Dr. GAJANAN BHALERAO (PT) Neuro physiotherapist

PhD scholar, Master's of Physiotherapy Neuro, Certified NDT therapist.


Traumatic Brain Injury

Neuro therapeutic approaches in neuro rehabilitation : Workshops Details

neuro rehab

Author of article:

DR. GAJANAN BHALERAO (PT), PhD Scholor, MPTH NEURO, Certified Adult NDT therapist. HOD Physiotherapy & Rehabilitation Dept in Sancheti Hospital Shivajinagar Pune

Associate Professor & HOD  PT in Neuro Rehabilitation  DEPT at Sancheti Institute College of Physiotherapy, Shivajinagar Pune


We have to study all the Neuro therapeutic approaches in  Neuro rehabilitation from BPT third year class, to fourth year and MPT.  In these Approaches there are similarities and differences, advantages and limitations of each approaches need to be understood and studied during our graduation.

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In third year and fourth year we need to discuss about it and show at least few techniques and do the demonstration on patients. It was very  difficult for me to understand all these components  and its was more difficult to apply these approaches in clinical practice.

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Even though i was exposed to these approaches/technique it was very difficult to practice it. There was not enough opportunity to attend these kind of workshops or training. this thought process regarding this issue has been continuously thought-provoking in my mind. And i have experienced my students coming to me with the similar problem. they have been facing the similar problem like i use to.

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There are so many approaches, What approach i suitable for my patient? This always a question with us all the time.

pt_2068_3236_o MiniToy on Crossroads what-to-do

What is the technique i use for improving the desired control? The more try to answer this question we get more confused and we reach no where.

confused Case-Against-Macroeconomic-Investing

So i  am planning to conduct a series of workshop on different approaches in neuro rehabilitation. These workshop will include practical demos on patients, clinical application of these approaches.  These workshop  will emphasis on similarities and differences, advantages and limitations approaches.

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Date Topic Participant Criterion Participant fee INR Resource No. of days
13/09/2014 Neuro therapeutic approaches in  neuro   rehabilitation :part I-  Proprioceptive neuro Muscular facilitation.


4th year +, BPT, MPT30 students MAX Indian –RS 1000/-International US $25/- Dr. GAJANAN BHALERAO (PT) 1 DAY
18th & 19th October 2014  Neuro therapeutic approaches in  neuro   rehabilitation : Part II-  NDT /Bobath approach in Adult hemiplegia  4th year +, BPT, MPT30 students MAX Indian –RS 2000/-International US $50/-/ Dr. GAJANAN BHALERAO (PT) 2 DAYS
27th December 2014 Neuro therapeutic approaches in  neuro   rehabilitation  : part III-  Brainstorm & Roods approach 4th year +, BPT, MPT30 students MAX Indian –RS 1000/-International US $25/- Dr. GAJANAN BHALERAO (PT) 1 DAY
3rd & 4th January 2015 Neuro therapeutic approaches in  neuro   rehabilitation : part IV-  Motor relearning program 4th year +, BPT, MPT30 students MAX Indian –RS 2000/-International US $50/- Dr. GAJANAN BHALERAO (PT) 2 DAYS
28th February 2015 Neuro therapeutic approaches in  neuro   rehabilitation : part V-  Recent advances with evidences.(CIMT, Mirror therapy, FES, BWSTT, mental imaginary training, strength training, robotic therapy etc) 4th year +, BPT, MPT30 students MAX Indian –RS 1000/-International US $25/-




Other Workshops

November2014 Spinal cord injury rehab 4th year +, BPT, MPT30 students MAX Indian –RS 2000/-International US $50/-/ Dr. GAJANAN BHALERAO (PT) 2 DAY
13th & 14th December2014 2D and 3D gait analysis and management of gait deviation 4th year +, BPT, MPT30 students MAX Indian –RS 2000/-International US $50/- Dr. GAJANAN BHALERAO (PT) 2 DAYS
14th & 15th March 2015 Neuro therapeutic approaches in stroke   rehabilitation:  part VI-  Motor control & Strategies to improve motor control 4th year +, BPT, MPT30 students MAX Indian –RS 2000/-International US $50/- Dr. GAJANAN BHALERAO (PT) 2 DAYS

Please give your suggestions 1akuzic3mu6ujpl6tedtew

NDT/Bobath Certificate Course in the Management and Treatment of Adults with Hemiplegia, Pune, India 2015

NDT/Bobath Certificate Course in the Management and Treatment of Adults with Hemiplegia
Sancheti Institute College of Physiotherapy, Sancheti Health Academy, Shivajinagar, Pune, Maharashtra, India

Sancheti is organising  second ADULT NDT course in INDIA.

