Conditions we treat

It is when clients are at home that I feel Neurological Physiotherapy has the biggest impact in the rehabilitation process. After the initial shock of the injury, followed by an in-patient rehabilitation programme, clients are discharged home. It is at that point that the true reality of the situation hits and the person’s life has been so incredibly changed. Clients are then mentally and physically ready to adapt to the new challenges they face. With the right input and motivation they are then focused to reach their maximum potential.

Treatment is based on trying to re-educate normal movement, where possible. I use specific handling techniques to re-align muscles and mobilise stiff joints to their correct position. This will allow the individual the possibility to activate the movement for themselves. With lots of repetition this will provide the opportunity for brain re-learning to occur and movements can build up leading to better function. Every movement is a potential exercise if executed correctly. This will ultimately lead to enhanced quality of life.

Stroke (CVA)

A stroke is when the blood supply to part of the brain is blocked usually due to a blood clot (emboli) or a bleed in the brain (haemorrhage). Lack of oxygen to the part of the brain supplied by that vessel results in brain damage.

Strokes can affect people in different ways. No two people have exactly the same set of problems. The problems they present with are directly related to the area of the brain that has been damaged by the stroke. Symptoms can be mild and the person may have been managed medically in the community by their G.P. Other people with more moderate or severe symptoms will have been admitted into hospital and undergone rehabilitation for 3 – 6 months.

Neurological physiotherapy can help people with all levels of stroke. Higher functioning patients can be helped to achieve full function again and realistic goals can be worked towards for more moderate or severe problems.

It is a great myth that you will only get recovery within the brain in the first 6 months following a stroke. Research is now available confirming that the brain is a more flexible structure than first thought. This means that the brain will try to make new connections, around the area of damage, in order to reconnect with your muscles and joints. This will restore function and means movements can be re- learnt. Recovery of movement is possibly quicker in the first 6 months but in my experience it can continue for several years following the initial stroke. I have knowledge of some clients just beginning to walk at 1 year post stroke.

With the endless pressures within the NHS the level of treatment a person receives when discharged from hospital is ever decreasing. Often there is a gap before Community Neurological Rehabilitation Teams begin treatment at home. The team will usually offer treatment for approximately 3 - 4 months. Many clients are told they have ‘plateaued’ towards the end of this time period. Sometimes this may not be accurate, it can be that progress is still occurring but at a much slower rate. It is advisable to continue neurological physiotherapy for as long as recovery is taking place in order to steer the re-building of new pathways in the right direction.

Several factors affect how much recovery occurs and for how long:

  • The severity of the initial stroke.
  • The time elapsed since the initial stroke.
  • How determined and motivated the person is.
  • Compliance with any home exercise programme that is set.
  • The amount of help and support they are given from their family or carers.

It is important to realise that stroke can be a potentially deteriorating condition. If the person is unable to move effectively themselves, joints can get stiff and muscles can tighten. It is therefore important to maintain what function they have already achieved. This can be done either through a home exercise programme that is reviewed at intervals, or more regular physiotherapy sessions if they are unable to complete exercises independently.

Your neurological physiotherapy session will be tailored to your individual needs. Whether you require a short course of treatment to bridge the gap between hospital discharge and community services, or you require regular rehabilitation, or maintenance. Your needs will be discussed at the assessment and catered for.

An essential part of a neurological physiotherapist’s role is not only physical but to understand the psychological impact that the Stroke has left. I am there to support and encourage the person while ensuring that they do not lose sight of their goals.

Spinal Cord Injury (SCI)

Spinal cord injury can occur for many different reasons. It can be due to illness e.g. tumors or a traumatic event e.g. breaking your neck. Both can result in the spinal cord being severed either completely (complete injury) or partially (incomplete injury). This results in loss of feeling and movement below the area of damage. If the damage is in the neck this will affect the arms, legs and trunk (tetraplegia/ quadriplegia), or if the damage is in the middle or lower back then the legs and pelvis (paraplegia) will be affected. However, one side of the body can be more affected than the other and with incomplete injuries part of the spinal cord will still function and this can give mixed symptoms.

As each injury is different no two people have the same symptoms.

