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stroke & neurological physiotherapy

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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.

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.

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

3 tips: preparing for 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. Slow breathing

Take three slow deep breaths, sitting up as tall as you can, as you breathe in through your nose and out through your mouth. Do this five times.

2. Sitting tall

Sit up as tall as you can, imagining a very strong elastic band through the top of your skull pulling you gently but strongly towards the ceiling. Stay sitting up tall for ten seconds. Do this five times with a short rest in between.

3. Working your tummy muscles

Place your hands in your lap and think about where your shoulders are in relation to your pelvis. If your shoulders are behind your bottom, try to sit forwards (without using your arms if possible, so that your tummy muscles do the work, not your arm muscles) so that you are sitting in your best sitting posture. Imagine a torch light shining from your breast bone and slowly turn your body to shine the torch to one side and then to the other. Do this three times to each side keeping your best posture all the time. Try to lead the movement with your tummy muscles rather than shoulders or head. Do this five 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

3 tips: preparing for standing practice an 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. Breathing

Take three slow deep breaths, breathing in through your nose and out through your mouth. Pause for a minute or so and then repeat.

2. Sit up tall

Sit up as tall as you can, imagining a very strong elastic band through the top of your skull pulling you gently but strongly towards the ceiling. Stay sitting up tall for three seconds.

Do this five times.

3. Posture

Take three more slow deep breaths, this time concentrating on your tummy button and imagining the area behind your tummy button filling up with air and your lower ribs going out to the side as you breathe in. As you breathe out concentrate on your posture, trying not to slump downwards as you breathe out. Do this five times.

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.

Festive meals & family gatherings: 3 tips on how to reduce time sitting after stroke

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

1. Get involved

Whilst the Christmas meal is being prepared, try to get close to the action so that you can, for example, stand up whilst the potatoes are being peeled, or whilst the table is being laid.

2. Check out your surroundings at the start

Find somewhere where you feel safe and confident to stand up, either with or without some help or support. This may take some investigation and trials, but it will be worth doing at the start of a busy day. Having sufficient time and opportunities to practice and gain confidence in standing are essential in building strength and improving ability to stand for longer.

3. Make a point of standing

Making a point of standing up at different stages of the day will minimise stiffness. For example, stand up when people arrive, stand up when you sit round the table to eat, stand up when you have finished your turkey, stand up when you have finished pudding and stand up if there are any chocolates or other treats on offer.

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.

Shopping and other outings: 3 tips on how to reduce time sitting after stroke

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

1. Set an alarm

If you need a wheelchair when you are out shopping or for longer distances, then set a phone alarm to remind you every hour to stand up and have a good stretch.

2. Pushing a wheelchair

If you are being pushed around in your wheelchair and you can manage to walk a short distance yourself, then change places each hour – so you push them!

Pushing a wheelchair with someone sitting in it is easier on the flat than pushing an empty chair. If you need to, walk with a wall close by on one side so that you can stop and lean if necessary when you need to.

3. Posture check

When you go to the W/C or get back to the car and have to stand up, spend longer in standing than you need to. Check your posture and gently place more weight on one foot than the other and, if possible, step one foot back and forwards a few times with each leg.

Check your posture again and turn your head slowly to look over one shoulder and then the other three times.

The next blog will cover 3 tips for reducing time sitting after a stroke at festive meals and family gatherings over the holiday season.

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

Why is spending time standing up important?

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Humans are bipedal creatures. We have evolved so that we can stand up and balance on our feet and use our hands for an enormous variety of tasks.

Initially hunting, gathering, tending, nurturing and feeding would all have been vital skills. Today we use our hands with a slightly different emphasis – for example the skills of grooming and intricate tool use receive more attention, as well as pushing the correct buttons on a remote control.

In more affluent societies the time spent in sitting rather than standing has historically increased. The average time spent watching television per day is nearly 4 hours and this is done sitting down. With the advent of the management of our lives using keyboards and smartphones we spend more time relating to electronic devices in our lap area and less time on our feet.

The support of the body in a sitting position is the subject of enormous research and there are now a huge variety of ergonomic and posturally supportive chairs and seating systems.

Over the next few months we will sharing a series of tips, to help anyone who has had a stroke build their strength, confidence through increasing time in standing by incorporating this into their daily routine wherever they are. *

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 our specialist neuro-physios, just get in touch on 01306 888171.

* heads up! neuro-physios assess and treat people with strokes and many other neurological conditions. Each person has different individual physical characteristics and capabilities and whilst our blogs contain some general advice and information, any activity should first be practised with a specialist neurological physiotherapist while the most effective and safe exercise programmes are those designed in conjunction with, and regularly reviewed and progressed by, a neuro-physio.

heads up! Stroke & Neurological Physiotherapy

The Clockhouse
Partridge Lane
Newdigate
Surrey
RH5 5EE
01306 888171

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