Seats available – 24 only
Course Dates:
19-01-2015 – 06-02-2015
It will be 5 days/week for three weeks. Saturday & Sunday off.

Course Number: 14A101
Course Status: Approved

Registration Fee: A non-refundable RS 5000/- and $ 100 for international delegates (No application will be processed without it).

Course Fees: These include course tuition fees, course material, daily breakfast, lunch and high tea on all 15 days of course (5day/week).

Registration Fee Up to 31/09/14 RS 5000/- $ 100
Early bird Fee UPTO 30/09/2014 Rs1,00,000/- US  $ 2050/-
Regular Fee 01/10/2014 TO 31/010/2014 Rs1,10,000/- US  $ 2100/-
Late Fee 01/11/2014 TO 31/30/2014 Rs1,20,000/- US  $ 2150/-


After November 31st registration is closed.

Please register early to get benefit.

Please Send DD/ Multi city Cheque in favor of “Sancheti Continuous Physiotherapy Education (CPE) Program” payable at Pune.

Banking details for electronic transaction

Bank name:                 Bank of Maharashtra

Branch:                        Pune Main branch, Lokmangal Pune -411005

IFSC code:                  MAHB0001150

Account name:            Sancheti continuous physiotherapy education (CPE) program

Account number:        60130671451

Note: We reserve the right to cancel this course, if necessary. Full tuition reimbursement will be provided on a prorated basis in the event of sponsor or Coordinator-Instructor cancellation.

(NOTE: Application fee is non-refundable.)

Location: Sancheti Institute College of Physiotherapy, Sancheti Health Academy
Thube Park 11/12
Shivajinagar, Pune, Maharashtra, India, 41105


Cathy Hazzard, B.Sc, MBA, PT, C/NDT CI
Ms. Katy Kerris, OT, C/NDT

Course ID no. 15A101

Cathy Hazzard, B. Sc. P.T., MBA is a Physiotherapist with over 25 years experience working with adults with varied neurological diagnoses. Her clinical background also includes experience and continuing education courses in manual therapy and orthopedics. She obtained an MBA in 1993 while continuing to work as a PT. She has been an NDTA™ Coordinator Instructor in Adult Hemiplegia since 1998 and has taught introductory, certificate and advanced level NDT courses extensively throughout North America (Canada, United States, and Mexico) and internationally in such countries as Ireland, Hong Kong, Singapore, Estonia, Colombia, and Peru. Cathy practiced in Calgary, Alberta, Canada for over 20 years in the acute, rehabilitation and outpatient phases of care. She is now working in private practice and Home Health on Vancouver Island, British Columbia. Cathy served as the Chair of the NDTA™’s Instructor Group from 2002 – 2005 and a member of the Board of Directors of NDTA™ from 2003 – 2007. (

Ms. Katy Kerris, OT, C/NDT

She has 25 years of experience working with neurologically impaired and orthopedic patients. She uses an NDT perspective in treating neuro patients. In addition she has  a Certified Hand Therapist and also have a strong background in manual therapy.she is an OT Adult Hemi Instructor. She has taught several introductory level classes and assisted in teaching several 3 week certificate courses.

Course Contact:
Dr. Gajanan Bhalerao
Phone: 9198 22623701
Fax: 9120 25539494

Application of Registration:-

Application for NDTA Adult Certificate course 2015 India

Hydrotherapy for traumatic brain injury with hemiplegia – our challenges and solutions

Swimming pool
Swimming pool (Photo credit: Wikipedia)

This is the case of a 16 yr old boy who met with an accident leading to a traumatic head injury in August 2011. He was in a coma for 1 month after which he gradually started showing improvement. I started treating him in January 2011. He had suffered a diffuse axonal injury due to which both the sides of his body were involved.  Initially he was hypotonic on both sides and trunk . He could move his left side voluntary control grade III in upper and lower limb but no control on right side. Within next 2 months he started sitting without support, supine to sit with support and required minimum to moderate assistance for sit to stand from high bed. He could stand with weight bearing on both legs with moderate assistance. His left side improved up to grade VI. His tone in trunk &  RT upper & lower  limb started improving (grade II).

Assisted walking training on the ground

In March and April 2012 he was showing a picture of RT hemiplegia with grade II in UL & LL with developing spasticity. We used to make him walk with FRO and push knee brace on Rt (hemiplegic side). Initially with back forearm support walker then without walker. Assisted walking training was started ( we have to passively step forward the hemiplegic leg ).

