Mr Peter Harding
Msc. Msc. Grad Assoc Phys. MCSP
Neuro-Physiotherapy is used to help patients who are suffering from neurological diseases and can also be helpful to patients who have suffered a stroke or have sustained a head injury.
Ataxia, Balance and Vestibular problems, Cerebral Palsy, Dystonia, Facial Palsy, Multiple Sclerosis, Motor Neurone and other Degenerative Diseases, Parkinson's Disease, Polyneuritis and other Polyneuropathies
Spinal Cord injury, Neuro-Physiotherapy
Post stroke spasticity occurs as a result of injury or damage to the central nervous system i.e. the brain or spinal cord (CNS). Damage to the CNS can be caused by stroke, brain injury, Multiple Sclerosis; to name but a few. Such damage can result in physical symptoms including weakness or paralysis, loss of fine motor control of movements, and muscle spasms or tightness. It is spasms and tightness of muscles that are usually referred to as post-stroke spasticity. It is important to manage post-stroke spasticity properly and effectively in order to improve function, improve quality of life, and prevent contractures.
If spasticity is affecting a relatively small group of muscles, it can be treated by injecting tight, spastic or over-active muscles, with small injections of Botulinum Toxin-A (Botox™) to weaken or paralyse specific over-active muscles. In all cases, physiotherapy is essential to manage post-stroke spasticity especially following Botulinum Toxin-A injection therapy. Spasticity associated with acquired brain injury, spinal cord injury or M.S. can also be reduced with Botulinum toxin-A injections.
Improved function mobility, seating and positioning.
Increased ease of care, dressing hygiene and bathing.
Avoiding Contracture Formation in conjunction with Stretches, Serial Casting and Splinting.
Increased Comfort, pain reduction, sleep improvement and improvement of Orthosis compliance or fitting.
Cosmetic Factors, improved body image.
Improved response to Physiotherapy.
Some treatment goals may include:
Spasticity is the severe muscle stiffness caused by damage to the brain or spinal cord and is a major challenge to any rehabilitation team. Spasticity can prevent or hamper an individual's functional recovery, cause pain, disturb sleep, cause unnecessary complications and present major difficulties for the patient and carers. The treatment of spasticity often requires a multi-directional approach to achieve the best results for the individual. Seldom is one treatment effective in assisting the patient. At Neurophysioplus we can offer a comprehensive assessment and treatment strategies to reduce the spasticity and improve function and/or comfort.
Treatments include exercise therapy, stretches, serial casting, thermoplastic splinting, Botulinum Toxin-A injections, advice on posture, positioning and seating. We can also advise on Orthosis. The treatment of spasticity like all rehabilitation processes must start with the establishment of specific and achievable goals and a carefully planned strategy to achieve these goals. It is not always necessary to treat spasticity as it can be useful in some individuals e.g. spasticity in a leg may serve as a brace to support the individual's weight for transferring or walking.
In general terms 3 potential aims of treatment:
To improve function
To reduce risk of unnecessary complications
To alleviate pain
Occasionally a justifiable aim is not specifically to help the patient, who may not perceive any problems with spasticity, but to make nursing easier for the main carers and to assist with the maintenance of hygiene, dressing and transferring.
Functional Electrical Simulation (FES) can help people who have had damage to their brain or spinal cord to move more easily. FES uses a small electrical impulse to activate paralysed muscles to produce useful movement. The electrical impulses work by exciting the nerves leading to the muscles. Self-adhesive patches (electrodes) are usually placed on the skin close to the nerve supplying the muscle; this is often over the centre of the muscle. Leads connect the electrodes to a stimulator that produces the impulses.
Who may benefit from FES?
People who have difficulty moving due to damage to their brain or spinal cord such as from a stroke, suffers of Multiple Sclerosis (MS) or who have had an incomplete spinal cord injury (T12 or above). It can sometimes be used with people who have had a head injury. To be effective it is important that the nerve fibres between the spinal cord and the muscle are not damaged.
A mimimum prerequisite for ODFS is that the patient must be able to stand and take a few steps with or without a walking aid
The impulses need to travel along the nerves to the muscles.
The most common problem treated by FES is called 'Drop-Foot'. This is the inability to lift the foot and toes when swinging the leg during walking causing the toes to catch or the foot to drag on the ground. 'Drop-foot' is caused by weakness of the muscles that lift the foot and excessive tightness (spasticity) in the muscles of the calf. Stimulation is given to the muscles at the front of the leg. The simplest stimulator is the 'Odstock Dropped Foot Simulator' (ODFS). A switch worn in the shoe triggers the stimulator, an electrical stimulation then reaches the muscles through electrodes stuck to the skin on the side of the leg, just below the knee.
Stimulation may be given as a sort of exercise (Microstim) to strengthen weak muscles or relax tight ones. People who benefit from this usually have some movement of their arm & hand. This sort of treatment is often used as an adjunct to a physiotherapy programme. At Neurophysioplus we can offer all types of Functional Electrical Stimulation at competitive rates.
Serial Casting and Thermoplastic Splinting
Muscles need to be stretched or put into a lengthened position daily to maintain their length and flexibility. We all do this during our normal activities. However, if movement is difficult because of spasticity, pain or weakness then muscles may require assistance to prevent shortening or contractures. Research has shown that spastic muscles require several hours of prolonged stretch to maintain their length. The only way this can be achieved is by splinting to maintain, or serial casting to increase, muscle length. The latter is most effective following Botulinum Toxin- A injections. At Neurophysioplus we are able to advise and treat problems associated with muscle shortening.
The SaeboFlex® is a custom made, dynamic hand splint that allows patients following stroke, acquired brain injury and M.S. the ability to open their hand for grasp and release activities. The SaeboFlex is most appropriate for individuals who are unable to open their hand due to increased tone (muscle stiffness/ spasticity following damage to the CNS), or those that have some active finger extension (hand opening) without function. There is no doubt that the more you use your arm and hand the better your chances for improvement. The SaeboFlex has been shown to improve strength, range of movement, motor control and overall arm function. At Neurophysioplus we would be happy to advise whether a SaeboFlex could help.
Below are some conditions treated by Neurophysioplus Ltd.
Rehabilitation is a programme that helps a person who is recovering from illness to regain as much function as possible. The aim is for our clients to become as independent as possible despite their disability. Rehabilitation also aims to teach strategies for ongoing disabilities.
Common conditions that may require rehabilitation are:
Acquired Brain injury including stroke, spinal cord injury
Brain injury and head injury
Spinal cord dysfunction
Multiple Sclerosis
Parkinson's disease
General immobility caused by prolonged bed rest & illness
The Physiotherapist assesses and manages your mobility (including walking aids if required), improves balance and assists with regaining strength and control of your arm(s), leg(s) and body. At Neurophysioplus we can offer a tailor-made rehabilitation programme, and for the more able-bodied we have a very well equipped physiotherapy gym.
Standing and tilt table
Allows the physiotherapist to
stand patients, which would
otherwise be extremely difficult.
Johnson inflatable splints
To improve joint range and
muscle length
Complex Patient
Management
We can assess, treat, advise
and act as the patients advocate
for patients with complex
rehabilitation needs.
FES(Functional Electrical Stimulation) and who benefits
Botulinum Toxin-A (Botox injection therapy)
© Copyright Neurophysioplus Ltd 2007
Neurophysioplus Ltd
Registered Office | 15 Second Avenue, Selly Park, Birmingham, B29 7HD
Registered in England & Wales Reg No. 5988036
