Physio for Stroke, Head Injury, Parkinson's Disease, Spinal Cord Injury

Help with fear of falling

Wed, 06 Sep 2023 11:59:02 GMT

Being afraid of falling so much or so frequently can dominate after Stroke

These exercises can be used by anyone with that sense of falling or being unsafe. After stroke your body often tells you you are falling when you're not actually falling. Also it may not tell you you are falling when you are. One component of this problem is the self righting mechanism of the eyes. And of course there are other parts to the same problem, including altered reflexes, loss of strength, altered feedback of sensation and many more.

Question is though, what can be done ? These exercises can be done by anyone, including sitting in a chair, or even lying on a bed. They often need quite a bit of persistence to master, but are WORTH it ! Have a go and let us know how you have got on.

Using electrical muscle stimulation to help shoulder pain after stroke

cmackellar@uwclub.net (Campbell MacKellar) — Thu, 22 Sep 2022 10:53:08 GMT

The Neuro Trac Rehab muscle stimulator is very straightforward to use regularly

Shoulder pain after stroke is a big problem. The stats say that 7/10 people with arm problems after one have shoulder pain. Some of these are due to the upper arm bone (humerus) dropping slightly in the shallow socket where it normally sits.

Using a trophic stimulator, also known, just to keep us on our toes, as an EMS or electrical muscle stimulator, can help re activate the shoulder muscle around that joint. For some this will reduce or even eliminate the pain they get.

The video here shows probably the best result I have witnessed on this problem, and the gent involved certainly got the benefit. Worth a try, as a gadget like this is probably around the £40 to £80 mark.e body content of your post goes here.

The Seven Secret Esses of Training

cmackellar@uwclub.net (Campbell MacKellar) — Wed, 21 Sep 2022 06:44:05 GMT

There aren't Seven, they're not very secret and don't all start with an S. Read on...

I hope you like the title... Actually there are at least Nine ! Whether you are training for the Tour de France or a local athletics club event, you're recovering from a Stroke, or you just want to exercise more for your health, you can do it better by adding variety. It'll be more fun and more effective. It is meant to be fun after all. Even if you're lucky enough to get paid for it.

I have put some videos up on Facebook about this and they have good solid content... they just might not be as entertaining as "Titanic". Certainly not as popular. More useful. Shorter, thankfully.

So here goes.

Stamina. Well what can you say about stamina training ... surely not much to say... you get on your bike, go for a run long and steady, get in the pool and plough up and down don't you ? Yes you do.... but if you leave it there then you have missed a trick. The great Canadian physiologist, John Douillard teaches a breathing technique that IMHO should be in everyones' skill set.

He calls it Darth Vader breathing. Just copy and paste that phrase into youtube and try to copy it... then try to gently exercise using it. First make sure you ( best done on a turbo trainer ) can take your pulse while exercising at a pre set and repeatable resistance.

Then learn the Darth Vader exercise and practice using it while you get used to exercising while you breathe in that way. Simples. What you will find is that your heart needs to work a lot less for the same workload. A little bit of magic.

Nearly everyone does far too much stamina work and not enough of the other. If performance of interest to you, whether you're a runner, cyclist or swimmer then aim for more variety. For most of us, a long period of exercise is only needed once a fortnight. By that I mean bike rides over 20 miles, runs over 5 miles, swimming over a mile.

If you are in the higher echelons of sport you can disregard those numbers, they are different for you. But most of them will still be over doing the long slow stuff.

Strength. Strengthening exercise needs to be quite specific to the sport. If you are a runner then running against resistance... towing a car tyre is often used. On a bike ride up a hill in too high a gear. You don't need to use a massive resistance to get an increase in strength.. but if you use a lower resistance you need to do it for longer. You still get more strength.

Speed. On a bike you need to make your legs go faster until you start to bounce in the saddle, repetitively. in bursts. I do mine under a doorway and reach up to fix my hands on the lintel. Less bounce more speed. Runners.... run down hills as well as up. Near my house there is a lovely wood with a good path through it. There's a section of about 150 metres where the track goes down hill and then back up. Not steep. Down hill I can run faster than I ever can on the track, no surprise. The uphill slows me down nicely without going base over apex. Olympic sprint winner Alan Wells was one of the first to really do a lot of arm work, particularly a boxing exercise with a speed bag. He was pretty good. Has faced a lot of allegations about steroid use. I have no idea whether guilty or not, but the exercise would, in fact, be quite sufficient on it's own. Controversial.

