heads up!

stroke & neurological physiotherapy

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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 enquiries@headsup.co.uk

 

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 enquiries@headsup.co.uk

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.

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.

5 areas neurological physiotherapists work with Parkinson’s patients

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Every patient is an individual, we take the time to assess each patient not only at the first session but also throughout the duration of treatment, and to ensure the programme we develop is right for each patient and their circumstances.
At initial enquiries and consultations we are often asked, what are 5 areas a neurological physiotherapist may work on with people with Parkinson’s:

1. Physical mobility – for example getting in and out of bed or standing up from a chair.

2. Improving walking and turning – strategies to get going more easily and get into a rhythm of walking and doing walking exercises, for example marching.

3. Posture – keeping posture as good as possible by regular specific stretching exercises and working together to keep a good range of spinal mobility.

4. Strength and fitness – working on the anti-gravity muscles which keep us upright and making sure that physical activity is appropriate to keep up strength and maintain an optimal level of fitness.

5.  Balance and co-ordination – understanding which particular activities are providing most
challenge and working on strategies and building strength and confidence to improve balance.

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.

ACPIN 2016 Conference Round-up

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Three members of the heads up! specialist neurological physiotherapy team attended the recent ACPIN (Association of Chartered Physiotherapists in Neurology) two-day conference in London, in association with INPA (International Neurological Physical Therapy Association).

The event brought together experts from across the globe, in neurological physiotherapy, rehabilitation and research. We have pulled together the key points, from a selection of the programme speakers:

Dr. Emma Stokes, Dublin, introduced day one by talking about the World Congress of Physical Therapists and the three priority areas they had identified:

  1. Research
  2. Evidence
  3. Practice

 Prof Derek Wade, Oxford presented “How to use evidence, follow guidelines, and be patient centred”. He discussed what we could do is not necessarily what we should do and how rehabilitation is all about behavioural change:

  • Guidelines – the evidence is always incomplete. They are not binding and not enforced. They are focused on treatment and not the problem
  • Evidence – has enormous limitations, often not well described on what they did and RCTs patients are allocated and not randomised
  • Theories – should be developed which are based on evidence, but developed over time.

Prof Louise Ada, Sydney presented: “One size does not fit all” concept in mobility intervention for stroke:

  • The speed of walking post stroke is a key determinant in whether a person walks outside the home. There is a need to look at groups of people with different walking speeds differently
  • Current trials are not good at describing participants or interventions
  • Cueing of cadence using a metronome is cheap and effective in improving walking speed and distance in people who have had strokes.

Prof Gert Kwakkel, Amsterdam (visiting Prof Chicago) presented: “Understanding upper limb recovery early post stroke: some lessons of the EXPLICIT – stroke programme”

  • The quality of trials is improving, up one Piedro point over the last 10 years and how.
  • In the future, there will be 4D analysis of movement – 3D+EEG
  • Stroke rehab app http://www.viatherapy.org

 Prof Sarah Tyson, Manchester presented “Patient-led therapy during in-patient stroke rehabilitation”

  • In hospitals all policies focus on patients NOT doing something in order to prevent damage
  • Good rehabilitation is about good organisation
  • Out of 28 days, when patients were supposed to exercise daily, only 7% exercised every day. The average was 11 days and 1/3 people exercised less than 7 days.

Prof Steve Wolf, Emory University USA presented: “Collaborative decision making and the development of best evidence apps”

  • PASS Physical Therapy and Society Summit – recommendations advocate for leadership role in prevention, health & wellness
  • He discussed genetics, robotics, telehealth and regenerative medicine
  • Frontiers in Rehabilitation Sciences and Technology (FIRST Initiative) www.viatherapy.org; www.neurorehabdirectory.com

 Prof Fiona Jones, London presented: “It’s all about the small steps” sharing and creating solutions for successful self-management after traumatic brain injury:

  • Lots of stories of people who had had traumatic brain injury not being heard
  • Often people denied that they had had a brain injury
  • Need change agents, people who really get it and want to make it work
  • People needed to support their partner/family member to take some risks. Risks are an essential part of neurological rehabilitation
  • Pilot carried out at King’s College Hospital, now looking at training people in all four major trauma centres in London and making a training film.

