stroke & neurological physiotherapy
Contact us 01306 888171
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. read more
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. read more
Our Headsup! practice in Sevenoaks is run out of 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
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. read more
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. read more
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.
It is a genetic condition caused by inheriting a defect in a single gene from one of your parents
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. read more
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’. read more
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!
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:
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:
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 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:
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.
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.
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.
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!
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.
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.
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.
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.
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.
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.
“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.