heads up!

stroke & neurological physiotherapy

Contact us  01306 888171

Neurological Physiotherapy in Newdigate

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The Clockhouse, Newdigate

Our Headsup! neurological physiotherapy clinic and main office in Newdigate is situated just outside of Newdigate village, near Dorking in Surrey. There is plenty of free parking on site. We have 3 private clinic rooms and a small gym where we offer small group sessions as well as individual treatment. All of our therapists are specialists in neurology.

Our base near Dorking is easily accessible to all of Surrey and West Sussex via the A24, M23. From the rest of the UK we can be reached via the M25 and mainline trains from Central London which stop at Guildford, 45 minutes away and Dorking, Redhill and Reigate, all within a 30 minute drive. Other areas we cover include: Horley, Horsham, Bookham, Ashtead, Woking, Wimbledon, Sevenoaks, Merstham.

We also have other practices in Kingston upon Thames and Sevenoaks, Kent.

Neurological Physiotherapy in Kingston

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New Victoria Hospital

Our Headsup! practice providing Neurological Physiotherapy in Kingston in south London is based at New Victoria Hospital. The location is conveniently based just off the A3 with onsite parking, there is also a bus stop near the main entrance which takes you to Kingston, Raynes Park and Wimbledon train stations.

We are based in the main physiotherapy department and work closely with our MSK, respiratory and women’s health colleagues.  Close working links are also well established with the relevant consultants working out of New Victoria Hospital, especially our neurology and ENT consultant colleagues.

Heads up! have their own large clinic room at New Victoria Hospital as well as access to the physiotherapy gym to use the equipment such as the treadmill and exercises bike. We also have access to a hoist and other manual handling equipment to help in transferring patients should it be required.

We also have other practices in Dorking, Surrey and Sevenoaks, Kent.

Neurological Physiotherapy in Sevenoaks

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Manor Clinic

Our Headsup! practice providing Neurological Physiotherapy in Sevenoaks, Kent is based at Sevenoaks Physiotherapy Clinic in Manor Clinic on Sevenoaks High Street. Within this practice, we have access to a wide range of equipment, including gym equipment such as a treadmill and a pilates reformer machine, and if appropriate, this equipment can be accessed as part of your neuro-rehabilitation. Other clinicians, such as musculoskeletal and sport physiotherapists and podiatrists also work out of Manor Clinic, and this enables heads up to work collaboratively with other professionals if that is indicated in a patient’s recovery.

We also have other practices in Dorking, Surrey and Kingston upon Thames.

PPPD

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What is PPPD?

Persistent Postural-Perceptual Dizziness (PPPD) is one of the most common causes of long-term
dizziness.

PPPD is described as symptoms of dizziness and unsteadiness which are present on most days for
three months or more and are made worse by movement or by certain visual challenges such as a
supermarket or scrolling on your phone.

PPPD stands for:

Persistent – symptoms are there most of the day, most days of the week.

Postural – symptoms are usually worse when standing up and moving around, and better
when resting.

Perceptual – something that is felt by you, but not necessarily obvious to others.

Dizziness – the symptom that most people experience.

It usually begins following something which affects the balance system in the inner ear such as an ear infection, BPPV, head injury or migraine. But can also be caused by a medical issue which results in dizziness (i.e. heart problems) as well as dizziness from anxiety. Rather than the symptoms gradually improving once the initial cause resolves they continue and begin to impact more and more on daily life.

The symptoms are usually not as extreme as the initial onset but are there more often than not. This sensation of ongoing dizziness begins to occur as our brains start to become more and more aware of the feelings of dizziness and motion and don’t ignore it as it usually would. The brain becomes hypervigilant to the sensation of dizziness and motion making the experience of dizziness increase, this leads to a vicious circle of increased sensations and increased awareness of symptoms. This is sometimes described like malfunctioning computer software as the brain begins to change how it processes information related to motion.

How might it affect me?

People suffering from PPPD often report the following symptoms (although these can be different
for every one):

  • A sensation of rocking/swaying as if on a boat
  • Feeling like head is in a goldfish bowl
  • Feeling like brain moves slower than head when turning head
  • Mismatch between head and eye movement
  • Feeling drunk
  • Feelings of dissociation/de-realisation
  • Veering when walking or bumping in to things in narrow spaces

These symptoms can make many daily activities challenging to do, in particular people with PPPD often (but not always) report the following difficulties in daily life:

  • Struggling in busy environments such as the supermarket or train station
  • Visual patterns being difficult to look at – chequred tiles, highly patterned carpets
  • Symptoms when scrolling through phone or when using the computer
  • Difficulty using escalators
  • Increased symptoms when traveling on a bus/train or whilst being a passenger in a car
  • Repeat movements such as hanging out washing increase symptoms
  • Veering into others when walking next to someone

All of this can make it very challenging for people to manage all things taken for granted in daily life such as traveling into work, using a computer, going shopping, visiting restaurants and can result in people becoming less and less able to do all the things they need to.

