This covers a wide range of physiotherapy from acquired brain injury such as Stroke, Parkinson’s disease and Multiple Sclerosis along with other demyelinating diseases like Motor Neurone Disease. Neurological physiotherapy may also be useful following neurosurgery and peripheral nerve or cranial nerve injuries such as Bell Palsy.

Neurological physiotherapy typical cases include:

Stroke
This is the colloquial term for CVA (Cerebrovascular Accident) Stroke can be catastrophic it is rarely anything but and after the initial shock and relief that you have survived patients are initially medically stabilised and then begin rehabilitation. Some strokes are treated in the community or hospital and hospitals are moving towards a concept known as Early supported Discharge (ESD). ESD is where patients are discharged into intermediate care or the community whilst still undergoing treatment. This change has been based on a few studies of limited relevance to the patients and as a result people often find themselves at home with more complex symptoms requiring on-going physiotherapy. Stroke often results in individuals being left with significant lasting disability that if left untreated can persist and can deteriorate further.

Presentation is typically seen as loss of function and sensation on one side of the body, known as hemiplegia.

Rehabilitation focuses on relearning motor functional tasks, practicing normal movement patterns that were prior to the stroke automatic and muscle stretching and strengthening to regain arm and leg function and working on grips, balance and walking.
Recovery from stroke is not limited to the first 6 months after the stroke. Nerve plasticity (there ability to repair after the initial damage) has advanced rehabilitation to incorporate neuronal physiology to aid with this plasticity to regain function years after the initial insult if some activity is present.

Multiple Sclerosis

The presentations of this condition can vary and patients frequently experience sensory, muscle (motor) and balance deficits. Patents can also experience bladder, balance and postural problems.

Rehabilitation works on trying to regain lost function due to the nerve demyelination and correcting abnormal movement to maintain function independence..

Parkinson’s disease
Initially this condition is medically managed with Dopamine to correct the clinical imbalance. Often as the condition deteriorates and the effects of the medicine begin to wear off and they notice a deterioration in a range of activities.

Presentation may include changes to walking where you may experience difficulty in initiating and stopping walking, and changing direction. Tightness in hips and thorax and knees are also common presentations as is in the later stages a loss of facial movements, slowing of speech and shrinking handwriting.

Rehabilitation can assist in slowing the progression of all of these areas by stretching the tight muscles, mobilising the stiff joints to maintain function and walking independence for as long as possible. Rehabilitation can also address speech and facial expressions changes to stimulate the small muscles of the face. Work on walking and the use of timing and music can assist with walking independence and reduce the need to use walking aids.

Written by Dr Nicky Spence

Nicky Qualified in 1991 and has a wide range of experience across the NHS and the private sector spread over the last 25 years. Her specialism is a mix of musculoskeletal experience and neurological rehabilitation. As an experienced physiotherapist, Nicky has published several books, academic journals and conference presentations. Nicky has maintained her continuing professional development by attending post graduate courses (e.g. Advanced Bobath) and has an MSc in Health care practice and PhD in Stroke rehabilitation.