Advancing Neurological Rehabilitation: The BRAIN Framework for Clinical Reasoning in Neurophysiotherapy

Background/Objectives: Clinical reasoning is essential in neurological rehabilitation, in which patient management is complex and multifactorial. However, existing models lack operationalization for neurophysiotherapy practice. This paper proposes the Biopsychosocial Reasoning Approach In Neurophysiotherapy (BRAIN) framework, a unified clinical reasoning model that integrates the International Classification of Functioning, Disability, and Health (ICF) with neurophysiotherapy-specific domains of physical function. Methods: The BRAIN framework was developed by integrating previously validated models: the ICF, the American Physical Therapy Association (APTA) patient-management process, and Kisner and Colby's interrelated aspects of physical function, adapted for neurological populations. The model employs a biopsychosocial, patient-centered, and goal-oriented approach, thereby providing a structured workflow for examination, evaluation, diagnosis, prognosis, intervention, and outcomes assessment. Results: The BRAIN framework provides an operationalized mapping between ICF body functions and neurophysiotherapy-specific impairment domains, a clear separation between body functions and body structures, tiered assessment pathways addressing patient heterogeneity, and a unified language for interdisciplinary communication. The model incorporates shared decision-making and goal-oriented reasoning within the clinical workflow. Conclusions: The BRAIN framework offers a structured, teachable template for clinical reasoning in neurological physiotherapy. As a theoretical proposal, there is a need for empirical validation through expert consensus and clinical implementation studies.