Another big challenge with PPPD is how it can be perceived by those around you, although having PPPD can make you feel very unwell you will generally look well to people around you and this can make it very difficult for them to understand the challenges you are facing and why you can’t tolerate certain situations. PPPD is often misdiagnosed as anxiety and, although this can be part of the issue, it is not the sole feature of the condition and some people with PPPD do not experience any anxiety.

How can physiotherapy help me manage it?

PPPD can take a long time to improve and there is no quick fix, however with the right input the symptoms can improve significantly.

One of the key things is understanding what is going on so explaining PPPD is a key part of the physiotherapy role.

Vestibular physiotherapy is key in helping to decrease the sensitivity of your brain to motion. We use specific exercises to help improve your tolerance to visual stimulation and to improve your balance. We know with PPPD that starting an exercise programme too intensely can lead to an increase in symptoms so we always start exercises carefully and steadily and make sure they are specific to each individual.

What other treatment is available?

For some people who are struggling to make improvements with exercises alone there is some research to show that low dose SSRI medication can help. These are thought to work by improving communication between different areas of the brain helping to improve processing of balance information. These have been shown to help even in people with out anxiety or depression.

There is also some evidence to show that when PPPD is accompanied by anxiety then CBT (Cognitive Behavioral Therapy) can be helpful. CBT can help to decrease a person’s fear around movement induced dizziness and help them to gain confidence in returning to environments that trigger dizziness.

However, all these are additional supports for PPPD and they require physiotherapy to work alongside them, they are not alternatives to physiotherapy.

If you think we may be able to help you in the management of PPPD, then please call us on 01306888171 or email [email protected]

Ramsey Hunt

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Ramsey Hunt Syndrome has been in the news recently with the singer Justin Beiber being diagnosed with it in June 2022. Knowing a few patients with the debilitating condition it seemed like a good time to write a blog about what it is and how neuro physiotherapy can help anyone suffering from it.

Ramsey Hunt is a neurological condition that affects adults (commonly those over the age of 60). It is caused by the same virus that causes chicken pox in children and shingles in adults, Varicella Zoster Virus. Following chicken pox in childhood the virus can lay dormant until it is reactivated causing shingles, if it affects the facial nerve then it is called Ramsey Hunt Syndrome. The virus can become reactivated when your immunity is low and less able to fight off infection, stress can often be a cause of weakened immunity and therefore Shingles and Ramsey Hunt can be triggered by a period of significant stress. In Ramsey Hunt the reactivated virus causes irritation and swelling to the facial nerve leading to facial weakness. Due to the close proximity of the facial nerve to the nerves of balance and hearing it is also possible to experience loss of hearing and balance/dizziness problems associated with Ramsey Hunt Syndrome.

You can’t catch Ramsey Hunt Syndrome from anyone, however if you have no immunity to chicken pox (no childhood exposure or vaccination) then you can catch chicken pox from someone with Ramsey Hunt Syndrome if in contact with an open blister.

Ramsey Hunt typically presents with a rash or blisters around the ear and scalp on the affected side and can cause blisters inside the mouth. Weakness in the face can lead to difficulty closing your eye and blinking, smiling, and eating and sometimes causes changes in taste. You might also lose hearing on the affected side and experience problems with getting dizzy and being off balance. Although it doesn’t directly affect your ability to speech the weakness in the lips and cheek muscles can make forming some sounds difficult.

Urgent treatment at onset of symptoms can be critical to improving the outcome of your facial palsy ideally early diagnosis and starting anti-viral medication and steroids with-in 72 hours can help limit the extent of the facial weakness. It is also very important to get urgent advice on eye care to avoid damage to the eyeball due to limited blinking.

The outcome depends on the severity of the facial weakness and speed of recovery. Once you’ve accessed urgent medical care for diagnosis and timely management of the condition then it’s time to start physiotherapy to learn what is best to do in the management of facial palsy and how to help ensure you make steady progress with exercises to maximise your recovery and limit complications.

Physiotherapy can also help if you have issues with dizziness and poor balance by providing an individual exercise programme to help improve the function of your balance systems.

Useful info:

Ramsay Hunt Syndrome – NORD (National Organization for Rare Disorders) (rarediseases.org)
Ramsay Hunt Syndrome – Facial Palsy UK

If you think we may be able to help you in the management Facial Palsy and Balance problems, then
please call us on 01306 888171 or email [email protected]

Huntington’s Disease Awareness month – #SpeakOut4HD

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What is Huntington’s Disease?

It is a progressive brain disorder that leads to uncontrolled movements, changes in how you think
and emotional problems. Symptoms most commonly appear between the ages of 30 to 40 years
old.

