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258 Section IV: Postoperative Care and Rehabilitation

below are some general principles to remember during the rehabili- Goals
tation of the neurological patient. Relieves pain, reduces inflammation, and accelerates tissue repair
• Body parts can compete for representation in the brain and use of and cell growth.
a body part can enhance its representation, in the same way as
lack of use will shrink its representation in the CNS [1–3]. Applications
• The premotor cortex can substitute for the motor cortex to control Musculoskeletal pain, nonhealing wounds, and pressure sores.
motion. It has been demonstrated that although the main output of
the premotor cortex is ordinarily the primary motor cortex, it can Contraindications
also be the source of supraspinal control signals [1,2]. Over areas of infections or neoplasia [11].
• The contralesional hemisphere can take over motor control if all
else fails. Ipsilateral corticospinal neural pathways have been doc- Thermotherapy
umented, especially for more proximal muscles. In severe unilat- Mechanism of Action
eral hemisphere lesions, the undamaged hemisphere could take Superficial heat and cold are used therapeutically to manage soft
over and enhance the use of this pathway, although the exact tissue and joint injuries, altering the inflammatory response. The
mechanism is unkown [1,5,6]. most important physiological effects are as follows.
• Neuroplastic mechanisms can be facilitated and this is a good • Superficial heat: vasoconstriction, decreases blood flow, decreases
basis for intervention. Early, intensive and focused NR is greatly swelling, reduces enzyme‐mediated tissue damage, analgesia.
advocated [1]. The neuroplasticity of the patient underlies all • Superficial cold: vasodilation, increases blood flow, relieves pain,
learning and will be enhanced by following five principles: prac- increases soft tissue extensibility, relaxation of muscle spasm.
tice, specificity, repetition, intensity, and motivation [7,8].
Goals
• Superficial heat: pain relief in chronic lesions, increase in elasticity
Physical Modalities of muscles, tendons and ligaments, and relief of muscle spasms.
Physical modalities refer to a group of therapies applied in patients • Superficial cold: pain relief in acute lesions.
with neurological and motor rehabilitative dysfunction. These
modalities are characterized by specialized exercises and applica- Applications
tion of noninvasive equipment with precise purposes in the restora- • Superficial heat: chronic lesions, chronic pain, decrease in range
tion or maintenance of the debilitated patient. This chapter focuses of motion, and muscle spasms.
on the rehabilitation of neurological diseases (intracranial, spinal, • Superficial cold: acute lesions and acute pain.
or neuromuscular disorders). Some of the most common therapies
are described in the following sections. Contraindications
Over areas of infections, neoplasia, and open wounds [9,10].
Electrical Stimulation
Mechanism of Action Therapeutic Ultrasound
Electrical stimulation is applied by an electrical stimulator that Mechanism of Action
transmits a current from one electrode to another in a specific area A deep heating modality that can elevate tissue temperature at
of the body. The stimulator parameters (frequency, amplitude, duty depths of 2 cm. The mechanism of action is the same as that for
cycle, and intensity) are modified to achieve a specific function and superficial heat but at a deeper level. Additionally, this modality has
purpose. nonthermal effects caused by cavitation and acoustic streaming.
Goals Goals
To increase muscle strength, control pain, and reduce muscle Vasodilation, pain relief in chronic lesions, increase in elasticity of
spasms and edema; and to provide neurological stimulation muscles, tendons and ligaments, relief of muscle spasms, and stimu-
(sensory). lation of healing.
Applications Applications
To prevent muscle atrophy, to build up muscle mass, and reduce Chronic lesions at deeper locations or affecting large muscles (i.e.,
neuropathic pain and pain associated with osteoarthritis, muscle quadriceps muscle; Figure 29.1), fibrosis of soft tissue and ankylosis
spasms, edema, and decreased nociception. due to prolonged immobilization, and nonhealing ulcers or
fractures.
Contraindications
Over areas of neoplasia or infections; patients with pacemakers [9,10]. Contraindications
Over areas of infections and neoplasia and areas with a metal
Laser Therapy implant [9,10].
Mechanism of Action
The term “laser” is an acronym for “light amplification by stimu- Massage
lated emission of radiation.” A laser is an instrument that produces Mechanism of Action
stimulated emission of photons. The proper application of laser Massage is the manipulation of soft tissues of the body by the thera-
therapy to the target allows each individual cell the opportunity to pist’s hands and by use of other instruments. There are multiple
absorb as many photons as possible, and this photobiostimulation techniques directed towards a specific purpose but, basically, all of
increases cellular health and energy. them apply pressure for tissue movement.