Geert Verheyden (review) – Ten guiding principles for movement training in neurorehabilitation

This article presents a comprehensive set of guiding principles for motor therapy, at first for the domain of neurorehabilitation. The article is a narrative review and although there is value in this type of summaries, it is for me insufficiently clear what the origin is of the ten principles. With other words, what was the basis of the author for deriving these elements as the guiding principles. For instance, Lennon et al. (Lennon, S., Ramdharry, G., & Verheyden, G. (2018). Physical Management for Neurological Conditions E-Book. Elsevier Health Sciences) also present 10 key principles of physical management in neurorehabilitation. I understand the difference in scope (movement training versus physical management), but some framework for the pathway to the ten principles presented here should be proposed to the reader.

The introduction lacks a coherent flow. Paragraph 1 is clear and demonstrates the advantage of a common language (but is this the aim of this article?). The link between the next four paragraphs (neuroplasticity, theories, technology and patient) and the guiding principles is unclear to me. They seem to provide some examples of knowledge linked to the domain but their fit within the story is lacking. The last paragraph should explicitly state the aim.

I would be in favour of a sort of methods section (1) how the principles were determined and (2) how the information for each of the principles was collected.

My suggestion would be to rethink the build-up of figure 1. It seems now presented as a continuum which is actually not the case.

The presentation of each of the principles is in my opinion too exemplary. I like table 1 with definitions and examples and would therefore suggest that each of the principles would consist of:

  • Definition; what is the agreed explanation and meaning of principle (and what is it perhaps not). This definition should be referenced. I’m afraid not one principle in table 1 has a reference now. Sometimes, under definition, there is actually no definition given (e.g. 7. biomechanics in table 1).
  • Evidence-based practice results: this is now lacking. As a reader, we need to have confidence that what is suggested is actually of benefit. A reader now would not become convinced about such an advantage. Examples should also be specific. Now, many of the literature findings presented are vague I’m afraid.
  • Examples of the principle applied in clinical practice. Again, one needs to be specific here. For instance in table 1, line 1, “Sensory priming as a warm-up exercise.” What is meant by this? This is actually the case for nearly all principles in table 1.

The discussion should start with the aim and critically reflect upon the product (the principles) and process (how the principles were derived), and what the next steps would be. A limitations section is always useful for a reader.

One thought on “Geert Verheyden (review) – Ten guiding principles for movement training in neurorehabilitation

  1. Geert Verheyden (GV) (review)
    (GV) This article presents a comprehensive set of guiding principles for motor therapy, at first for the domain of neurorehabilitation. The article is a narrative review and although there is value in this type of summaries, it is for me insufficiently clear what the origin is of the ten principles. With other words, what was the basis of the author for deriving these elements as the guiding principles. For instance, Lennon et al. (Lennon, S., Ramdharry, G., & Verheyden, G. (2018). Physical Management for Neurological Conditions E-Book. Elsevier Health Sciences) also present 10 key principles of physical management in neurorehabilitation. I understand the difference in scope (movement training versus physical management), but some framework for the pathway to the ten principles presented here should be proposed to the reader.

    I thank Geert for his constructive review. I have made relevant changes throughout the paper to address each point. I believe the paper now has a clear aim and background within the introduction. The discussion now links more closely with the aims of the paper and includes a limitation section. Table 1 has been updated to provide clearer, referenced definitions with more specific examples for each.

    I believe this narrative review now has more clear structure and will be a useful resource as a common language for movement training for clinicians, patients, researchers, and students.

    Responses
    (GV) The introduction lacks a coherent flow. Paragraph 1 is clear and demonstrates the advantage of a common language (but is this the aim of this article?). The link between the next four paragraphs (neuroplasticity, theories, technology and patient) and the guiding principles is unclear to me. They seem to provide some examples of knowledge linked to the domain but their fit within the story is lacking. The last paragraph should explicitly state the aim.

    I have updated the introduction to keep the aim of the paper focused on the advantage of a common language. Paragraph 1 still begins by introducing a need for a better language to describe motor training interventions in neurorehabilitation, and then proposes that guiding principles can be a useful way to assist with this process. Previous guiding principles with regards to neurorehabilitation in general as suggested by Geert (Lennon et al, 2018) are included, as well as principles of neuroplasticity commonly used in neurorehabilitation teaching (Kleim & Jones, 2008).

    The next section then again directs the reader to the important of guiding principles devoted specifically to motor training, and that useful principles can be derived from the theoretical areas of motor control theories and motor learning, exercise science and self-management. The next 4 paragraphs then elaborate on the importance of these areas.
    The section on rehabilitation technology has been moved to the discussion to support the potential role of the MTPs.
    The final paragraph in the introduction now explicitly states the aim of the paper.

    (GV) I would be in favour of a sort of methods section (1) how the principles were determined and (2) how the information for each of the principles was collected.

    As stated above, a section in the introduction now expands on the important theoretical areas where the ten principles have been sourced – motor control theories and motor learning, exercise science and self-management. An argument for the importance in combining guiding principles from these areas for teaching, research and collaboration is reaffirmed before the body of the paper begins, which briefly summarises the relevance of each principle.

    (GV) My suggestion would be to rethink the build-up of figure 1. It seems now presented as a continuum which is actually not the case.

    Figure 1 has been changed to remove the arrow which gave the impression of a continuum, and now present more like a group of principles.

    (GV) The presentation of each of the principles is in my opinion too exemplary. I like table 1 with definitions and examples and would therefore suggest that each of the principles would consist of:
    Definition; what is the agreed explanation and meaning of principle (and what is it perhaps not). This definition should be referenced. I’m afraid not one principle in table 1 has a reference now. Sometimes, under definition, there is actually no definition given (e.g. 7. biomechanics in table 1).

    Each of the definitions have been updated as required and supporting references have been included.

    (GV) Evidence-based practice results: this is now lacking. As a reader, we need to have confidence that what is suggested is actually of benefit. A reader now would not become convinced about such an advantage. Examples should also be specific. Now, many of the literature findings presented are vague I’m afraid.

    The next column is now labelled ‘Possible examples to consider’ and have been reviewed to provide more specific examples. Evidence – based results for all these principles is beyond the aim and scope of this paper. Evidence within the main body of the paper discussing the relevance of the principles has already used over 150 references with an attempt to provide a wide variety of evidence that include a range neurological populations. I understand that there would be evidence that support some of the specific examples, and as stated at the beginning of the discussion it is hoped the MTPs assist by ‘Providing principles that can be updated as evidence grows.’ The aim of the table was to provide a list of examples to give the reader some practical examples for each principle to consider in clinical practice.

    (GV) Examples of the principle applied in clinical practice. Again, one needs to be specific here. For instance in table 1, line 1, “Sensory priming as a warm-up exercise.” What is meant by this? This is actually the case for nearly all principles in table 1.

    Table 1 has been updated with more specific descriptive examples.

    (GV) The discussion should start with the aim and critically reflect upon the product (the principles) and process (how the principles were derived), and what the next steps would be. A limitations section is always useful for a reader.

    The discussion now starts with the aim of the MTPs and then reflects on their potential role. A paragraph on limitations has now been included.

    I again thank both reviewers for taking the time to review this paper. I feel it is now a much improved narrative review for the readers of OpenPhysio Journal.

    James McLoughlin

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