Skill. The last exercise is also a skill one. As is pedalling with one leg. Runners; do some work on form, arm form, striding, bounding and hill reps too.

Surge. Also known as plyometrics, essentially it's practicing accelerations... from medium to nearly flat out and with a little too much resistance for comfort ! If it won't upset the neighbours, practicing standing broadjumps ( a bunny hop if you like ) up the stairs. With practice you should be able to jump the height of your inside leg. Maybe more. Consider wearing shin pads, especially if you are not used to doing this kind of thing.

Suppleness or Stretch. This is important and counts as a training session. Which means that you need to recover after it. This is not to be done immediately prior to a different category of training or a race. You can do some light stretching before ordinary exercise, but don't work at it like you are trying to increase your base line range of movement. Too late for that just before competition.

Sychology ( sic ). Well it sounds like an ess. Motivating the highest performers is not a job for a short article like this. For the rest of us its about keeping it fresh and fun. So lots of variety is the way. With friends. Without. Indoors. Outdoors. Circuit or Gym training . Classes like spin for example. Ride a bike. Run. Swim. Play a game. Consider training with someone like me who has a great sense of humour and is really fun to be with. Well it said so on my Veggiedate.org web profile. So it must be true, right ? The lady I married in 2005, a consequence of that might disagree. But we are still married and still talking to each other. Result.

There is interesting research about now, showing the dramatic jump in pace that people can tolerate in competition. So practicing competitions may in itself provide some of the boost needed to sharpen your performances, if performance is indeed your goal.

The Eighth secret S is Sustenance ...food. I recommend only eating things that you can recognise what plant it came from. Cook in water, steam or bake. Using oil adds calories you can't use well and removes too much water from the food itself, as you are cooking at artificially high temperature. Meat is not necessary to live on, so if you eat it do so sparingly. Anything from the dairy is not necessary. Humans are the only species to take milk from another species, and consume as adults. It isn't a good source of calcium either. Western society is facing an epidemic of osteoporosis and is consuming dairy like it's going out of fashion. Which it also is.

Sleep. Sleep is a marvellous thing. If you are a parent you don't need this pointing out. Its great if it's you and it's great if other people ( especially the little ones ) are doing it. If you are not a parent, learn to treasure it. Many of us treat sleep like an inconvenience ( well I was young once too ) . Actually sleep is an amazing resource for the keen competitor and those recovering from illness. During sleep the whole hormone balance in your body changes, improving repair and response to training. Team Sky, love em or hate em, know STUFF. They even used to take their own mattresses to Hotels, to maximise the benefits of sleep.

I can't recommend it, but have to note that some of my own best performances, have been after a really rubbish night's sleep. So figure that out if you can. So I am glad to be of the opinion that there is still a little bit of magic to be figured out about how humans tick.

More research needed then.

sFun. Short for it's fun. I hope you didn't come here for the jokes, as they are pretty much in the category of "Dad Jokes" . I allow myself this little luxury as being a Dad has taught me a lot.

Helping people see better

Tue, 15 Feb 2022 14:12:01 GMT

How to help navigate after a stroke. Do people get lost ? In their own home ?

I have been helping this lady with walking practice and she was having difficulty placing the stick in the best place for helping the balance.

Adding coloured strips to shoe and stick helped to line things up, and made balance safer.

I also recommend using similar ideas for brake levers on wheelchairs, which are invariably difficult to see against a bland background. Same goes for the release levers on the footplates, which can be equally hard to spot. Why are they made this way ? No matter as it's an easy one to improve. Try it and let me know whether it helps.

This is one of the many ways your local friendly physio can help. It isn't always just about exercises, sometimes little changes to your surroundings are enough to improve perception, and hence to improve function.

I do think that these ideas can help people so that they don't get lost in their own home. By that I mean making mistakes in judgement when moving, most commonly when trying to get through a doorway, and not leaving enough room to one side. Again get some advice on how to prevent this. Just ask.

