INDEX

S.No TOPIC Page No

Declaration ii
Faculty Guide Approval iii
Acknowledgement Iv
1. Introduction
2. Anatomy
2.1 Brain 1
2.2 Arterial blood supply
3. Types
Alzheimer’s disease 5
3.1 Stroke
Parkinson
3.2
3.3
4. Examination 8
5. Case study 9
6. Reference 10
1. INTRODUCTION
A neurological disorder is any disorder of the nervous system.
Structural, biochemical or electrical abnormalities in the brain, spinal cord or
other nerves can result in a range of symptoms. Examples of symptoms
include paralysis, muscle weakness, poor coordination, loss
of sensation, seizures, confusion, pain and altered levels of consciousness.Brain, spinal
cord, and nerves together makes up nervous system. They control the workings of our body. With
increasing age, individuals are facing age-related neurological disorders that affects the daily activity
of human being which is called ADL , Also general function such as gait( person manner of walking)
and balance are affected thereby the well being of human being is disturbed . Hence, protection of
brain, muscle, and neuromuscular function is crucial in maintaining healthy life and to enhance
quality of life.

There are over 500 neurological disorders which is seen among the people of different
age group . Although neurological disorder mainly occur in ageing brain that is old aged
people .

Types of neurological disorders are -

Spina bifida
Spina bifida is a birth disorder that occurs when the spinal cord don't form properly.
Parkinson's disease 
It is a nervous system disorder in which nerve cells of our brain start producing
dopamine
Alzheimer's disease
It is age related neurological disorder that destroy brain cells with ageing brain
 Stroke
It is the stoppage of blood flow to the brain
Injuries to the spinal cord 
It refers to the injury to the vertebra or the nerves passing to the spinal canal it also
refers to as trauma
Cancer, such as brain tumours
It refers to the abnormal growth of the brain cells which disturb the normal functioning
of the brain
Patient are treated focusing mainly on motor learning because the structural and
functional alterations in the brain of old people is increasing
The role of physiotherapist by means physical therapy in neurological disorder mainly
is to enhance the motor activities by improving the blood circulation in the body and
strengthening of the muscle thereby enhancing the functional ability of the brain , also
improving the muscular strength

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2. ANATOMY
2.1 Brain Anatomy

Part Function

1. Frontal lobe Motor function ,problem solving decision

making , social behaviour

2.  Parietal lobe
Processing language and mathematics and
sensory information

3. Occipital lobe Visualization

Organization of temporary input and

processing
4. Temporal lobe

Coordination and control

5. Cerebellum

Breathing , heart rate and balance

6. Brain stem

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 Part Function

Maintaining the body status

7. Hypothalamus

Control heart rate , respiratory

8.Medulla Oblongata
movements, act of swallowing
and secretion of saliva

9. Pineal Gland Produces melanin

10.Pituary Gland Control release of hormones of

endocrine gland

Monitors the involuntary

11. Pons actions

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2.2 Arterial Supply to brain

Circle of willis
Internal carotid arteries supply 80% of the brain and all the vertebral arteries
contribute the remaining 20 % of the blood

Blood flow happen in the following way

After entering the brain the internal carotid artery splits into two that is anterior
cerebral artery and middle cerebral artery. The blood then enter anterior cerebral
artery which supply the medial , frontal and parietal lobes and they are connecting by
the anterior communicating artery

Middle cerebral artery supplies most of the lateral surface of cerebral hemisphere of the
brain

Before splitting into the middle and anterior cerebral arteries, the internal carotids
artery gives rise to internal choroidal artery which supplies number of different
structures of the brain and the posterior communicating artery which connects the
internal carotid artery to posterior cerebral arteries which supply the remaining
structures

Then the The vertebral arteries gives rise to the posterior inferior cerebellar artery
(PICA)which supplies the inferior part of the cerebellum of the brain

The vertebral artery and the anterior spinal artery forms the basilar artery then the
basilar artery gives rise to anterior inferior cerebral arteries and superior cerebellar
arteries which supplies the rest of the cerebellar surface of the brain

And then at the mid brain the basillar artery splits into two posterior cerebral

The anterior cerebral arteries, internal carotid arteries and posterior cerebral arteries
are all connected known as circle of willis this interconnection allows blood to flow
over and over again .