What causes Huntington’s Disease?

It is a genetic condition caused by inheriting a defect in a single gene from one of your parents

What are the symptoms?

Huntington’s Disease has a wide range of signs and symptoms, which appears first varies from person to person and symptoms can change throughout the progression of the disease.

Changes in activity and movement :

  • Involuntary movements such as jerking or writhing movements which can travel around the
  • body
  • Stiffness or contractures in the muscles
  • Difficulties with walking and balance
  • Changes in eye movements
  • Difficulties with speech and swallow
  • Changes in how you think (cognitive function)
  • Difficulty focusing/organising/prioritising a task
  • Tendency to get stuck on a certain thought, action or behavior – inflexibility/perseverance
  • Difficulty in controlling impulses ‘acting without thinking’
  • Lack of awareness of behaviours
  • Slow to process thoughts, difficult to find the right word
  • Challenging to learn new information
  • Changes in emotions (caused by the damage to the brain and not as a response to the diagnosis)
  • Feeling irritable, sad or apathetic
  • Withdrawing socially
  • Insomnia
  • Decreased energy levels
  • Frequent thoughts of death or self-harm

Can physiotherapy help?

YES!!! Research shows that increased levels of physical activity has several benefits in Huntington’s
Disease:

  • Increased quality of life and confidence
  • Improved balance
  • Able to walk further and faster
  • Prevention of stress and aggression
  • Decreased symptoms of anxiety and depression

Have a look at http://eurohuntington.org/active-huntingtons/ and https://www.hda.org.uk/media/1602/move-to-exercise.pdf for advice on how to get active with Huntington

Where can I find further information about Huntington’s Disease?

https://www.hda.org.uk

http://eurohuntington.org/

If you think physiotherapy will help you to increase your activity levels then please contact us on 01306
888171 or email [email protected]

Motor Neurone Disease – Kevin’s story – March 2023

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Kevin Stokes. Male Aged 66 yrs. Diagnosed Motor Neurone Disease April 2022

LIVING WITH MND

It is important to note that since my diagnosis in April 2022 the working assumption (since confirmed) has been that it was heredity. I was also aware that trials were underway on drugs for the main heredity mutant genes. Since April there has therefore always been a ray of hope – something that the majority of MND sufferers do not yet have. This has naturally helped me stay positive and be proactive in keeping my body ‘going’ as much as possible. Starting the Tofersen trial has only strengthened my resolve to be a ‘medical miracle’.

I accept that sufferers currently without treatment may well have a different outlook. In no particular order some of the main issues living with MND from my perspective have been:

  • Sense of hopelessness that the disease will just take hold more and more and nothing one can do about it
  • Speed of deterioration which makes getting used to disabilities hard and therefore difficult to plan and organise for
  • People not knowing what to say to you
  • Becoming more and more dependent upon loved ones and carers and an increasing sense of being a burden
  • Fear of being trapped in a body that does not react but still being mentally alert
  • Just everyday issues facing anyone with a disability i.e., accessibility issues, adaptations to the home, lack of independence
  • A system that is geared towards your deterioration rather than helping you stabilise if possible. I accept that until recently there has not been an effective treatment so not surprising this has been the stance.
  • On a positive note, Tofersen has changed the landscape and given all MND sufferers hope as
    the speed of medical advancements takes off. Even more reason to keep going as much as
    one can.

NEURO PHYSIO

Firstly, let me add for the record how fantastic Carol has been over what is just over a year. Not
only in her professional expertise in keeping my body going as much as possible but also in her
quiet counselling, ready ear, and ability to motivate.

Particular plus points have been:

  • Encouraging and challenging me to achieve my best in all the exercises
  • Determination to keep me doing what I can for as long as I can
  • Adapting physio and exercises to a deteriorating situation without drawing attention to such
  • Explaining what is happening to my muscles, what action they control, connectivity and how
    they were being helped.
  • Despite muscle wastage maintaining movement and neural connectivity to my legs
  • Helping to maintain whole body flexibility
  • Maintaining walking ability for as long as possible
  • Changing the routines to tackle areas in different ways
  • Knowledge to get to the root cause of tightness rather than address the symptom
  • Keeping a watchful eye on the whole body and looking for any new tightness
  • Advice on home exercises
  • A sounding board for issues relative to living with a disability in practical terms and advice
    on what might help
  • Being and keeping me positive
  • Being a proactive and willing partner on the journey that I am now on
  • After each session giving me a sense of achievement – and feeling I had made progress

Exercise

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Life during lockdown is certainly a massive change from our normal life. Maybe you would normally attend an exercise class, go to the gym or for a swim as a way to keep fit and active. It may be that you also have a specific programme of exercises recommended by your physiotherapist to work on at home.