Thanks, Andy

An early attempt at a video CV for Andy

Fri, 13 Nov 2020 12:43:20 GMT

Video CV may well prove a bit less dry than the paper versions

I have reviewed lots of other peoples CVs in the past, and always found it hard to get a real idea of the person behind it. Here is my own first attempt at an improvement.

All kinds of exercise

Fri, 03 Jul 2020 17:40:35 GMT

The Seven Main Kinds of Exercise to do after Stroke or Head Injury

There are Seven main elements to any exercise programme. Whether you are a top flight sports person, or someone recovering from major illness or injury, your exercise plan needs to include exercises that do all of these things.

It's going to vary according to the level that you are already at, and of course what the aim is. For some, your aim might be to walk ten metres, for others it might be to run a four minute mile. The advice works for everyone.

The seven points to ponder are:

1. Stamina.

2. Strength

3. Speed

4. Suppleness ( stretch )

5. Surge ( plyometrics )

6. Skill

7. pSychology ( meditation, cognitive therapies etc.)

8. Sustenance ( nutrition )

9. Sleep !

That's right Nine. And if anyone can suggest more I would be happy to listen. I still call it the Seven Secret S's though, as only 7 of them include exercise forms.

How to treat shoulder and neck problems. Method 7

Wed, 10 Jun 2020 10:54:35 GMT

Here we look at some of the home treatment methods that can be tried.

A simple home treatment method for sore necks and shoulders. If you want to try this kind of self treatment you will need guidance with this, so drop us a line and we can meet by video link. Our video link is totally secure, but needs no knowledge of adding software to your computer, phone or tablet.

How your neck and shoulders work

Wed, 10 Jun 2020 10:19:40 GMT

It's an amazing system. Here are some key points to ponder when it comes to exercises and manipulations of the neck and shoulder.

If you learn a bit about how you are built, we think it will be easier to follow home exercises and self treatment procedures that we teach people to use at home. We'd love to improve these as always, so do share your criticisms and ideas. We won't take it personally. We'll just make it better.

Remote working by video link

Sat, 09 May 2020 09:20:35 GMT

This is a subtitle for your new post

We've been working with video exercise "handouts" for the last 12 years, so it was a relatively straight forward adjustment to maximise this element when the Corona virus lockdown started. We still visit some of our patients, but many are benefitting from Skype, What's App and Zoom calls.

We also have our own system built into our notes system that requires no knowledge of programmes to download or other hurdles with the famous systems mentioned.

The software company that runs the system has even featured us in a case study about using this kind of working. It's helping us now, as we all live with the lockdown situation, but we think it will become part of the future anyway. That's because it's better in some ways.

By that I mean that we can easily add in a 10 minute consultation by video link on a day when we wouldn't plan a full visit, which takes an hour in your home, and probably adds at least half an hour travel time to our day. It can just help to check that a home exercise is being done accurately, and encouraging enough to help people really get stuck in to their rehabilitation at home.

And in a more independent way than if we are there with you. So we think that it will change our working practices for the better in future.

Big Toes and Walking

Fri, 03 Apr 2020 07:49:28 GMT

Who knew there was so much to say about big toes ?

Who knew there was so much to say about your big toe ? The joint that attaches your toe to the main part of the foot is key to walking. So it needs to be flexible enough to provide the propulsion stage of walking.
This clip shows how you can have a go at improving the range of movement in the big toe joint, and the effects ought to be two fold.
One is improvement in any pain that you experience and the other is to have better gait or style when walking.
Do send your comments and share your experience if you try this at home.

Neurotrac Rehab Muscle stimulator

Mon, 02 Mar 2020 18:58:50 GMT

More than a year after stroke, new treatment approaches can start a new level of recovery.

One of my favourite electronic muscle stimulators is the Neurotrac Rehab. It's very cost effective at around the £90 mark, but under the bonnet its surprisingly adaptabel, with 19 programmes for stimulating muscle recovery after stroke, to TENS signals for pain relief. TENS has in my experience been one of the most effective treatments for Thalamic or Central post stroke pain.

It doesn't necessarily completely take away the pain, but is very safe and has no side effects in itself.

The worst I have seen is a light rash, simply down to a reaction to the glue in the self adhesive electrode pads that stick on to the skin. The few that I have seen this happen to have all been able to continue after switching brands of the electrodes themselves.