Treatment is tailored to your needs but could be aimed at:

Complete injuries

  • Reducing secondary problems occurring e.g. muscle shortening and loss of movement in joints.
  • Maintaining the movement that exists.
  • Strengthening weak muscles and discouraging altered movement strategies from occurring.
  • Reducing muscle spasms.
  • Implementing a standing programme.
  • Postural re-education and positioning advise.
  • Promoting independence.
  • Maintaining good respiratory function.
  • Teaching of family/carers on moving and handling techniques and stretches.
  • Improving quality of life.

Incomplete injuries

  • Re-educating normal movement and preventing compensatory strategies from developing.
  • Strengthening weak muscles through specific exercises and task specific practice.
  • Preventing muscle tightness and joint stiffness.
  • Reducing hypersensitivity pain through handling techniques.
  • Implementing standing practice into daily life.
  • Promoting independence and progressing functional ability.
  • Teaching of stretches to family and carers.

Recovery from spinal cord injury can take many years. After the initial in-patient rehabilitation period you are discharged home. Provision for ongoing physiotherapy is often poor and the person can find it difficult to adjust. Neurological physiotherapists understand the client’s problems and the impact this has on their everyday life. It can often feel as though the person knows more about their condition then other health professionals that they come into contact with. This can be very lonely. Neurological physiotherapy helps to motivate clients to keep working hard while supporting you and understanding the difficulty’s you face.

Parkinson’s disease (PD)

Parkinson’s disease is caused by a lack of neuro-transmitter (dopamine) within part of your brain. This means that signals do not pass from one nerve cell to another. It can therefore be very difficult to start or stop movements. Symptoms vary from person to person and can include:

  • Problems starting and stopping movements
  • ‘Freezing’ when walking.
  • Stooped posture.
  • Gait problems.
  • Balance problems.
  • Tremors.
  • Muscle spasms.
  • Stiffness of muscles and joints.
  • Impaired sensation.
  • Difficulty getting in and out of bed, or moving from sitting to standing.
  • Difficulty with handwriting.
  • Difficulty dressing and undressing especially with buttons.
  • Slowness of movement.
  • Breathing problems.
  • Speech problems.

Neurological Physiotherapy can help to:

  • Reduce tightness in muscles and relieve associated pain.
  • Mobilise stiff joints.
  • Improve posture through re-education and muscle strengthening.
  • Teach movement strategies for functional tasks.
  • Balance re-training.
  • Gait re-education.
  • Improve breathing.
  • Maintain independence and prevent deterioration.

It is useful to assess people diagnosed with Parkinson’s disease as early as possible. This allows me to identify and treat any smaller problems that arise and prevent them developing into larger functional issues. Clients usually undergo a short course of treatment followed by completion of home exercise programme independently. This is then reviewed at 6-8 week intervals and relevant changes are made.

Multiple Sclerosis (MS)

Multiple Sclerosis is a problem affecting the conduction of nerve impulses. The ‘insulating’ sheath around the nerve (myelin sheath) becomes inflamed and breaks down. This causes gaps to develop in the sheath and affects the speed and efficiency of the signal being transmitted. Signals are either delayed or do not reach the muscles at all. All areas of the body can be affected, from the arms and legs, to speech and memory problems. This may be happening at different speeds which account for the different types of MS. These are:

  • Relapsing /remitting – the persons experiences ‘bouts’ of reduced function
  • Progressive – Symptoms never go away and steadily increase.
  • Secondary Progressive – this is when relapsing/remitting MS changes into a more progressive type.

Neurological physiotherapy can help to:

  • Manage symptoms and maintain current functional levels.
  • Stretch tight muscles and reduce muscle spasm.
  • Mobilise stiff joints.
  • Re-educate function through facilitation of specific functional tasks.
  • Postural advice.
  • Promote independence
  • Advice regarding splints and aids that maybe appropriate.
  • Teach carers and family relevant stretches and handling techniques.

It is never too early to begin neurological physiotherapy. The earlier you begin after your diagnosis, the easier it is to begin maintaining yourself. Knowing how MS is affecting you physically and which exercises and activities are right for you, is vitally important. Any problems can be picked up at an early stage and treatment can begin. This makes it easier to rectify problems. It is often useful to have a short course of Physiotherapy initially followed by a home exercise programme completed independently. Clients are then reviewed at 6-8 week intervals in order to monitor any change in condition and exercises are amended as needed. If the individual experiences a relapse or new problems develop then a short course of neurological physiotherapy is often beneficial.