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3. TYPES OF NEUROLOGICAL DISORDERS

3.1 Alzheimer’s disease

It is also known as AD . It attacks the brain function and affects the memory, language,
behaviour and thinking of a human being .Most people who are affected by this
disorder are of 65 or above although the onset of disease can occur early

Cause- It is a neurodegenerative disease that is the cell in the brain die cause can be
genetic or environmental factors , generally it happen with aging of the brain

Symptoms-Symptoms of Alzheimer have 7 stages

Stage 1 – No impairment
The patient do not experience memory loss
Stage 2-Mild cognitive Decline
Mild changes which are the earliest signs of Alzheimer
Stage3-Early confusional
ADL can be disturbed problems may include organization and planning .Also there is
mood change person may become depressed anxious ,moody at times
At this stage diagnosed can be done .
Stage 4- Moderate cognitive decline
Reduce memory of personal history become isolated still indentifies known
Stage 5- Moderately severe cognitive decline
Cannot remember details of personal history
Stage 6- Severe cognitive decline
Memory continues to deteriorate required assistance in daily activities
Stage 7- Very severe cognitive decline
During this stage the person stops responding to their environment cannot speak
eventually no movement
TREATMENT –Due to the immobilisation of the muscles both antagonist and agonist
muscles become stiff and rigid .so following technique is instructed for mobilisation
1. Rocking technique
Stimulates the vestibular thereby providing the relaxation to the brain and the
muscles
2. Rhythmic initiation
Passive assisted, active assisted movements and resisted exercises
Physiological effects -It increases mobility and the strength of the muscles . Decreases
aggression and improves mood.  Maintain activities of daily living (ADLs). Also slows
the loss of memory.
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3.2 Stroke

A stroke is a medical condition in which poor blood flow to the brain results in cell

death.[5] There are two main types of stroke: ischemic, due to lack of blood flow,
and hemorrhagic, due to bleeding.[5] Both result in parts of the brain not functioning
properly.[5] Signs and symptoms of a stroke may include an inability to move or feel on
one side of the body, problems understanding or speaking, dizziness, or loss of vision to
one side.[2][3] Signs and symptoms often appear soon after the stroke has occurred.[3] If
symptoms last less than one or two hours it is known as a transient ischemic
attack (TIA) or mini-stroke.It is an emergency condition also it is a life threatening
condition it is the interruption to the blood flow to the brain or brainstem for more than
24 hours when there is interruption to the blood flow for less than 24 hour called the
transient ischemic stroke
Stroke can be of 2 types ischemic stroke and haemorrhage and ischemic ,in ischemic
stroke there is a plaque in the internal carotid artery but in haemorrhage there is
rupture of blood vessels

People may experience:

Difficulty walking, numbness, sight may become blurred, or loss of vision
there might be difficulty speaking called the slurred speech, or speech loss and difficulty in
swallowing the food
Body will become fatigue and
Headache and mental confusion
Pin pricking sensation in the limbs

Indications
Numbness
Loss the ability to pronounce words
Gait (reduce ability to walk in straight line)
Migraine

Treatment
Following treatment can be performed
Right Positioning –to reduce the pain and swelling and provide comfort

Early Mobilisation -increase in blood circulation and oxygen supply to the brain

GAIT-improves the walking and standing so that to walk independently

Treadmill training –Improves the aerobic function also provide opportunity for
gaining improvements in speed and endurance

Hydrotherapy –increase musculoskeletal extensibility

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3.3 Parkinson’s disease

It is also known shaking palsy Parkinson is the disorder of the brain that leads to
shaking and difficulty with walking , movement, and coordination it occurs due to the
not normal functioning of the basal ganglia of the brain

Cause
This disease is caused by the progressive impairment or deterioration of neurons
(brain cells) in the area of brain can due to proteins miscoding aggregation and toxicity
Mitochondrial dysfunction
Oxidative stress

Symptoms
Tremors
Rigidity
Postural instability
Reduction in facial expressions
Blurred vision

Treatment
1. Relaxation exercise –gentle rocking and slow rhythmic rotations movements
2 Flexibility exercise – range of motion exercise passive stretching passive positioning
3. Strengthening exercise - hydrotherapy
4. Balance training
5. Locomotors training
6 Postural interventions
4.Examination
Following examination is performed in neurological disorders
4.1 Dynamic Gait Index 
It is developed as clinical implement used to assess balance and fall risk. It involves not
only usual steady-state walking, but also walking during challenging tasks. People
usually who are aged diagnose with stroke or have vestibular disorders

Method
The functional walking tests normally 8 test are performed and grading system is
used out of 1-3 ,3 grade be the lowest
Also there are in total of 24 category score is given in each category 24 is the total
individual score possible. The individual who scores 19 or less is likely increase
incidence of falls.

Completion time -15 minutes

4.2 10 Metre Walk Test

It is a performance method used to examine the walking speed in metres per second
for a short distance. Also it can be used to determine functional mobility, gait, and
vestibular function. People with brain injury is most likely to examine with this test
Therapist mark the at the 2 m and 8 m also time should be noted by the therapist
with help of the stop watch .

Method
Ask the patient to walk in straight line and patient can use assistive device if needed

Completion time – 10 minutes

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5. Case study

Patient name – Krishna Gupta Age/gender- 80/F

Examination- BP-110/70mmHg
Temp-Normal
Chest- Clear
Dressing-no soakage

Known Allergies- No Known allergies

Significant Past History- Bronchial asthma

Diagnosis –Intracerebral haemorrhage

Surgery Performed – Craniotomy

Treatment and advice- Neurophysiotherapy

MRI Report – Attached below :-