progresses. Neurological conditions can occur suddenly, such as from an accident, or be progressive, such as with Parkinson's disease.

What does a physical therapy neurological test assess?

A physical therapy neurological test assesses coordination of body parts and motor control between the brain and muscles. This helps determine if the signals being sent to the brain are reaching the muscles quickly and efficiently and are functioning properly. 

How do you become a neurological physical therapist?

All physical therapists who graduate from an accredited physical therapy program acquire training in treating neurological conditions. Anyone wishing to specialize in neurological physical therapy can pursue a specialty certification as a neurological clinical specialist (NCS). You must complete 2,000 hours of treatment with patients with neurological conditions and pass an additional board exam.

Summary

Neurological physical therapy can help you with mobility and balance issues caused by neurological conditions. Depending on how severe your condition is, you may receive this therapy as an inpatient or an outpatient. Participating in this type of physical therapy can help you maintain your independence even if your condition worsens and makes everyday movements more difficult.

A Word From Verywell

Neurological physical therapy can be extremely beneficial for anyone who has been diagnosed with a neurological condition, whether recently acquired or chronic. Physical therapists work with patients to gain strength and functioning. Exercises can help you improve your mobility, gain independence, and decrease your need for assistance from others—all of which can lead to an improved quality of life.

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  1. Park A & Kennedy B. American Physical Therapy Association. Neuro exam and treatment: The basics and beyond. Updated 2016.