English: bathing hall, Carolus Thermen, Aachen...
commercial pool training

He could move the limb in supine but could not take a step forward while walking on ground.  So we have decided to take him for hydrotherapy to improve his control of lower limb and active walking. Taking a Patient to hydrotherapy was a good idea but we do not have hydrotherapy centre/ swimming pool for patients in Pune (Except in Aditya Birla hospital). So we contacted one of the commercial pool in Kalyaninagar. We explained them the condition of the patient & our objective. Then they gave us the permission. They have given us two lifeguards to help us during training session in the pool.

We were alloted a time of 7 pm to 8pm as the pool was occupied at other times. So, the patients had to adjust accordingly as they were not allowed to come along with regular batches.

Getting in Pool (Transfer)

While going for swimming we had one more challenge of  how to take the patient in the pool (transfer)? So for that I used my Ganpati Transfer method. We made the patient to sit on the thick towel, the towel acted like a sling where the patient was sitting in the centre of the sling. Then two people were holding the towel from the sides, this helped to lift the patient easily.  After lifting the patient we made him sit at the edge of the swimming pool with his legs dangling in the pool. Then he was assisted to slide down in the pool so that he can stand in the pool. This was a very easy and safe transfer.

Swimming with help of raft

Because patient had a poor balance he could not stand in the pool and poor control of Rt (hemiplegic side) he could not swim independently. So we made him lie-down on the Raft with his trunk on the raft. Which helped to control weight of the body and arms & legs were free to move.

As he was able to move the normal upper and lower limb he started to stroking/swing them in the water which helped him to propel his body forward in water. We were assisting the hemiplegic upper and lower limb for stroking/swinging.

This is how we started swimming a patient with head injury with Hemiplegia in the water with help of Raft. We continued this Practice daily evening for about two months (6days/week)

Assisted Walking Training in Water

He was having lot of difficulty in walking  steeping forward on ground, while doing assisted walking with AFO and Long knee Brace on Hemiplegic side. so we started training of assisted walking in water, with hand support. Because of the bouyancy his body weigth was reduced and he could stand in water with minimum assistance, this also helped in stepping forward the hemiplegic leg. It was very easy for him to walk in water with less support.

We were Training him Assisted Walking on ground since 2 months but he could not step forward actively, but after training of walking in water for 1 months he could step forward on ground also with walker without assistance.


Patients with brain injury or stroke patients with loss of consciousness they have multiple problems. Major problem is loss of consciousness, less arousal and alertness. Along with loss sensory motor control. Coma stimulation program emphasis on use of sensory stimuli of different nature. Such as use  of auditory stimuli, olfactory, visual & somato sensory stimulation. These multiple stimuli works but it takes lot of time and slow process. The stimulation or arousal doesn’t persist longer.

During my experiences of treating these patients with brain injury and comatose patients.  I learned that stimulus better and lasting result follow



1.We have to give multiple sensory stimuli simultaneously

2. Stimulus should be able to stimuli larger area of body.

3. Work more on righting reactions.

4.Work reactive postural control stimulation

5.Target more on improving head control and postural control.

6. Work in upright position such as sitting or standing.


7.Working on bed mobility– initially when patients are not able to do it. Do repetitive passive rolling, supine to prone, supine to rolling to sit.

8. Standing – passive standing with maximum support. Either on tilt table or standing with 2 persons support. Use knee support and ankle foot orthosis (AFO).

9. Walking training- start early ambulation. Initially we have to passively assist him in walking.

The key of effectiveness of these techniques are involves the principle of treatment from 1 to 6.

This helps in multiple sensory stimuli, postural control training in upright position, improves reactive control and righting reactions of body. This ultimately improves arousal & Improves motor control and postural control of body.

Nature of handicap of patient with brain lesions:: Bobath Approach

Nature of handicap of patient with brain lesions

 1. Neurophysiological considerations.

  • The physical handicap resulting from a lesion of the upper motor neuron is seen in terms of an interference of normal postural control.
  • We are dealing with abnormal coordination of motor patterns.
  • If we speak of ‘patterns of coordination’, we mean the pattern of normal& abnormal postural control against gravity.

 2. The fundamental problem

  • Abnormal patterns of coordination in posture & movement
  • Abnormal qualities of postural tone
  • Reciprocal innervations.

 3. Abnormal postural reflex activity

  • Associated reactions
  • The effect of released asymmetrical tonic neck reflex activity.
  • The effect of released positive supporting reaction.

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