Walking aids used in stroke and head injury treatment

Wed, 26 Feb 2020 11:36:06 GMT

Standard height walking sticks or tripods used to help walking after stroke and head injury, can create as many problems as they solve. Here is one alternative that might suit some people.

Walking sticks, tripod sticks elbow crutches and their like that are set at standard wrist height to help walking after stroke or head injury, can encourage the user to stoop slightly, and fix rigidly to the handle. This often creates a feeling of some safety during walking and standing, but using fixation as a strategy can have it's problems.

The beauty of human walking is it's effortlessness, flow and grace. It's incredibly efficient. Some people will always need some form of support for their work on walking, but when possible to progress to free walking, the high stick shown here can be a good thing to try, when transition away from plain sticks and tripods is on the cards.

Red Flags in Pain relief treatment.

Thu, 23 Jan 2020 10:09:30 GMT

This one way of treating long standing pain in people who've had a stroke.

When not to start pain relief treatment with Physiotherapy, Osteopathy, Chiropractic or other manual therapy. If you have these symptoms it's best to start with a trip to the GP.

These are usually known as red flags.

If you have:

Weakness or loss of movement of a body part... most common is the loss of ability to lift the toes and foot.

Loss of control of bladder or bowel. Either going too easily or if it's become more difficult.

Fever. High temperature that started around the time of the pain. Either can appear first.

Saddle anaesthesia . Pins and needles or numbness between the legs, where a bicycle saddle would be.

No change when you lie down or other main change of position. If movement or change of position doesn't alter your pain, up or down, then manual therapy probably isn't the place to start. Manual therapy can start after the trip to the Doctor.

Age . Back pain without a really obvious sudden cause, is really rare in under 20's and over 55's. When did yours start ?

Unexplained weight loss . If you're not trying to lose weight already and you have dropped a size or more in clothing. If the waist band steadily became loose ? See the GP first.

Major Trauma . If you have had a big fall.... off a horse, bike, or a car accident, it's good to have some tests like X-ray or scan before manual therapy.

Night pain . If pain wakes you, and it's not obviously because you moved suddenly, then check with your Doctor.

Mid back pain . Most back pain is in the low back or in the neck area. In the middle, between and below the shoulder blades sometimes means start at the Doctors. Check.

Rheumatoid Arthritis . If you have this most manual therapy is likely to aggravate. Nerve stretch work can be helpful, but you would need to be guided through this, don't try following home programmes.

Morning Stiffness. If it takes more than half an hour or so to get rid of morning stiffness after sleeping, then you will need a blood test from your Doctor and the right kind of physiotherapy work, which will be more exercise based than about joint manipulations.

So why would I write about this when Ships Physio is all about stroke and head injury ? Well it's just that we do use all the same techniques and ideas as our colleagues over in Musculo- Skeletal physio departments. I think that 8 out of 10 of " Neuro " patients have a problem with pain. The next couple of posts are about reducing Sciatic type pain, so this part about Red Flags is meant to stop people using home treatment unwisely.

How balance works in people. Use this to learn balance or find out how to help someone else.

Thu, 16 Jan 2020 15:01:03 GMT

How poor balance can be treated after stroke or head injury.

If you want to try some of this at home make sure you get some help first. If you just have a go at this unsupervised it's likely you will fall over. This gives an overview, and doesn't take you through the whole process to get to this standard.

More on Electrical Muscle Stimulation

Wed, 08 Jan 2020 10:13:15 GMT

One advantage of the Neurotrac Rehab Muscle Stimulator

One advantage of this smaller version of the Neurotrac Trophic Stimulator, is that as a very portable and wearable stimulator, it can have an external switch. The switch can be pressed to activate the shin muscles lifting the foot at exactly the right moment to help swing the leg through during early attempts at walking after a stroke.

A little later on an automated version can help further.

But for people who are unlikely to gain independent foot control, we like the Ottobock L300 Go or Go Plus. You can see the article about that here as well, as we have experience prescribing this and other alternatives.

Early Supported Discharge Team

Wed, 27 Nov 2019 15:15:42 GMT

Working together with the NHS

I have a simple view about the private sector and the NHS. We both need each other. Almost all the advancement in the treatment of stroke has come from independents. Almost all the practice of it takes place in the NHS. Mostly, and there are a few notable exceptions, the expertise and depth happens when you can see a patient almost every day for several months on end.