Prof Valerie Pomeroy, University of East Anglia presented: “Generating the evidence base for personalised stroke rehabilitation”

  • One third of people with stroke will decline to participate in research trails
  • Evidence Based Practice = “Using the best evidence available considering the person you actually have in front of you”.

Prof Lisa Harvey, Sydney presented: “Spinal cord injuries: recent trails and their relevance to other areas of neurology”.

 Prof Robert van Deursen, Cardiff presented: “Exploration of clinical-academic collaboration to achieve evidence based practice”:

  • Developing research evidence is about developing theory
  • In neurological physiotherapy we are dealing with behavioural change
  • Emphasised the importance of researchers and academics with a clinical background.

Prof Karen Middleton, Chair Chartered Society of Physiotherapy gave a punchy address talking about “knowing the customers and what their local needs are”

  • Prevention is the only way we are going to deliver sustainable health care
  • We are exemplary problem-solvers. We really do work in partnership with patients, their hopes and what they want to achieve
  • To focus on supported self-management and self-referral. Self management is about education for people to understand their disability and know when they need to seek help
  • We are in danger of being obsessed with evidence
  • We need to pull together as a profession and make the most of our professional body.

Prof Helen Dawes, Oxford Brookes University presented: “Walking and simulated walking control”

  • Used imaging and treadmill training
  • After stroke, people used a lot more metabolic and brain activity to move and walk
  • Pre-frontal cortex more active soon after stroke, but the activity decreases over time
  • Internal planning seems to affect walking more than external distractions i.e. thinking about what you are going to buy at the shops, is more distracting than confronting something in the environment.

To find out more about the conference – Evidence into Practice – visit www.acpin.net

 

Can you put a time on stroke recovery?

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Stroke recovery is a highly individual process, which depends on many different things. The severity of the stroke and location of the area of damage in the brain will all have an effect on the recovery time.

Initially, the biochemistry of the brain is disrupted by the stroke. Over a period of days and weeks things settle down and the initial shock wears off.

Stroke rehabilitation consists of treatment from stroke doctors and nurses, neurological physiotherapists, occupational therapists and speech and language therapists. This multi-disciplinary stroke rehabilitation is most effective in maximising stroke recovery.

Stroke recovery, in our experience of working with people over many years, takes place over many months and even years. At heads up! we have a hands-on approach, using our neurological physiotherapy treatment skills to re-align, re-activate and strengthen muscles.  We teach people how to move most efficiently and with the least effort possible in each person’s particular case.

Stroke recovery is a journey and specialist neurological physiotherapy input gives people treatment, advice and appropriate exercises specific to that person at that time. Doing the exercises given regularly and diligently as an adjunct to neurological physiotherapy treatment, will help to consolidate progress.

You can find out more from the Royal College of Physicians Stroke Guidelines https://www.rcplondon.ac.uk/guidelines-policy/stroke-guidelines

Longer term stroke recovery – one person’s story
A few years ago I saw a man who sadly had had a stroke only a few weeks after retiring, following a long and distinguished career. After five months spent in hospital and local rehabilitation unit, he came to heads up! and was unable to stand on his own without support.

His loving wife was his greatest supporter and inspiration. His previous employers were extremely generous and funded regular treatment for many months. At our suggestion he also worked regularly with a local personal trainer (under our supervision) and improved slowly, but surely.

Three years after his stroke he completed a sponsored walk of one mile. He used a stick and a bespoke leg splint. With many friends, family and some of the heads up! team cheering him, he walked a mile in just over three hours. This was his marathon. We were extremely pleased and proud to support him and delighted to report of his determination and amazingly successful fundraising effort.

 

headsup! have practices in the London and Kent areas. 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.

