1. Criteria for classification of neurophysiological and motor learning approaches.

Name of approach	Philosophy/theory	Treatment principles	Descriptive terms	Supporting references
Rood (neurophysiological)	Concerned with 'the interaction of somatic, autonomic, and psychic factors, and their role in regulations of motor behaviour'. Motor and sensory functions inseparable Focuses on the developmental sequence of recovery and the use of peripheral input to facilitate movement	Activate/facilitate movement and postural responses of patient in same automatic way as they occur in the normal Sequencing of movement from basic to complex (supine lying; rolling; prone lying; kneeling; standing; walking) Sensory stimulation (brushing, icing, tapping, pounding, stroking, slow stretch, joint compression) to stimulate movement at automatic level	Ontogenetic sequences Developmental sequences Postural stability Normal patterns of movement Joint and cutaneous receptors Golgi tendon organs Abnormal tone	Goff 1969; Rood 1954; Stockmeyer 1967
Proprioceptive neuromuscular facilitation (PNF) or Knott and Voss (neurophysiological)	Active muscle contractions intended to stimulate afferent proprioceptive discharges into the CNS increased excitation and recruitment of additional motor units Assumes that central and peripheral stimulation are enhanced and facilitated in order to maximise the motor responses required Cortex controls patterns of movement not singular muscular actions Necessary to return to normal developmental sequence for recovery	Diagonal and spiral patterns of active and passive movement Quick stretch at end of range to promote contraction following relaxation in antagonists Maximal resistance is given by therapist to facilitate maximal activity in the range of the required movement. Voluntary contraction of the targeted muscle(s) Manual contact and therapist's tone of voice to encourage purposeful movement Isometric and isotonic contractions, traction and approximation of joint surfaces to stimulate postural reflexes	Patterns of movement Stretch and postural reflexes Manual pressure Isometric and isotonic contraction Approximation of joint surfaces Afferent input	Kabat 1953; Voss 1967
Brunnström (neurophysiological)	Uses primitive reflexes to initiate movement and encourages use of mass patterns in early stages of recovery Aims to encourage return of voluntary movement through use of reflex activity and sensory stimulation Assumes recovery progresses from subcortical to cortical control of muscle function Stages of recovery: flaccidity; elicit major synergies at reflex level; establish voluntary control of synergies; break away from flexor and extensor synergies by mixing components from antagonist synergies; more difficult movement combinations mastered; individual joint movements become possible; voluntary movement is elicited	Use tasks that patient can master or almost master. Sensory stimulation: from tonic neck or labyrinthine reflexes, or from stroking, tapping muscles	Normal development Sensory cues Synergies Primitive reflexes Tonic neck reflexes Associated reactions Movement patterns Mass patterns Tactile, proprioceptive, visual, auditory stimuli	Brunnström 1956; Brunnström 1961; Brunnström 1970; Perry 1967; Sawner 1992
Bobath or neurodevelopmental approach (NDT) (neurophysiological)	Aim to control afferent input and facilitate normal postural reactions Aim to give patients the experience of normal movement and afferent input while inhibiting abnormal movement and afferent input To improve quality of movement on affected side, so that the 2 sides work together harmoniously Assumption that increased tone and increased reflex activity will emerge as a result of lack of inhibition from a damaged postural reflex mechanism. Movement will be abnormal if comes from a background of abnormal tone Tone can be influenced by altering position or movement of proximal joints of the body	Facilitation of normal movement by a therapist, using direct handling of the body at key points such as head and spine, shoulders and pelvic girdle and, distally, feet and hands Volitional movement by patient is requested only against a background of automatic postural activity NB. Techniques of treatment have changed over time; more recently they have become more active and functionally orientated However, there is a lack of published material describing the current treatment principles of the Bobath approach More recently (October 2000) it has been emphasised that the concepts of the Bobath approach 'integrate with the main ideas of motor learning theory', and that advocated key treatment principles include active participation, practice and meaningful goals (Mayston 2000)	Normal movement Abnormal postural reflex activity/tone Postural control Key points Reflex inhibitory patterns	Bobath 1959; Bobath 1966; Bobath 1970; Bobath 1978; Bobath 1990; Davies 1985; Davies 1990; Mayston 2000