Some of that did happen in NHS settings for stroke care, but gets rarer and rarer these days.

I was recently asked not to go on a hospital ward to give a second opinion. The member of staff told me that there were confidentiality issues, as I mignt see other patients. So you can see there are a lot of issues of confusion regarding working together.

Today I have spent quite a bit of time on the phone to speak with NHS staff from early supported discharge teams, and also ringing Mr. Isaac's team, one of the orthopaedic surgeons at Torbay District Hospital. This is just to ensure that before continuing with a case, that I have the right information about what is safe and realistic to attempt with someone who has developed other types of health problems.

So let's work together. Be assured, we all have the same goal, which is the improvement of lives of those we are asked to help. We all have similar approaches. I've worked inside the NHS for about 18 of my 36 years as a physio. I have the same insurers that NHS staff do. So let's work together.

Things that can. Things that can't

Wed, 13 Nov 2019 16:18:03 GMT

What can be recovered and what can't, by exercise alone

Just a quick word here about what's possible after stroke. If the hand has been very severely affected, and has gone stiff, the main picture shows very bent finger joints and actually straight knuckles. If the hand has gone stiff in the position shown here, then if it's lasted more than 3 months or so, then it will need surgery to release.

If the hand has been splinted as in the second picture, where finger joints are straight and the main knuckle is at a right angle then we would say that this can be corrected by physical therapy.

It's often known as the safety position for that very reason.

Expanding Horizons

cmackellar@uwclub.net (Campbell MacKellar) — Mon, 07 Oct 2019 09:24:42 GMT

How long after stroke can I improve ?

We recently started working with a person from Exeter who had a stroke several years ago. In the meantime they had been unable to stand and were worried that such an inactive lifestyle could lead to other health problems.

It's going to take quite some time but early progress suggests very strongly that their goal of standing is a hard one, that they are already making progress, and really quite quickly.

So when is the latest you can start rehabilitation after a stroke ?

Our own experience with this started with a patient that Andy treated in the late 1980's. Michael was living in Swaziland ( now called ESwatini ) in a very rural area. He had never walked after the stroke he had in 1981. He came to hospital for treatment of a huge pressure sore. Together with nursing staff treating the sores, Michael and the physio team started work. About 3 months later he walked out of the hospital just using a plain walking stick.

He still had a pronounced limp, but was able to cope with easy surfaces well, and bumpier surfaces with family supervision. That was a 7 year gap between stroke and starting rehabilitation.

Another patient we have been helping in Paignton, had a stroke over 4 years ago, and in a similar tale, had had very little help. With a short course of treatment she was able to start some early stepping and standing and there is undoubtedly more progress to come. The future is bright.

Tips to help ataxia

Wed, 11 Sep 2019 11:30:24 GMT

Ataxia is often feared by physiotherapists. But there is much to get started on

There are just a couple of key points here. This lady can use her hands quite well, but her feet keep losing contact with the ground as she sits and works. She can correct it, but it needs automating. Thats the challenge, so adding prompts, tiny changes to surroundings and cues can help.

In the bag.. Bioness H200

Wed, 31 Jul 2019 09:39:42 GMT

This little gadget is the bees knees.

Bioness H200 review. We have been using this technology for quite a while now. It's certainly helped it's use to have a better hand, which has made a substantial contribution to whole arm movements and hence overflowed into better balance and walking.

It turns out there were some technical problems with this unit that are now resolved, so we are looking forward to using it and will review again in the future... probably 3-6 months will be about right. Watch this space.

Some ideas for treatment after stroke

Thu, 11 Jul 2019 15:26:51 GMT

Ideas for treatment of stroke and head injury

Pain Relief after Stroke

Wed, 12 Jun 2019 19:36:07 GMT

Inflatable Garments Pile on the Pressure

We have been helping someone in Newton Abbot who has had a big stroke, leaving a great deal of residual pain. They have more than one type of pain. Here the pressure garment, in this case a Flowtron boot, is helping with hypersensitivity of the skin.

The same person also has deeper pain that's a bit like torn muscle, and joint pains, and these are thankfully responding to acupuncture and TENS.

