According to your clinical experience, which approach you prefer in clinic and do you think that it is better than other one approach? (For Stroke patients only)
A top-down approach such as using task-specific interventions.
A bottom-up approach, using weight bearing, PNF, and NDT techniques
A combination I would say. As an OT I will be mostly focused on ADL training and task-specific interventions, while the PT would be more focused on weight bearing, postural control etc. For severely injured patients with low postural control/sitting balance, going both an OT and PT for a training session really challenges the patient, while still keeping their motivation in a well-known ADL.
It has to be a combination of both 'top down' and 'bottoms up' approaches, since one must ensure that the client receives holistic care. The aim is to manage the disorder and restore functioning which involves the entire team at all levels from consultant right down to nurses aid. It is imperative that each do their part while recognizing that the timing related to initial diagnosis and treatment is priority while rehabilitative intervention by the therapy team is also crucial to recovery. The nursing interventions of course are of utmost importance.
Something to ponder.
Neurological patient such as CVA have different manifestation according site of lesion.
Most of the cases involved physical ability and also cognitive ability.
When instruments like robotic also helping in improve physical function in CVA patient. Virtual therapy (VR) nowadays seems have gain place not only improve physical function but cognitive.
Again, neuroplasticity should happen either top bottom and bottom top approach.
Still, look for more knowledge and information.
Cognition, awareness, motor planning, comprehension, to have motor control / righting reactions and normalize tone and control. Then refine and develop from there. That is what I do, as an OT, to develop the functional capacity to complete GM tasks to FM from there
Your question is very interesting and I read with interest the other answers.
For my part, based on my clinical practice in Canada as an occupational therapist in the context of rehabilitation practice in the community (after the client has returned home), I find that interventions based on top-down approaches allow more generalization and transfer of the skills acquired. Also, it seems that engagement in the therapy becomes more meaningful and useful for the client 'in real life'. One of the intervention approaches that I invest with individuals with stroke is the CO-OP (Cognitive Orientation to daily Occupational Performance) approach. If you are interested, there is a large literature on the subject among the population of individuals with stroke, including high-quality RCTs.
While I work with a younger population, research demonstrates that a top-down approach is more easily generalized to different contexts. While positioning for function may be necessary, and this may look more like a bottom-up approach, why couldn't the client once positioned appropriately, use their functional positioning to increase there level of participation in occupation-based activities- that follows a top-down approach.
A lot depends on the in which brunnstrom stage the patient is in. I would say a combination of both..but top down approach is preferrable. Motor relearning program is my choice most of the time as it is very clear cut and transfer of skill is included in the intervention after doing training in parts.
Dear Dr Muhammad Waqas . See the following useful RG link: Article Enfoques top-down y bottom-up para el tratamiento de la hemi...
Kindly see also the following very good RG link : Article Does training in a top-down approach influence recorded goal...
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