As therapists we often see that patient’s general fitness, muscle strength and endurance can diminish over the winter months as we are generally not as active. Therefore, it is even more important during lockdown to keep as active as possible and work on those home exercises and maybe that regular walk.

Motivating yourself to exercise regularly is for many people an ongoing challenge.

Here are a few top tips to help you to keep motivated. Through lockdown …and beyond!

  1. If it is a daily exercise programme try and do this at the same time every day so that it becomes part of your daily routine. If it’s a programme several times a week, allocate a day and time and add in to your calendar for the week ahead and try to stick to it.
  2. Break it up into bitesize chunks. Some people prefer to do their full programme in one go. For others this is too much so you could break it up into 2-3 10-minute sessions. Do what works best for you but try to keep to the same routine.
  3. Record your exercise for a while on a chart or tick it off on your calendar until it is established part of your daily/weekly routine.
  4. Reflect on how you feel when you have completed your exercises. How did your body feel? How was your mood? Did you enjoy the sense of achievement?
  5. Set goals for yourself. If you can link doing exercise to achieving what is important to you it can boost you to keep going. Discuss your goals with your physiotherapist.
  6. Anything is better than nothing. If for whatever reason (and this happens!) you don’t do so well one day, don’t beat yourself up. Get back on track as soon as you can. Start afresh the next day.

You can do it!

And remember that at Heads Up we are here to guide, support, and encourage you to achieve your goals.

We also have a new online exercise group for patients that have been assessed by us. It is a weekly class in standing and sitting aimed at improving general mobility, strength and balance.

Please speak to your physiotherapist or give us a call on 01306 888171 if this interests you and you would like to find out more. We would love you to join us.

 

 

 

Recognising vestibular migraine and tips on how to manage it.

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Did you know there are 190,000 migraine attacks every day in the UK! It’s the most common and disabling neurological disorder in the UK.  It affects 1 in 7 people making it more prevalent than diabetes, asthma and epilepsy combined (www.migrainetrust.org).

But what is migraine, according to Professor Peter Goadsby, professor in neurology at Kings Collect Hospital “Migraine is an inherited tendency to have headaches with sensory disturbance. It’s an instability in the way the brain deals with incoming sensory information, and that instability can become influenced by physiological changes like sleep, exercise and hunger.”

We also know that approximately 40% of migraine sufferers can have vestibular symptoms as part of their migraine causing problems with balance, visual disturbances or episodes of dizziness.  You may also only have symptoms of dizziness or decreased balance with your migraine, not everyone has accompanying head pain.

It’s good to know that it can be treated, we know that the best treatment for vestibular migraine involve a combination of medication, life-style modifications and vestibular rehabilitation delivered by a specialist physiotherapist.  It is usually better for vestibular migraine patients to begin their treatment with medication and life-style changes prior to starting vestibular rehabilitation.  This enables them to better tolerate the exercises without experiencing exacerbations of their symptoms.  The exercises are usually progressed very slowly in people to ensure we don’t exacerbate the migraine symptoms.  Exercises might involve visual exercises to decrease visual sensitivity (computer screens, busy shopping centers, travelling etc), balance exercises to help you feel steadier, core strengthening exercises and we may assess your neck.  Over activity and tension in the neck is often a common problem for people who suffer from migraines and can further exacerbate their symptoms.

So how can you begin the process of improving your symptoms?  Often making changes to your lifestyle can lead to a huge improvement in your symptoms, whilst they can seem initially difficult to do once you see an improvement in your symptoms you’ll be very glad you made the change.  You could have a go at the following advice:

Keep a diary – This can help in the diagnosis of your migraine and help you to recognise any triggers or warning signs.  It will also help you assess if any changes you make are helping, the migraine trust have some good diary layouts you can print out and use – https://www.migrainetrust.org/wp-content/uploads/2019/07/FS05aMigraineDiaries.pdf

Exercise – Research shows that exercise can be beneficial in decreasing the frequency of attacks, if you don’t normally exercise make sure you start gradually, perhaps with a walk every day.

Sleep – There is lots of research showing how profoundly sleep can impact on migraine, too much and too little sleep can both be issues and for some people it is the sole trigger.  Shift work and jet lag can impact massively.  Try the following tips to see if they help:

  1. Go to bed and get up at the same time every day
  2. Spend some time outside every day, natural light helps fine tune our body clocks
  3. Sleep in an environment that is restful
  4. Do any exercises before your evening meal and not before bedtime
  5. Avoid caffeine and alcohol before bed
  6. If you are wide awake in the night don’t stay in bed

Diet – Stay well hydrated and eat at regular intervals though out the day

Stress – Stress can be another big trigger to migraines, although it is easier said then done, looking at ways to manage stress can have a big impact on symptoms.

