Rainy Madrid but excellent days for studying

In the morning

It is the second day in advanced Bobath course in Centro Lescer and the second rainy day in Madrid. I was lucky, because my hotel had ONE umbrella in their closet! While we are studying and practicing, it is quite the same if it’s raining or not. 

Hydrotherapy :)

Anyway, these two days have been busy and full of neurophysiology and postural control and alignment and body schema and so on. These two days have been tough days for me, because I’m just a rookie in this connection making with function and neurophysiology. I’ve studied neurophysiology more for this years advanced courses, but still confused about so much information. I really start to realize how important it is to us to understand this nervous network with different kind of structures and feed forward and feed back systems. And because of this understanding, I also know now how important it is to get good postural setting before you can start to deal with the limbs. I think in our school we don’t get this much information about neurological disorders or neurophysiology like they do in Spain. Or then it is just me who didn’t go the right classes J.

I think most of the doctors won’t understand the recovery in neurological patients. The common thought is still that in stroke just the other side is affected. One pick up from the notes: the corticospinal tract starts from the primary motor cortex and it control the movement of the muscles of the limbs and trunk. The corticospinal tract, which activates limbs decussates in medulla (75-90%) and the rest which won’t decussate are activating the trunk muscles on the side which was known as the non-affected side. With this short explanation we should understand the problem in the trunk too. I hope we all understand that the “better side” is also affected. I know all Bobath therapists have learned this, but it would be excellent if the doctors would too.

Other pathways and systems, which are relevant in this course and for this issue, are for example pontine pathway, vestibular system, APA’s, graviceptors, parietal cortex and cerebellum, somatosensory system etc. This is maybe so boring to read so I will leave it here, I just want’t to say that’s there is an important role to understand these tracts and the neurophysiology when you or I treat the patients. It can be effective and give good recovery, but you need to know how to use and correct the system.

“Postural control in humans is complex, and involves a multijoint kinetic chain from the feet to the head”(Massion, 2004).

Sensory information is important for recovery and voluntary movement. Sensory input is needed to corticospinal recovery. We did today sensory integration and two-point discrimination test. The setting is important again. In sensory integration we can get information if the part of the body is in patients body schema and two-point discrimination test tells us if there is still a viable corticospinal pathway. Neither of these guarantees movement, but there is possibility for function.

The days have still been amazing with great Mary Lynch Ellerington. This highly experienced and talented Bobath Instructor gives our brain surprises every day. She is fantastic with the patients and us and the knowledge and handling skills are magical. I am honoured that I had this opportunity to meet her and get to this course. I still have three days to go but I have already learned so much for my own work that I can’t wait to get back with my clients. In next blog I try to tell you more about our patient here in the course. She is a very nice young woman, who understands few words English too!

Now, it’s time to go to sleep and get ready for tomorrow.

Cuatro Torres, Business Area

Yours,

TAB