Hands-on neurological physiotherapy at heads up!

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We offer individual and specialised neurological physiotherapy treatment. Helping each patient work towards improving their movement and confidence, following a stroke or neurological condition such as Parkinson’s, multiple sclerosis, vestibular dysfunction and adults who were born with cerebral palsy.

We have worked with many people who have had a stroke, both recently or a long time ago. In the weeks and months following a stroke, recovery can be accelerated and optimised by specific hands-on treatment.

Our physiotherapists have many years’ experience, activating and re-aligning muscles and joints by physically moving the patient’s body. We work together to improve movement quality and although everybody is different, if we work hard it is invariably possible to make a positive impact.

headsup! have practices in the London and Kent areas. 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.

Why hands-on physiotherapy matters

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3 reasons hands-on neurological physiotherapy treatment helps recovery of control of movement after stroke.

Working together
People who have had strokes or have other neurological conditions such as Parkinson’s or balance disorders often find moving around difficult. Movement may be weak and limited, slow or lack co-ordination. Simply telling people to move, talks to the part of their brain which is responsible for producing movement. This part may not be communicating clearly with the other parts of the nervous system, which are responsible for actually doing movements. This may mean that movements are simply not able to be initiated without a little help.
During hands-on physiotherapy treatment the neurological physiotherapist and person receiving treatment work together, so that the patient can again feel how to move with more control and less effort.

Information
Stroke and other neurological conditions often affect the feeling, or sensory part of the nervous system. This means that the body may feel numb or not normal. Hands-on therapy gives information, through pressure, touch and manual guidance to help the nervous system learn to feel again.

Training
Physiotherapists are trained in using their hands. An experienced neurological physiotherapist will use their hands to re-align muscles and stabilise the body so that it can be more efficiently active when movement is difficult.

headsup! are 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.

3 tips: improving the quality of your standing practice (advanced)

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This is part of our series of tips to reduce time sitting after stroke and practice standing. Visit our website for more tips. Before carrying out any of the exercises in our blogs please read the important note below*

1. Create a checklist

Have a checklist in your head about the quality of your standing. The aim is a good posture, which allows a relaxed standing position, with weight evenly distributed on both feet and the back in a neutral position.

Everybody is different and people find individual reminders useful. Some common ones are “feet level, hip width apart, knees soft, bottom tucked in, tummy strong, ribs gently down but breast bone up, shoulders relaxed with soft arms and head up with chin gently tucked in and back of the neck long with crown of head up”.

2. Create and develop sense of your posture

Developing your own personalised checklist (with the help of a neurological physiotherapist ideally) and using a mirror if this helps you. A mirror may help to create and develop your sense of your own posture. Keeping still in your “best” posture and closing your eyes to enhance your appreciation of where your body parts are in relation to each other will help this improved posture to become more familiar and natural to you.

3. Joining posture with movement

Thinking about posture and movement is the next stage and developing strength in the trunk muscles. An easy way to do this is to take something with both hands from a shelf in front of you, or simply touch the wall in front of you or stand in a door frame and touch the frame either side at about shoulder height and then squat down and touch the floor with both hands or put an object on the floor, then pick it up again.

headsup! are 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.

* Please read before undertaking any exercises listed in this blog:

Neither headsup! neuro-rehab Ltd nor Anna Hamer accept any responsibility for any individual undertaking the activities or exercise suggested in our blogs, except to the extent those individuals are acting upon specific instructions from headsup! neuro-rehab Ltd specialist neurological physiotherapists.

If you are in any doubt please consult a specialist neurological physiotherapist. Please make sure you have suitable help to hand before embarking on any activities

3 tips: improving the quality of your standing practice (intermediate)

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This is part of our series of tips to reduce time sitting after stroke and practice standing. Visit our website for more tips. Before carrying out any of the exercises in our blogs please read the important note below*

1. Standing and using your arms

Think about HOW you stand up. Ideally weight should be evenly distributed on both feet and although using hands on the arms of a chair is something we would often do, if we take a lot of weight through the hands to push up then we are not asking the legs to work as hard as they might, so we may miss out on opportunities to strengthen the legs.