If you want to read more on the topic of vestibular migraine then follow the links below:

https://www.menieres.org.uk/information-and-support/symptoms-and-conditions/migraine-associated-vertigo

https://vestibular.org/migraine-associated-vertigo-mav

https://www.migrainetrust.org

If you think we may be able to help you in the management of your migraine, then please call us on 01306 888171 or email [email protected]

 

What is Dystonia and tips on how to manage it

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The NHS define Dystonia as ‘the name for uncontrolled and sometimes painful muscle movements (spasms)’ its usually a lifelong problem but treatment, including physiotherapy can help to relieve the symptoms.   It can be a really challenging condition to live with and finding the correct treatment can be difficult.

Cervical dystonia (uncontrolled movements in the muscles around the neck) is the most common focal dystonia (a dystonia present in one part of the body), it often occurs in middle age and builds up slowly to reach a plateau over several months or a year.

Task specific dystonia’s are focal dystonia’s that occur when trying to perform a specific activity an example of this is Writer’s cramp – a dystonia that affects muscles in the hand, and sometimes forearm, only when someone tries to write; or Musicians dystonia – which affects someone only when they try to play their musical instrument.

Dystonic movements are thought to originate from the part of the brain called the Basal Ganglia, although the cause of most dystonia’s is often unknown.  The Basal Ganglia is a part of the brain, which helps to regulate and control movement.  Researchers think there could be abnormalities in the brains ability to process a group of chemicals called neurotransmitters; these are chemicals, which help different areas of the brain to communicate with each other.

The most common treatment for focal dystonia’s is Botulinum Toxin injections, which are carried out by a specialist neurologist.  Small amounts of this chemical are injected into the affected muscles to limit how well they contract, leading to a temporary improvement in the dystonic movements, the injections are often done a few times a year to help in the management of the dystonia.

Alongside the use of Botulinum Toxin physiotherapy can be beneficial in helping you manage your dystonic movements.  A physiotherapist will analyse how you move and look at how you can strengthen weaker muscles improving your posture, which can help in dystonia management.  They may also suggest lifestyle changes, which can help you manage your symptoms.

Here’s some tips for you to try out at home:

Writer’s cramp:  Try using a bigger diameter pen and writing on a sloped board

Cervical Dystonia: Try gently touching your head or chin, usually on the side of the dystonia, this can help settle it, sometimes resting your head back on a supportive surface can settle the dystonic movements

In general, most dystonia’s will be exacerbated by stress so look at ways of managing stress such as relaxation techniques – mindfulness, gentle exercise such as walks, can help.  When you are in a position that triggers your dystonia try to minimise the time in that position.

If you want more information try the following website:

www.dystonia.org.uk

If you think a specialist physiotherapist assessment would be beneficial in helping you manage your dystonia, then call us on 01306 888171 or email [email protected]

PD Warrior

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We already know the positive difference that physiotherapy can make to people living with Parkinson’s disease. Regular exercise has long been recognised as a powerful tool to help improve mobility, posture and balance. Research by Lord and colleagues 2013 and Van Nimwegan 2011 indicate that at diagnosis, people with Parkinson’s disease are already 30 percent less active than their non-Parkinson’s age matched peers.

PD Warrior is an exercise based rehabilitation programme developed in Australia for individuals with mild to moderate idiopathic Parkinson’s disease.

Earlier this year, I completed Levels 1 and 2 of the PD Warrior course which included theoretical concepts, clinical evidence supporting the PD Warrior approach and practical exercises. Throughout the course we were joined by some wonderful volunteers with Parkinson’s disease and we spent time carrying out assessments to establish key areas on which they needed to focus.  These included balance, fine motor skills, dual tasking and freezing of gait. We encouraged them to establish some goals. Each volunteer was then taught their individualised exercise programme. To complete the day we all experienced a PD Warrior circuit together which was hard work but great fun!

The PD Warrior approach to exercise incorporates 7 key principles which are thought to drive neuroplastic changes within the brain, aiming to slow down the symptoms of Parkinson’s disease.

These key principles are:

  1. High Effort, exercising at a recommended 8/10 effort level
  2. High Power, focusing on strong, large amplitude movements
  3. Frequency, where daily exercise is recommended
  4. Specificity, where the exercises tailored to each individual
  5. Meaningful, with exercises aimed at improving a functional task or helping to achieve a goal
  6. Complex – increasingly complex and adding dual tasks to the basic exercises
  7. Fun – ideally in a group setting

The other large element of the PD Warrior programme is educating, encouraging and motivating each individual to create long term behavioural change with regards to regular exercise.  PD Warrior also offers an online community and support.

It is clear from reading the feedback from existing PD Warriors that this approach, although hard work, can empower individuals not to let Parkinson’s take control of their lives.

I look forward to applying these concepts with our valued clients at heads up.