Johnstone (neurophysiological)	To control spasticity by inhibiting abnormal patterns and using positioning to influence tone Assumes that damaged postural reflex mechanism can be controlled through positioning and splinting Based on hierarchical model that assumes recovery is from proximal to distal Aim to achieve central stability, with gross motor performance, before progressing to more skilled movements Inflatable air splints: apply even, deep pressure to address sensory dysfunction	Use of inflatable splints Emphasis on correct position and use of splints Early stages: patient in side lying, with splint on affected arm Treatment progresses through hierarchy of activities, progressing from rolling through to crawling Family involvement encouraged	Muscle tone Air/pressure splints Positioning Reflex inhibition Tonic neck reflex Anti‐gravity patterns	Johnstone 1980; Johnstone 1989
Carr and Shepherd or motor learning or motor relearning or movement science (motor learning)	Assumes that neurologically impaired people learn in the same way as healthy people. Assumes that motor control of posture and movement are interrelated and that appropriate sensory input will help modulate the motor response to a task Patient is an active learner Uses biomechanical analysis of movement Training should be context‐specific Essential for motor learning: elimination of unnecessary muscle activity; feedback; practice Focus is on cognitive learning	(1) Analysis of task (2) Practice of missing components (3) Practice of task (4) Transference of training Biomechanical analysis with movements compared to the normal Instruction, explanation and feedback are essential parts of training Training involves practice with guidance from therapist: guidance may be manual (but is used for support or demonstration, not for providing sensory input) Identifiable and specific goals Appropriate environment	Motor control Motor relearning Feedback Practice Problem solving Training	Carr 1980; Carr 1982; Carr 1987a; Carr 1987b; Carr 1990; Carr 1998
Conductive education or Peto (motor learning)	Aims to teach patient strategies for dealing with disabilities in order to encourage them to learn to live with or overcome disabilities Integrated approach emphasising continuity and consistency Assumes that feelings of failure can produce a dysfunctional attitude, which can prevent rehabilitation Teaches strategies for coping with disability Active movements start with an intention and end with the goal Conductor assists patient to achieve movement control through task analysis and rhythmical intention or verbal reinforcement Emphasis on learning rather than receiving treatments	Educational principles and repetition used as a method of rote learning Highly structured day Group work Task analysis Repetition and reinforcement of task through rhythmical intention or verbal chanting Activities broken down into components or steps Patient encouraged to guide movements bilaterally	Education Rhythmical intention Intention Integrated system Group work Conductor Independence	Bower 1993; Cotton 1983; Kinsman 1988
Affolter (motor learning)	Interaction between individual and environment fundamental part of learning Perception seen as having an essential role in the cycle of learning Incoming information is compared with past experience ('assimilation'), which leads to anticipatory behaviour Assimilation and anticipation seen as basic for planning and for performance of complex movements Feedback is important to learning process	NB. This approach started from theory, rather than from clinical practice Starting at an elementary level, there will be no anticipation The patient starts to initiate more steps There is increased anticipation of the steps to be taken As experience increases, the patient will start to search for missing objects The patient is able plan more than 1 stage ahead and can perform new sequences if functional signals are familiar Not only can the patient think ahead but is able to check all the steps of the task in advance	Perception Assimilation Anticipation Complex human performance	Affolter 1980
Sensory integration or Ayres (motor learning)	Functional limitations compounded by sensory and perceptual impairment Sensory feedback and repetition seen as important principles of motor learning	Sensory feedback Repetition	Sensory and perceptual impairment Behavioural goals Feedback Repetition Adaptive response	Ayres 1972

The criteria listed in this Table are those used in previous versions of this review. These criteria are not used in this updated version of the review. (See Table 5 for the criteria used for classification of interventions within this updated review).