In common with all physiotherapy, neurological physiotherapy is vitally concerned with movement, but one possible difference compared with more traditional physiotherapy “treatment” is that a neurological physiotherapist’s intervention may be predominantly in the area of teaching and training the client in gaining or regaining function. As such, neurological physiotherapists develop expertise in analysing abnormal movement, hypothesising reasons that the movement is occurring and developing a regime that assists the client to relearn lost or impaired skills.
An integral part of the process is the ability of the therapist to analyse lost function in terms of component tasks. From this, training takes place in the context of skill acquisition – a process that any of us use when learning a new skill or ability. It also requires the therapist to have a sound knowledge of the basis of human movement in order to address impairment issues. This includes anatomy and biomechanics, as well as the obvious neurological knowledge of the sensorimotor systems, motor control, motor learning and the neuro-plastic nature of recovery from neurological damage.
The range of skills and functions with which neurological physiotherapists and their clients work can be many and varied, from being able to maintain a seated position, through to moving from sitting to standing; and from walking with assistance, through to negotiating the crossing of a road safely and efficiently. With a younger client with a traumatic brain injury, the intervention may extend to resuming higher-level mobility required in his or her vocation, for example climbing scaffolding for an injured ceiling fixer. Neurological physiotherapists often work with tasks that everyone takes for granted in the normal course of events – anyone who has even temporarily become dependent in any task of daily life can appreciate the inherent rewards in assisting someone to regain the dignity of being independent.
Because the level of function being retrained can be so complex, the neurological physiotherapist needs to be aware of issues other than physical. For example, perceptual,
Cognitive and behavioural issues all impact on a client’s safety and performance when they move in their environment and carry out their daily activities. This also involves working closely with the client, family, and other allied health, medical and nursing staff.
Neurological physiotherapists work with many different people at different ages and stages of life, in public or private health systems. Neurological impairment, disability and handicap can result from trauma (such as brain or spinal cord injuries), from disease processes (such as Parkinson’s disease, multiple sclerosis, motor neurone disease and muscular dystrophy) or from cerebrovascular events such as stroke, to name just a few. There is increasing evidence that even though some neurological diseases may be considered degenerative, physiotherapy intervention, in the form of training and exercises, can improve or maintain function and enhance quality of life, particularly by preventing falls, maintaining independence, health and fitness.
Within the Australian Physiotherapy Association there is a special interest group for neurological physiotherapy. In the near future, there will be the option of physiotherapists qualifying to use the title “Neurological Physiotherapist” to further identify the special skill and knowledge of this area of physiotherapy. Already, many such physiotherapists have attained postgraduate qualifications such as Master’s and Doctor of philosophy degrees relevant to neurology. Such research is adding vital information to the body of knowledge and focusing interventions, using a clear base of evidence.
Agnosia: a disorder of recognition from injury to higher order information processing cells which can result in an inability to recognise or distinguish faces or objects.
Agraphia: inability to write that can arise from trauma to areas of brain responsible for cognitive or motor skills necessary to write.
Alculia: a disorder characterised by an inability to comprehend or write numbers or perform arithmetic operations.
Alexia: inability to read due to brain damage causing cognitive or visual problems.
Neurological physiotherapy 
Clients and professionals alike are often surprised to discover the unique roles and skills that neurological physiotherapists offer. 