So What Is Neurological Physiotherapy?

There are many different specialist areas of physiotherapy including neurological, orthopaedics, musculo-skeletal, surgical, respiratory, paediatrics and elderly care to name but a few! Each one requires years of working alongside colleagues in that particular field of physiotherapy, gathering knowledge, skills and experience as well as attending courses at post graduate level to become a specialist in that area.

Neurological Physiotherapy is a specialist area of physiotherapy which focuses on the treatment of individuals with neurological conditions and disorders that impact the functioning of the brain, spinal cord, and nerves. There are many neurological conditions including stroke, multiple sclerosis, Parkinson`s disease, acquired brain injuries, spinal cord injuries, transverse myelitis and motor neurone disease and many, many others.

Neurological conditions can result in a wide variety of symptoms:

• Weakness; when there is damage to the brain, spinal cord or nerves there is an interruption of the signals that instruct the muscles to move which leads to weakness. There is no damage to the muscles themselves.
• Changes to muscle tone; high tone (hypertonia) is an increase in the tension within the muscles which makes it difficult for them to relax. This can make normal movements difficult to achieve and potentially lead to contractures whereby joints can become “stuck” in a fixed position. Low tone (hypotonia) is a reduction in the tension within the muscles which results in reduced strength and again, difficulty in carrying out functional tasks.
• Changes to sensation; This can range from a complete absence of sensation ( the ability to recognise touch) to a change in sensation such as tingling, or a “dull” feeling when being touched.
• Changes to proprioception; proprioceptors are specialised cells which detect movements and inform our brain of where the body is in space. They are crucial for balance and an awareness of our movement.
• Rigidity; this is when muscles become stiff or inflexible, it can stop your muscles from stretching and relaxing which can lead to pain, muscle cramps and problems with balance.
• Fatigue
• Visual disturbances; double vision, loss of peripheral vision or blind spots can be some of the symptoms.
• Pain; this can be due to various reasons including neuropathic pain caused when areas of the brain that interpret pain are damaged.

All of the above can contribute to difficulty in moving effectively and complete your normal day to day activities.

• Walking patterns can be affected making walking more effortful and tiring
• There may be an increased risk of falling
• Transfers may be difficult, for example getting in and out of a bed or chair
• There may be reduced arm and hand function
• Difficulties with every day tasks for example cooking, taking a shower

Treatment modalities utilised in neurological physiotherapy include:

• Bobath concept; developed by Dr and Mrs Bobath in 1948 this focusses on using hands on therapy to regain normal movement patterns.
• Postural management; promoting a symmetrical posture is very important and we look at positioning in bed, armchairs and wheelchair. We can advise on specific products where necessary to help achieve this, for example Simple Stuff Works.
• Exercise programmes; to improve strength, flexibility and balance.
• Gait retraining: to improve walking patterns, advise on appropriate aids
• Falls prevention; this may include exercises for strength, balance and co-ordination, advice on your environment for example reducing trip hazards
• Muscle stimulation; there are several battery operated devices available that can sometimes be helpful in stimulating a muscle contraction. This can assist in promoting movement, maintaining or improving joint range of movement and maintaining muscle length.
• Lycra garments; lycra garments can sometimes be helpful as they provide compression to an area of the body. This can help to normalise muscle tone
• Botox injections; Botox can be injected into specific areas of the body to reduce tone and tightness. Normally we would liaise with a specialist clinic to carry out the injections.
• Advice on orthotics; splints can often be beneficial on maintaining or improving the range of movement at a joint or relieving pain.

At NTRehab we specialise in the treatment of people diagnosed with neurological conditions.

About the Author – Jane Creed MCSP SRP
Jane qualified as a chartered physiotherapist in 1992 and worked in the NHS for 15 years before going into private practice. Jane specialises in neurological rehabilitation and has completed many post graduate courses including advanced Bobath.
Jane is a member of ACPIN (associated of chartered physiotherapists in neurology) and the HCPC (health and care professions council).

Visit Jane’s LinkedIn profile: www.linkedin.com/in/jane-creed-ntrehab