Update on Parkinson’s Disease…

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Parkinson’s Disease is thought to affect around 1 in 350 adults, which means there are an estimated 145,000 people in the UK with the condition. It can lead to slowness in movement (bradykinesia), tremor and rigidity. This can cause postural changes, reduced balance and difficulties with mobility.

Parkinson’s disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra. Nerve cells in this part of the brain are responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements. With the loss of dopamine-producing nerve cells, this part of the brain is unable to work normally, causing symptoms of Parkinson’s to appear.

Physiotherapy can help with this. The benefits of physiotherapy for those with Parkinson’s is widely recognised. The 2017 NICE guidance for Parkinson’s Disease in adults recommends referring people who are in the early stages of the disease to a physiotherapist with experience of Parkinson’s disease for assessment, education and advice, including information about physical activity. Additionally it recommends offering Parkinson’s disease-specific physiotherapy for people who are experiencing balance or motor function problems.

Neuroplasticity is the ability of the brain to adapt to new information, with neurons and neural networks in the brain to changing their connections and behavior accordingly. There is a growing body of evidence that exercise causes positive neuroplastic changes in the brains of those with Parkinson’s Disease.

A significant component of physiotherapy is exercise. Doing 2.5 hours of exercise a week can slow the progression of symptoms. Exercise can help manage physical symptoms along with other symptoms such as sleep problems, fatigue, mood and mental health. It can be as important as medication to help take control and manage symptoms. (Parkinson’s UK)

Access to specialised Physiotherapy can be limited. An audit from Parkinson’s UK in 2017 found that only 16.8% of individuals had been referred to physiotherapy at diagnosis and only 52% of individuals had received physiotherapy input within two years of diagnosis.

At Heads Up Neuro Rehab, we are experienced in working with individuals with Parkinson’s and can provide specialist guidance and support at all stages of Parkinson’s. The time we are able to offer enables us to fully understand our patients’ needs and to provide individualised rehabilitation and maintenance programmes. We will assess your posture, muscle strength, balance and gait (walking pattern) and supply a combination of ‘hands on’ treatment, self management advice and exercise.

If you or someone you know feels that you could benefit from our service, please get in touch.

Giving people the time: How Lucky I am to be a specialist Neuro-physio

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Since the clinic – heads up! – began 20 years ago we have always focused on quality of movement not just quantity of movement.

We often see people who have just got moving as best they can and have become heavily reliant on walking aids such as three-pronged walking stick or tripod. We work together so they can improve their stability and confidence in walking so that they might be able to use a high pole or walking stick which offers less support but may allow a more symmetrical walking pattern.

We are so fortunate to be able to give the time to work very specifically with people on whatever they want to work towards. Often people are fundamentally weak following a stay in hospital and may be de-conditioned and generally unfit. We work to strengthen weak muscles and help them to activate better and more often the correct muscles in the right sequence for a task. We sometimes also work with local personal trainers, who provide specific fitness training under our guidance.

We treat people in their gym, office and really anywhere that is relevant to the person with the neurological condition.

What we do with people in treatment sessions is very important, however, as important is what people do outside treatment and we invariably give people exercises and activities to practice between sessions. Every home programme is specifically designed for the person who has had a stroke or has a neurological condition. We hand write all our exercises and recommendations.

In our neurological physiotherapy treatment sessions we always discuss and devise the things we ask people to do with them so that they understand what they are doing and why they are doing it.

Monitoring and progressing the exercises people are doing between treatment sessions is an integral part of treatment.

Helping people to develop a routine of regular exercise and feel the benefit of the habit of doing appropriate exercise is a very satisfying part of our job. We use photographs, videos, handwritten exercises, tick boxes and stick men to illustrate our home programmes. Each programme is individual and we always check that people are doing the exercises correctly and that they are appropriate and working for them.

As I read the other day, “If you don’t find time for exercise, you’ll have to find time for illness”. 20 years ago I started heads up! a private stroke and neurological physiotherapy practice in order to be able to give people the individual treatment and the time, personal attention and continuity of input to allow everybody to explore their full potential for recovery. To find out more about what we do and how we can help please just get in touch.

Five Year Forward View (FYFV): delivering care closer to home?

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We have heard a lot about the crisis affecting the NHS this winter. Professor Karen Middleton, the chair of the Chartered Society of Physiotherapy wrote in The Huffington Post on 13th January 2017, “ It’s clear that the NHS needs a whole-system transformation and that’s what Mr Stevens is looking to achieve with the Five Year Forward View (FYFV).

This document, published in 2015, sets out a vision of taking services out of hospital and delivering more care closer to home. Meaning more community rehabilitation and care to help get patients discharged from hospital and preventive services. This should in turn reduce the number of people admitted in the first instance.

It also places a heavy emphasis on primary care, expanding the team in GP surgeries so that patients can see a wider range of professionals – including physiotherapists – as a first point of contact.”