Traumatic Brain Injury (TBI)

Brain injury occurs usually when there is a sudden trauma to the head e.g. a sporting accident, vehicle accident or violent assault. TBI can also occur due to a tumor or haemorrhage. The symptoms of a brain injury are vast and can include movement problems, cognitive and speech problems, and also emotional changes. Usually several health professionals, as well as a Physiotherapist, are involved with the person e.g. Consultant, Speech Therapist, Occupational Therapist, Social Worker and often a Case Manager. It is vital that good communication is established between all professions involved in order to provide the best care and meet the needs of the individual.

As each person with a TBI is different a full assessment of their problems is carried out. Treatment will involve re-aligning of muscles and joints through specific handling techniques in order to provide the correct sensory input. This will allow the individual to experience normal movement and join in the movement actively for themselves. Treatment plans are tailored to the person’s cognitive abilities and level of support they possess. It is often useful to work closely with family and careers in order to ensure a consistent approach of handling and positioning is maintained throughout the 24 hour period.

Vestibular Problems

Vertigo (dizziness) is a very unpleasant symptom that can occur rapidly and can affect someone’s life with devastating effects. People who suffer from dizziness lose confidence as normal everyday activities exacerbate their symptoms.

Vertigo can be due to a problem with the brain (following TBI, tumor, illness etc.), because of a disturbance of our internal balance mechanisms in the inner ear or a problem with the vestibular nerve that has been damaged following a virus (vestibular neuritis).

Fluid within the ear canals detects movement of the head and feeds this information back to the brain via the vestibular nerve. Crystals (that are normally present) can move into the wrong ear canal and cause altered signals to be sent to the brain (Benign Paroxysmal Positional Vertigo). This can make you feel like you are spinning when you aren’t actually moving.

Firstly, neurological physiotherapy would help to identify what is causing the vertigo. Then, using a series of exercises to challenge the vestibular system the problem can start to improve. However, it is a common misconception that to bring on the dizziness is making the problem worse. Clients need to challenge their vestibular system in order to facilitate its recovery. However this needs to be in a controlled manner as it can feel quite unpleasant.

Clients often avoid moving their neck and this can result in stiffness. It is therefore very important to ensure that the individual’s neck movements are preserved.

Balance Problems

Problems with balance are frequently seen with a variety of conditions. The cause of the problem can be complex and due to many factors. Often poor sensation and joint position sense in the feet can be seen e.g. peripheral neuropathies. This associated with possible muscle weakness can cause a person to fall. As we get older these problems become more common place due to other medical conditions.

Neurological physiotherapy can help to improve your balance. Through specific exercises and rehabilitation your balance systems can be challenged. This, alongside, use of appropriate aids can reduce the risk of further falls. It may also be useful to practice getting up from the floor to ensure the individuals safety.

Bell’s Palsy

Bell’s palsy is caused by a virus that attacks the facial nerves. Usually the person has had a cold and gradually a facial weakness develops. The muscles become weak and cause asymmetry. The individual’s eye may not close and they may have problems with speech and eating or drinking. Usually one side of the face is affected. This is very distressing for the individual and can affect their confidence. They may not want to leave the house or socialise.

Neurological physiotherapy can advise you about how to manage with the problems at this acute stage. Stretches to the tight muscles on the ‘unaffected’ side of the face help to regain symmetry. With specific sensory stimulation and exercises, muscles gradually become more active. A muscle stimulator can be used at home to help strengthen muscles along with a daily exercise regime.

Clients should seek a neurological physiotherapist’s assessment as soon as the GP has diagnosed Bell’s palsy. The sooner rehabilitation can commence the sooner recovery can begin.

To contact us for an appointment or regarding any queries please call 07816 768456 or email info@dawnburrow-neurologicalphysiotherapyservice.co.uk

Stroke (CVA)
Neurological Physiotherapy
Treatment is based on trying to re-educate normal movement, where possible.

Parkinson’s Disease (P.D)
Parkinson’s Disease
Parkinson’s disease is caused by a lack of neuro-transmitter (dopamine) within part of your brain.
Spinal Cord Injury (SCI)
Spinal Cord Injury (SCI)
Spinal cord injury can occur for many different reasons.

Multiple Sclerosis (MS)
Multiple Sclerosis (MS)
Multiple Sclerosis is a problem affecting the conduction of nerve impulses.