Health Promotion and Wellness in Neurologic Physical Therapy: Strategies to Advance Practice.

BACKGROUND AND PURPOSE: Neurologic physical therapy (PT) can assist people with neurologic conditions and injuries to optimize their health and well-being by addressing barriers at the individual, relationship, community, and societal levels. The purpose of this special interest article is to provide consensus-driven strategies to address barriers to implementing health promotion and wellness (HPW)-related neurologic PT practice. SUMMARY OF KEY POINTS: Environmental scan, literature review, and expert input were used to determine barriers and develop strategies. Barriers include lack of time; low knowledge, self-efficacy, and awareness; client complexity; and lack of HPW resources; as well as concerns regarding payment and scope of practice. Four key strategies emerged: (1) develop and disseminate a consensus-based scope of practice for HPW in neurologic PT; (2) increase knowledge of resources related to HPW; (3) promote delivery models for HPW-related neurologic PT; and (4) encourage advocacy, community building and partnership along the continuum of care. RECOMMENDATIONS FOR CLINICAL PRACTICE: Clinicians should practice to their full scope of HPW-related PT practice. This includes optimizing movement, including physical activity and fitness, as well as reinforcing the importance of healthy sleep, nutrition, stress, and smoking cessation. These activities address primary, secondary, and tertiary prevention. Clinicians are encouraged to report their experiences with HPW-focused delivery models and outcomes. Additional research is needed to understand the full impact of HPW on PT practice (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A364).

Muscle Overactivity in the Upper Motor Neuron Syndrome: Assessment and Problem Solving for Complex Cases: the Role of Physical and Occupational Therapy.

The role of the physical or occupational therapist in addressing muscle hyperexcitability is to carefully assess the implications that the abnormal tone has on function, especially active movement patterns. A thorough evaluation that includes neurologic and nonneurologic attributes allows the clinician to determine the most efficacious treatment interventions, especially when considering severity and chronicity of deficits. A holistic assessment that includes patient factors and resources guides the clinician's plan of care to allow for optimal functional outcomes.