2. Stand up tall

When you are standing up make sure that you stand up as tall as you possibly can before you start doing anything in standing. Think about having strong legs and your hips forwards, chest lifted and head up with shoulders and arms relaxed. Say to yourself “stand up tall”, or “heads up! bottom in!”

3. Weight on each leg

Having checked that you are standing up tall, gently take more weight over to one leg so that you are putting 75% of your weight on one leg and 25% on the other. Hold this position for three seconds and then change so that there is more weight on the other leg.

Do this five times on each leg. Try to keep your body up tall and hips facing straight forwards.

headsup! are 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.

* Please read before undertaking any exercises listed in this blog:

Neither headsup! neuro-rehab Ltd nor Anna Hamer accept any responsibility for any individual undertaking the activities or exercise suggested in our blogs, except to the extent those individuals are acting upon specific instructions from headsup! neuro-rehab Ltd specialist neurological physiotherapists.

If you are in any doubt please consult a specialist neurological physiotherapist. Please make sure you have suitable help to hand before embarking on any activities.

3 tips: Increasing the time you spend in standing

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This is part of our series of tips to reduce time sitting after stroke and practice standing. Visit our website for more tips. Before carrying out any of the exercises in our blogs please read the important note below*

  1. Identify a daily activity

Identify an activity you can do in standing as you become more confident on your feet. Examples of this may be brushing your teeth, washing your hands or brushing your hair.

2. Listening to music and watching TV

If you listen to the radio or watch television, stand up either during a news bulletin or during the advertisement breaks. If you listen to music, identify a particular song you like and try to stand up for the duration of the song. You can then build up the time by adding other songs.

3. Build on your confidence

As your confidence improves in standing, increase the number of times you stand up in the day. If you cannot stand for long then try and stand more often. This will build your confidence and strength.

headsup! are 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.

* Please read before undertaking any exercises listed in this blog:

Neither headsup! neuro-rehab Ltd nor Anna Hamer accept any responsibility for any individual undertaking the activities or exercise suggested in our blogs, except to the extent those individuals are acting upon specific instructions from headsup! neuro-rehab Ltd specialist neurological physiotherapists.

If you are in any doubt please consult a specialist neurological physiotherapist. Please make sure you have suitable help to hand before embarking on any activities

3 tips: improving the quality of your standing practice (introduction)

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This is part of our series of tips to reduce time sitting after stroke and practice standing. Visit our website for more tips. Before carrying out any of the exercises in our blogs please read the important note below*

1. Foot control

If you are able to move your feet forwards and backwards with reasonable control, then do this a few times with each foot if possible, whilst you are sitting down, before you get ready to stand. This warms up the leg muscles and gets them ready for action.

2. Distributing body weight

When standing up try and get the weight transferred evenly over both legs. Think “is my weight even? How much weight have I got on my right foot – press a little into the floor with your right foot if you can as you think this, then do the same on your left foot.”

3. Turning your head

Stand up as tall as you can, bring your hips forwards, raise your chest – imagine a light on your breast bone shining straight in front of you. Lift up your head and if you feel stable enough, slowly turn your head to look over to one side and then the other side. Do this three times each way.

headsup! are 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.

* Please read before undertaking any exercises listed in this blog:

Neither headsup! neuro-rehab Ltd nor Anna Hamer accept any responsibility for any individual undertaking the activities or exercise suggested in our blogs, except to the extent those individuals are acting upon specific instructions from headsup! neuro-rehab Ltd specialist neurological physiotherapists.

If you are in any doubt please consult a specialist neurological physiotherapist. Please make sure you have suitable help to hand before embarking on any activities

Heads up! Stroke & Neurological Physiotherapy

The Clockhouse
Partridge Lane
Newdigate
Surrey
RH5 5EE
01306 888171

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