The two pictures show the boot inflated and deflated. The electrically powered air pump that does the work automatically , so treatment can continue for 20 or even 30 minutes and can be done at the patient's convenience, perhaps while watching a film or reading.

Electrical Muscle Stimulation

Tue, 28 May 2019 08:46:59 GMT

This muscle stimulator really works well

You know how after stroke and head injury, it can be really hard to get the muscles in the forearm to lift hand and fingers. Careful use of an electrical stimulator, in this case we're using the Neurotrac Rehab from Verity Medical, can really help kickstart the paralysed muscles.

The electrodes these days are really easy to use, and are self adhesive. With a little care they will last 3-4 weeks of daily use, so at around £4 a set, its not prohibitively expensive to use over three or four months to get things really going well.

AFO splints

Tue, 21 May 2019 09:08:30 GMT

How to choose a splint

This just shows a bit more detail of the Trulife Matrix Splint. We often recommend these to help people walk after a stroke or head injury. They're even better at helping someone with a local nerve injury to the leg, when balance, knee strength and other limbs aren't affected.

We sometimes use them even when the unwanted tight muscles, spasticity, are overworking quite strongly. It's a case by case thing to decide, so just ask.

Simple Things

Mon, 13 May 2019 15:07:47 GMT

Sometimes something really simple just works

Just casting my eyes around the living room, my gaze fell upon this cylindrical cushion. For this lady, resting her hand on this was comfortable, achievable by a carer, simple and effective at reducing the fixed postion. It was one option for helping to prevent her hand going stiff and being stuck in a contracted position. If, for example you are a physiotherapists looking at this with experienced eyes, you might say that function is unlikely to return. And unlikely is right... except that its IS returning.

Which came first I will never be 100 % certain.. the determined and continued work to prevent the permanent stiffness that can happen after stroke or head injury, or the spontaneous ( if behind schedule ) recovery of activity.

Of course this wasn't the only avenue ever explored. In this instance we have also used the Bioness H200, standard splints, other trophic stimulators and acupuncture for pain relief. Hand function is still poor, but the shoulder and shoulder girdle are now coming along nicely.

It's also my philosophy that we can not know what other treatments are around the corner. So the message is to keep doing everything we can to maintain potential. If we can keep the fixed stiffness away, and a new more active treatment comes along, then it will be a win win situation.

Small gains

Tue, 07 May 2019 07:53:31 GMT

Little things can make a difference

This week we have been thinking about the little things. For one person, we have changed the walking stick for one that has a slightly smaller triangular base. It's still stable enough for walking balance, but makes navigating around furniture much easier. Inside the boots, we have fitted a different kind of moulded inlay, which secures the heel bone in a better position, allowing better balance after the stroke.

And one other thing.... I was visiting the Occupational Therapists Conference at Exeter this week I found a simple low cost way of looking out for family members that you worry about. The simple motion detection system tells you when your vulnerable family member is moving from room to room or when they stop doing a normal routine... simple and clever at the same time. Great if you can't be there all the time. Drop me a line and I'll put you in touch.

Hydrotherapy in Newton Abbot

Wed, 01 May 2019 14:21:14 GMT

Will hydrotherapy help me or make me worse ?

Well of course hydrotherapy will help me. Won't it ? Really the answer to this one is just maybe. Hydrotherapy has lots of possible benefits. It can feel lighter, relieve pain, help with feeling safe and supported, and help someone experience the sheer enjoyment of freedom of movement again.

But sometimes, even for people who love water, swimming and all that goes with it, after some form of injury to, or illness affecting, the brain, it can really worsen the problems of muscle tightness ( aka spasticity ). Until recently we had a very simple answer to this, with the clinic being right next to the pool in the above picture. Sadly Torbay's only public access facility closed at the end of January 2019.

This amazing pool run by Hannah's, served the people of Newton Abbot, Torquay, Totnes and Teignmouth for many years. Happily, we have been told that it will re-open shortly. Watch this space.

Predicting the future after stroke

Sun, 28 Apr 2019 19:29:12 GMT

This is a subtitle for your new post

My Mum Has Had a Stroke...
The doctors said that her recovery would continue for six months. It's well past that now, is there still hope?
It's true to say that a lot of spontaneous recovery comes in the early months. Many people have a great deal of difficulty really taking part in their programme during that time. First it's the whole shock of it. Most are in hospital in the early days and for some that adds to the difficulty. Back at home in more familiar surroundings, with help from family and friends, many people with stroke are more able to put the most into their programme. In some areas in Britain it's also the point where the amount of professional help starts to diminish.