Having spent the best part of 20 years of my working life in the NHS, I am a staunch supporter.

But 20 years ago starting heads up! – a private stroke and neurological physiotherapy practice – I wanted to give people the individual treatment, time, personal attention and continuity of input to allow everybody to explore their full potential for recovery. This passion is still at the heart of the practice today.

NHS focus has changed from in-patient rehabilitation to early discharge and treatment at home. Self-management and time-limited treatment provision is widespread. The design of the service rather than the individual needs of each person seems to dictate what treatment is available and for how long.

As the focus in neurological physiotherapy in some services has moved from “hands on” more towards “hands off”, people have been assessed, advised and encouraged to return to as much function as possible as quickly as possible.

The vast majority of people are keen to be at home rather than in hospital but sometimes we hear that people do feel abandoned when community services do not live up to their expectations.

Understanding and recognising the value of all levels of care is essential for people to receive the best possible opportunity. We often work closely with our colleagues in the NHS and sometimes stepping in between discharge from hospital and the start of community services.

Specialist neurological physiotherapy certainly plays an important role in enabling people to be discharged from hospital as soon as possible, providing treatment at home aimed at getting people who have had strokes to be as independent as they can be. At heads up! we work very closely with relatives and carers of people with neurological disability helping them to find the best ways that they can work together to get the best recovery.

On the preventive side neurological physiotherapists have an important part to play in assessing, treating and advising people with issues surrounding balance and mobility and we see people with a very wide range of problems both in their homes and at our clinics.

Anna Hamer is a specialist neurophysio working everyday with patients who have had a stroke, Parkinson’s, MS, Cerebral Palsy, Brain Injury and many more.

Deep breathing benefits the whole body

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We often say – ‘let’s go and get a breath of fresh air’ as a way of becoming more alert, less stale and getting ready for another activity.

In these winter months regular deep breathing helps keep us free of coughs and colds and our airways clear. When we don’t move around a lot and become sedentary the respiratory system is not stretched and so we only use a very small proportion of our lung capacity.

In our neurological physiotherapy sessions we often work with people to teach them how to more effectively use their lungs to get better rib cage movement. This is especially important for people who have had spinal cord injuries who often have reduced respiratory capacity and are prone to chest infections.

When we take a really deep breath in and out we use more air than usual and this means that the stale air at the bottom of our lungs is moved and so more of our lung tissue becomes active. As we sit up straighter, away from the back of the chair then our body, the trunk or torso, becomes more active and the lungs less compressed by an inactive body.

Improving posture by sitting up as straight as you can helps to give the lungs more space to move in the chest and allow you to take an effective deeper breath. Concentrating on breathing out even further than you think you can will encourage a deeper breath in on the next in breath.

When practising deep breathing exercises it is important to only do around five deep breaths at a time. Doing too many will make you light headed so be cautious when you start and doing them with a family member or another person who is doing them at the same time will give you confidence.

Have a go!

Standing up and sitting down as a leg strengthening exercise

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If you are not doing as much walking around as you would like to after suffering a stroke or being in hospital then it doesn’t take long for your body to become de-conditioned and your muscles to lose some of their strength.

Any neurological condition such as cerebral palsy, stroke, spinal cord injury, multiple sclerosis or Parkinson’s will affect the ability of muscles to activate strongly and consistently and in a co-ordinated way.

One good simple way of strengthening your legs is just to practice standing up and then sitting down and then standing up again. If you make this a habit so that when you stand up in the mornings you incorporate three to five repetitions of simply sitting down again and then standing up, this is a convenient and easy way to get all the leg muscles working.

As we get older we tend to use the arms of chairs more to help us get from sitting into standing.

This is normal. However, if you have had a stroke then often one arm will become accustomed to pushing on the arm of the chair and the body then becomes twisted towards that side so that more weight is put on that leg, the stronger leg, and less on the other leg which has been more affected by the stroke.

It is important to have the feet fairly level and about hip width apart and this will help to give both legs the opportunity to take equal weight so that they both get the benefit from the sitting to standing to sitting exercise.

Familiarising yourself with your feet

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Familiarise yourself with the exercises in the previous blog “getting ready to be active”.

If you have muscle stiffness and reduced movement after a stroke or because of Parkinson’s, cerebral palsy a brain injury or other neurological condition regular small movements will help reduce discomfort from stiffness.

Priming the legs for standing up

Once you are feeling more alert and are more active in your body in sitting then firing up your legs in preparation for standing is a good idea. Firstly rub your thighs with your hands and then gently step one foot forwards a couple of inches and then back then the other foot forwards and then back. Do these small steps forwards with each foot five times and then take three or four really deep breaths in and out, making the out breath last for as long as you can.

