the Johnstone approach
Alwnick, UK
In November 1999 I went up to Alwnick Infirmary in Northumbria, UK, to gain some knowledge about the Johnstone approach. This was developed by Margaret Johnstone and is based on Bobath but extends the aim of restoring normal movement by involving the carers, thus ensuring that an environment supporting optimal recovery is maintained throughout.
Specific to the Johnstone approach are:
* Interdisciplinary teamwork and Involvement of the family
* Specific attention to the arm
* Activities on the floor
* Use of tools (e.g.. Urias splints, rocking devices, Worf turntable, or the Fitter apparatus)
The highlight of my visit was a 2 day course - expertly held by Anne-Marie Verstraeten (OT) and Koen Putman (PT) from Belgium, which covered the use of Urias Splints in rehab. Thanks to Prue Smith, the Superintendent at Alnwick, I was allowed to stay on for a few days to practice some newly found skills with the stroke patients there.
Unfortunately, little has been published about Johnstone on the web, and I hope my little contribution will influence the experts to make their knowledge more widely available. The course has also widened my interest in Pusher's syndrome which is becoming increasingly common in my workload, and with which Johnstone has been researched.
Solothurn, Switzerland
Following my introduction to the Johnstone approach at Alnwick, in September 2001 I decided I needed more detailed information about the matter; my travels then took me to Solothurn, which is a delightful city (and canton) in the North West of Switzerland.
Solothurn houses the Burgerspital, a rehab hospital whose staff have been instrumental in the development of the Johnstone approach. Lots of research has been done there in association with the University of Leuven in Belgium. Gail Cox Steck, the physiotherapist in charge of continuing education there, very kindly took me on for a week to give me an idea the clinical reasoning behind the approach.
In fact, Johnstone concept was there presented to me in a multimodal approach. The concept has been expanded by constantly integrating strategies from theoretical advances in motor control and learning.
These aims are achieved by:
*
starting the rehab programme in a learning environment, planning realistic goals and treatment strategies after negotiation with patients
*
interdisciplinary team work in order to influence the normality of future motor patterns, keeping compensation to a minimum and to prevent the establishment of learned non-use possibility for a long-term rehab management plan and follow-up
*
outcomes must stand to the test of long-term accountability
At the Burgerspital, all staff directly in contact with the patient, including docotors and nursing staff is instructed in the approach. The effectiveness of this way of working is what all rehab units should be striving for.
Further Reading
Ada et al (1990) stroke rehabilitation: Does the therapy area provide a physical challenge? Australian Journal of Physiotherapy Vol 45 33-38
Carr J, Shepherd R, (1999) Neurological Rehabilitation Butterworth-Heinemann
Carr J, Shepherd R (1987) Movement Science Aspen Publishers, USA
Chedoke Mc-Master University (1995) Chedoke Mc-Master Stroke Assessment Chedoke Mc Master Hospitals and University
DeWeerdt W., Selz B. et al (2000) Time use of stroke patients in an intensive rehabilitation unit: a comparison between a Belgian and a Swiss setting Disability and Rehabilitation vol 22 no.4, 181-186
Feys et al (1998) Effect of a therapeutic Intervention for the Hemiplegic Upper Limb in the Acute Phase after Stroke. A single, blind, randomised, controlled multicentre trial Stroke. 29:785-792
Horstenbach J., Mulder T., (1999) Neuropsychology and the relearning of motor skills following stroke International Journal of Rehabilitation Research 22 11-19
Horak F. (1991) Assumptions underlying motor control for neurological rehabilitation. Contemporary management of motor control problems - proceedings of the 11 step conference Foundation for Physical Therapy
Johnstone M (1996) Home care for the stroke patient Churchill Livingstone
Johnstone M (1995) Restoration of normal movement after stroke Churchill Livingstone Kunkel A. (1999) Constraint-induced movement therapy for motor recovery in chronic stroke patients Arch Phys Med Rehab Vol 80
Kwakkel G (1998) dynamics in Functional Recovery after Stroke Ponsen and Looijen Netherlands
Kwakkel G et al (1999) Therapy impact on Functional Recovery in Stroke Rehabilitation Physiotherapy Vol 85 377-391
Langhammer B., Stanghelle J (2000) Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomised controlled study Clinical Rehabilitation 14 361-369
Majsak M., (1996) Application of motor control principles to stroke population Aspen Publishers
Mant J et al (2000) Family and Support for Stroke: a randomised controlled trial Lancet Vol 356
Nudo et al (1996) Neural Substrates for the Effects of Rehabilitative Training on Motor Recovery after ischaemic infarct Science Vol 272 1791-1794
Shumway-Cook A, Woolacott (1995) Motor control Williams and Wilkins, USA
Taub E., et al (1993) Technique to improve chronic motor deficit after stroke Arch. Phys Med Rehabilit Vol 74, April
Winstein, CJ (1987) Motor learning considerations in Stroke rehabilitation In Dundan, P.W. and M.B. Badke (Eds.), Stroke Rehabilitation: The Recovery of motor control 109-134 Chicago. IL:Year Book Medical Pub.
Wolf S.,et al (1989) Forced use of upper extremities to reverse the effect of learned non-use among chronic stroke and head injured patients Experimental Neurology 104, 125-132
(The abovementioned aims and literature review are courtesy of Gail Cox Steck, Burgerspital, Solothurn)