A day in the life

Thu, 18 Apr 2019 19:02:29 GMT

Helping other physios learn

Last week I was working with a small group of other physios, to design and start this years education programme for physiotherapists who specialise in treating people after strokes, multiple sclerosis, head injuries and similar areas of work. There are only a few of us in the county, so one of the things I have been thinking about is how we can help a much larger number of patients.

Perhaps we could think of training health care workers in nursing homes ? There are something like 10,000 people working in residential and nursing homes in this half of the county. And many more providing help to mums and dads living with disability in their own homes.

Using the Neurotrac Stimulator

Wed, 17 Apr 2019 17:07:38 GMT

Electrical Muscle Stimulators or Trophic Stimulators

It can look pretty dramatic, when you first use one of these very inexpensive systems ( about £90 ) to re activate paralysed or weak muscles. Here we're working on someone who has a dropped foot or dropfoot. The electrodes can stimulate the muscle to work ok, but it takes a lot of training for them to be able to use the muscles again on their own.

But lots of practice can produce really useful results. Keep up the good work.

Managing and treating Spasticity

Tue, 09 Apr 2019 05:55:29 GMT

Understanding spasticity is key to managing and treating it. Obvious when you say it, but who really does understand it ?

There are lots of medical definitions that describe what spasticity is, but the understanding of why it is, will help far more in it's treatment. So why do people have spasticity is a much better question. I hope this short article will help both patients and physiotherapists, so here goes.

In this I will talk about stroke mostly, as it's by far the most common condition that people have where they experience it . But equally this happens after head injury, and to people with other illnesses affecting the brain and spinal cord. The earliest I have seen this condition appear is within hours after a stroke, so what's going on ?

One traditional view is that spasticity establishes after repeated stimulation of some reflex or response. If we think of a classic picture of a person with a lot of this high uncontrollable muscle tone in their arm and hand, it's fair to say that it often appears with a substantial effort, such as early attempts at standing.

It also happens after stimulating a particular area of the body, and this could be simply from contact with a sheet or bedding. If that's happening, you would definitely note that as a receptive field. And if you can identify such a field, then working to de-sensitise it is key. Stretch may work, probably if sustained and pressure is also a good candidate, which is where pressure garments come in.

We use these a lot, and it's simple to trial. We get a wetsuit... typically a very inexpensive thing to do.. usually around £20 to £40 and cut out the relevant area and apply it every day, for several hours.

Another way is splinting, and the picture above is an example of this. Here we have combined a modern carbon fibre AFO, or ankle -foot -orthosis, with a pair of humble wellies. The wellies provide pressure in the right areas of the foot, keep the splint well aligned and in this case motivate the patient, by helping visualise walking, as she always wore wellies when walking dogs.

Stroke Treatment in Torquay

Sun, 07 Apr 2019 16:43:27 GMT

Strokes or Cerebro-Vascular Accidents ( CVA ) come in many guises

We've been working in Torquay lately, helping a lady there with the aftermath of her stroke. For her the biggest challenge now is how to navigate her own living room.... she struggles to leave enough room for her own body and things that she carries, in this case her walking stick. This one is a tripod stick, and we have covered one leg, that should be sticking out at a right angle, with pink tape. The idea is that the extra visible clues will help the accurate use of stick and feet together.

It's an unusual one but another type of problem to solve. If I get a chance in a couple of weeks I'll put in an update.

Teaching Physiotherapists about Ataxia, Parkinsons Disease and Strokes

Sun, 07 Apr 2019 14:54:58 GMT

Who says committee meetings are dull ?

A quick snap of the recent Devon ACPIN meeting held at the Turtley Mill pub. As you can see it's not all doom and gloom. We have a small but perfectly formed team here, but although we have an enjoyable group, this year bolstered by a student contingent, we do get quite a bit done.

