The recovery of function during physiotherapy: A theoretical basis for stroke rehabilitation.

This research was undertaken to address a number of problems identified in the literature, the most fundamental issue being, the lack of evidence of effective physiotherapy intervention for stroke patients. It appeared that a contributing factor was a lack of appropriate measuring tools that fulfilled both the theories of measurements and the theoretical basis of current physiotherapy practice.The purpose of the study was therefore, to choose a measure, define and validate the measure and to use the measure to develop knowledge and understanding of not only the outcome of physiotherapy, but also the physiotherapy process itself. The Bobath Approach was chosen for evaluation as this appeared, from the literature, to be the least evaluated and the most frequently used approach in the UK.A triangulation of qualitative and quantitative methodology was used in a research programme that was divided into four phases: 1. Identifying the measurement needs in stroke rehabilitation and choosing a measure that fulfilled the required specification. 2. Having chosen the TELER method, developing TELER Indicators definitions in a patient driven study, involving the clinical knowledge of practising physiotherapists and 'expert' physiotherapists in the area of neurological rehabilitation. 3. Validating the definitions of the TELER Indicators using the Motor Assessment Scale. 4. Using the developed measure in 4 single case studies.The research involved 71 stroke patients on 12 stroke units, scored on a total of 322 functional goals, 247 demonstrating a consolidation and acquisition pattern. The study established the characteristics of functional recovery during physiotherapy, providing information and knowledge regarding the model of intervention used, and the pattern of selective trunk muscle recovery occurring. It was concluded that, motor relearning does occur during the implementation of the Bobath Approach for the treatment of stroke patients and furthermore, it was established that, there is a misunderstanding of the concept of spontaneous recovery within the literature. The similarities and differences between the Bobath Approach and the Motor Relearning Programme were identified, establishing a theoretical basis for stroke rehabilitation.