heads up!

stroke & neurological physiotherapy

Contact us  01306 888171

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.

 

 

 

What is Dystonia and tips on how to manage it

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

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

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

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

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

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

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

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

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

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

If you want more information try the following website:

www.dystonia.org.uk

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

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.

Recent Parkinson’s diagnosis? What our patients say

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

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

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

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

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

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

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

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

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

 

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.

5 reasons early neurological physiotherapy is important for Parkinson’s

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We must remember that a positive difference can be made to people who have lived with Parkinson’s for a number of years. But the question we are regularly asked is, why early neurology physiotherapy is so important?

1. When presented with a diagnosis of Parkinson’s most people will have questions which they would like to put to a knowledgeable professional experienced in the field.

2.  Most people want to know what they can do to minimise the effects of Parkinson’s Neurological physiotherapists will give helpful tips and advice.

3.  Regular exercise is a powerful tool to keep the body and mind in the best shape possible. Specific advice for each person helps to tailor the exercise and activity to best address their individual needs and preferences.

4.  Assessing and minimising postural asymmetry and any areas of specific spinal stiffness           together with postural advice help to optimise posture.

5.  Taking baseline measures and providing a monitoring and advisory role is reassuring. The person with Parkinson’s will feel that there is somebody who knows about their physical state and can help them to remain as active as possible.

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

 

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.

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