Our plans for the next year include an Ataxia study day, a Parkinson's Disease study day and a yoga for neuro day as well. Quite an ambitious programme as there are only a small number to share the work. Our students from Plymouth University are going to put on a tweetchat about " How long can treatment last. When and how do we stop ? "

It's a tricky subject. Physiotherapy after stroke or head injury should be most effective in the early years after the onset, but sometimes people aren't ready to really get stuck into their rehabilitation. A sudden onset of this type of injury or illness sends shockwaves through every part of a family's life.

Family dynamics, finances, the interaction of friends, work, love lives, pet cares and accomodation may change, so who's to say when a patient's attention is best focussed on physical rehab. It's a sensitive subject, as it's all linked up with inequality. Availability of services from the NHS varies. Availability of services from the private sector are based on ability to pay, insurances, court of protection procedures, and a myriad of other considerations, so it's a subject that will need to be handled delicately.

So that will be the challenge: to run that event to the satisfaction and education of all. Which means that we don't think as a committee that we know the answers, just trying to draw together best practice across the region, and as this one's on Twitter, therapists from all over the world could in theory contribute. Exciting times.

Electrical muscle stimulation

Mon, 01 Apr 2019 16:04:30 GMT

We've been trialling the latest in treatment for drop foot, the L300 Go Plus

I wanted to put up this example from a recent trial that we did using this amazing kit. The person wearing this one is a colleague, a physiotherapist who I am sure hasn't had either a stroke or a head injury. One of the key things about it to note is, that it doesn't interfere with natural walking either.

Most of the splints I have seen in the past do exactly that. If you put them on a healthy person they are made to walk badly. If that's so then how is it helping someone who can't walk improve ? The first firm to solve this was a Swedish firm called Camp. They made the first carbon-fibre splints in the early 1990's and although a huge improvement on standard AFO's weren't very adjustable. Nowadays I like the Trulife Matrix series. I'll put up some pics of that soon.

Some tips on exercises to help with ataxia after stroke or head injury

Mon, 01 Apr 2019 05:44:05 GMT

A little help dealing with ataxia.

I'm not sure why, but I have met many neuro-physiotherapists who get a bit lost trying to help people with the symptom ataxia. This is the slightly ( or very) uncontrolled movement that I suppose could be taken for extreme drunkenness. Treating ataxia quite straightforward, if sometimes a little slow. There is a lot that can generally be achieved by doing the things that we CAN do.

One example would be attending to the flexibility of the spine. Ordinary mobilisations of particularly the spine that makes up the back of the rib cage, the thoracic area to regain the normal range of movement. I generally use the system originated by Brian Mulligan, originally designed to help people with back pain and stiffness.

When range is returning, then work on specific areas like righting and saving reactions can be more effective. More on this later.

More on helping people with ataxia

Mon, 01 Apr 2019 05:18:02 GMT

Help with goals for people with ataxia

In this clip, I'm showing the main aim of exercises in sitting to help control ataxia after stroke or head injury. The main aim or goal is to be able to keep the head quite still when twisting and turning the spine. In this example you can spot the deliberate mistake !

When I turn RIGHT my head stays still, but quite unintentionally I was too close to a wall, so when I turn to my LEFT my body automatically adjusted so that I didn't bang my knuckes on the wall. I didn't mean to do this but in fact it's a great illustration of spatial awareness.

In health we all learn to avoid obstacles or get round or over them, but this is often denied to people who have some form of brain injury or illness, like stroke or head injury, and sometimes it's seen in rarer illnesses like Multiple Sclerosis or MS, Korsakoff's, Myelitis, or Guillaine Barre Syndrome.

Pain after stroke. Is there a way forward ?

Tue, 12 Mar 2019 22:58:39 GMT

There have been quite a few developments in treatment of chronic pain

Just because you have had a stroke, doesn't mean putting up with pain in the long term. We use manual therapies, acupuncture, transcutaneous nerve stimulation or TNS ( also known as TENS ) , soft tissue techniques, trigger point therapies, myofascial release, pressure garments, flowtron garments and more.

Treating Post - Stroke Pain with Tape

Tue, 12 Mar 2019 22:56:39 GMT

Tape has many uses. From sport to stroke rehabilitation

We have recently been helping one lady in Torquay who has had a stroke, and one young man who has had a head injury. The tape can help with co-ordination, reduce ataxia and relieve pain. It's simple to apply and re-apply once the correct position has been decided.