Behavioral physiotherapy in post stroke rehabilitation

INTRODUCTION: Behavioral aspects of motor learning such as definition and assessment of patient-centered goals, specific motivation, training in the patients' environment, autonomous training and generalization of newly learned skills to daily life are not an explicit part of physiotherapy in neurorehabilitation. BEHAVIORAL PHYSIOTHERAPY: Specific goals are defined and applied in a step by step manner. Exercises and application in daily life were trained and anticipated as a "self control cue" for the following week. Motivation was sustained via supervision, feedback after successful trials and reward. Exercises have to occure at a daily basis and have to be implemented in everyday life. CASE DESCRIPTION: A 54 year old man who suffered cerebral bleeding with left hemiparesis 25 years ago. We report goal attainment, change of symptoms and walking capacities over a period of 18 months. RESULTS: Back pain and knee pain reduced to zero, rhythmic walking, walking speed increased, left leg less resistance, running possible. DISCUSSION: The here described principles of behavioral physiotherapy are crucial for successful outcome in extremely stable and persistent consequences of stroke. Studies with more patients are needed to strengthen our hypothesis.