Repeat five small steps forwards and backwards and then bring your nose forwards over your knees as far as you can. Keep your head up and choose a spot on the wall in front of you to keep looking at so that your head doesn’t drop down. Do this movement slowly three times. Repeat once more the five small steps forwards and backwards with your feet.

Now your body and legs are primed so that you are ready to get up and go. Before you get up check that your feet are level and hip width apart and focus your attention on your feet as you stand up.

Sitting less – moving more

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Winter 2016 – 2017

In this series of simple exercises and advice about keeping mobile during the winter months, there are some that people will find easy and also there are some people that will find everything hard.

As we are all different and have individual ways of moving, there is no substitute for the specific advice and individually tailored exercises which are given during a treatment session with one of our clinical specialist neurological physiotherapists at heads up!

If you are in any doubt about the suitability of any of the exercises suggested then please do not do them. Ideally the first time you do them it would be helpful to do them with another person. All the exercises suggested are best performed as part of a daily routine, for example after brushing your teeth in the morning so that you do them regularly and consistently.

Although we are unable to give specific advice over the phone, we are always happy to talk to anyone who feels that an individual assessment would be useful.

If you are stiff after suffering a stroke or because you have some other neurological disorder affecting your muscle stiffness such as Parkinson’s or cerebral palsy or multiple sclerosis then some simple daily exercises can help alleviate stiffness. Regularity is key and making exercises a part of your daily routine.

Getting ready to be active

It is said that sitting is the new smoking. Sitting for prolonged periods is especially detrimental to health. It is often difficult for people who have neurological disability to move around and standing up may not be easy.

It is difficult for anybody to go from being very inactive to being active so if you have been sitting for a long time, it will be easier to get up if you wake your body up a bit first. So sit up as tall as you can to begin with, then take three or four deep breaths in and out, bigger each time and keep sitting up tall as you breathe out. This wakes up the muscles of the back and the tummy.

Next look over to the right side and then to the left, moving your head gently and slowly to each side, three times each way. Next sit up as tall as you can then blow to the left and then blow to the right and do this twice each way. Then repeat moving the head from side to side slowly turning as far as is comfortable each way.

Place your hands together or support one wrist with the other hand and gently reach both hands forwards over your knees, gently bringing your back away from the back of the chair and do this five times. Take another three deep breaths before you take both hands forwards and then over to the left and then over to the right side three times each way.

These exercises prepare the body for activity and are a useful way to get ready to stand up after you have been sitting down for some time.

Walking outside in the winter

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Last week I was helping a woman who had a stroke in her twenties and is now in her fifties to her car. She said to me ‘I’m fine walking if it’s level and light Anna, but life’s not like that is it?”

This phrase has stuck in my mind and to me encapsulates the daily struggle some people who are living with disability following stroke face. Getting out and about is often more difficult in the winter months and in our neurological physiotherapy sessions at heads up! we work together to re-gain confidence in standing and walking.

At this time of year there are the challenges of short hours of daylight, unpredictable weather patterns and biting winds to name but a few. Often it is the confidence and encouragement afforded by being with another person which makes the important difference and allows people to continue to get out in the fresh air over the winter.

There is plenty of research backing up the benefits of walking in the countryside and the beneficial effects of being in nature on the mood. Even if you live in the middle of a city, the benefits of getting out and about are well worth the planning, wrapping up to keep warm and unwrapping again.

headsup! Is a team of specialist neuro physiotherapists covering London and the South East. We are always happy to discuss individual requirements and explore suitability for treatment over the telephone. If you would like to talk to one of the team, just get in touch on 01306 888171.

Recent Parkinson’s diagnosis? What our patients say

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We have worked with many Parkinson’s patients since the practice opened in 1997. Some people come to us a number of years after diagnosis, but many come at the early stages. This is what they have to say about specialist neurological physiotherapy at heads up!:

“It was lovely having the time and space just for me. I felt listened to and my concerns were heard.”

“With the help of my experienced and knowledgeable therapist, I now feel that I have the right programme of exercises and activities which suit me and where I am at the moment. This has helped me feel more in control of my life with Parkinson’s.”

“The whole heads up! team were extremely helpful in giving guidance and support, particularly in the first weeks of living with Parkinson’s”

“As soon as I started the exercises, I found some relief from pain and improvement in my mobility.”

“It’s very reassuring to know that heads up! have lots of experience of working with Parkinson’s – I feel confident that I know where to come if I need to in the future.”

“The team know their patients’ abilities and needs and are able to guide patients in a very professional way”.

It is great for the team to receive such wonderful testimonials, but more so, is seeing the positive changes and results in the people, friends and family we treat and support.

headsup! Is a team of specialist neuro physiotherapists covering London and the South East. We are always happy to discuss individual requirements and explore suitability for treatment over the telephone. If you would like to talk to one of the team, just get in touch on 01306 888171.

 

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