CONDITIONS

A stroke can occur when the blood and oxygen supply to the brain is disrupted, either as a result of a blockage (ischaemia) to the blood vessels supplying the brain, or as a result of a bleed (haemorrhage). This loss of blood supply and a lack of oxygen results in damaged brain tissue. Every stroke presents differently depending on where the damage occurs. A number of symptoms can present including:

· Muscle weakness or paralysis on one side of the body

· Numbness and altered sensation

· Neglect of one side of the body

· Visual impairment e.g. loss of vision, blurred vision, double vision

· Muscle spasms and spasticity

· Dizziness, reduced balance and falls

· Difficulties with daily activities e.g. walking, standing up, dressing etc

· Problems with speech, swallowing

· Cognitive impairments

· Fatigue

· Headache and pain

Rehabilitation is therapy that helps you to re-learn things that were affected by your stroke. It aims to stimulate your brain’s ability to create new neural pathways, (called neuroplasticity) to recover the functions of those parts of the brain that were affected by your stroke. Most improvement and recovery after stroke can occur in the first 6-12 months but can continue for years after stroke with targeted rehabilitation.

Your Neuro Balance Physiotherapists will set up specific training exercises based on your presentation and impairments after stroke, aimed at optimising Neuroplasticity and recovery. Your Physiotherapist can also provide you with education about lifestyle risk factor modification to help reduce your risk of a second stroke.

Stroke is a Medical Emergency and acute stroke management is Time Critical. If you or someone else is suddenly experiencing the signs of stroke, seek medical attention

immediately

by calling 000.

Parkinson’s Disease (PD) is a progressive degenerative neurological condition that is primarily a movement disorder, causing tremor, muscle stiffness and slowness of movement (bradykinesia). Its other characteristics can include changes in mood, voice, and cognition.

Currently there is no known cause for the development of PD.

The disease destroys neurones in a particular area of the brain known as the substantia nigra. This results in a reduction in dopamine, without which the brain’s ability to control movement is progressively reduced.

The defining features of PD are a variable combination of:

· Slowness of movement (bradykinesia)

· Activities of daily living such as writing, getting dressed and preparing meals can progressively become more difficult. Facial muscle activity can also be affected, resulting in a staring, expressionless appearance.

· Difficulty with swallowing and deteriorating speech quality can occur.

· When large muscles are affected, people with Parkinson’s disease can have difficult standing, walking and “getting going” or “freezing” of movement.

· Involuntary muscle activity can also be impaired, causing urinary problems and constipation.

· Muscle rigidity

· Increased muscle tone can cause stiffness, pain and cramps. People with Parkinson’s disease typically become stooped and may walk with a shuffle or a limp. Their arms cease to swing when they walk and they can have difficulty turning around on the spot.

· resting tremor

· Usually affects one side of the body first when the muscles are relaxed. Tremor usually affects the hands and arms and less frequently the legs, jaw or head. Stress or fatigue exacerbate tremor.

These symptoms can result in functional instability. Problems with balance and unsteadiness develop later. People with Parkinson’s disease may have difficulty getting out of bed, out of a chair or into and out of vehicles. Assistance may be needed to maintain mobility while avoiding the risk of debilitating falls.

No two people will experience the disease in exactly the same way. The nature, severity and impact of symptoms can vary significantly.

Treatment

There is no cure for Parkinson’s disease, but there are effective medical treatment and therapy options that can help manage symptoms, so people with Parkinson’s disease can continue to enjoy many years of independent and productive lives.

Physiotherapy for PD

People with Parkinson’s disease should remain as active as possible, maintaining daily activities and a regular exercise program. Your Physiotherapists will assess you and provide PD specific exercises, education and retraining to improve coordination, balance and movement. Your Physiotherapist will aim to help you improve your overall fitness and muscle tone, which can help minimise some of the abnormal movements associated with Parkinson’s disease.

Multiple Sclerosis (MS) is an autoimmune disease of the central nervous system. MS is a result of the body's immune system attacking its own myelin — the protective sheath surrounding the central nervous system. It interferes with nerve impulses within the brain, spinal cord and optic nerves. The breakdown of myelin can impair nerve transmission anywhere throughout the body’s central nervous system, which can manifest in a wide variety of symptoms.

Multiple sclerosis is progressive, often unpredictable and regularly varied in severity from one person to another, and symptoms can sometimes alter day to day.

Early signs and symptoms of MS can be detected in different ways and in different areas of the body:

· Bladder and bowel dysfunction

· Cognitive fog / impairment

· Emotionally labile

· Fatigue· Headache

· Hot and Cold sensitivity

· Numbness

· Pain

· Sensory symptoms

· Spasticity

· Swallowing impairment

· Tremor

· Visual Impairment

· Weakness

· Impaired ability to perform ADLs, e.g. walking, standing up, up/down stairs

Three Types of Multiple Sclerosis

1. Relapsing-remitting (RRMS)

2. Secondary progressive (SPMS)

3. Primary progressive (PPMS)

A relapse is a relatively sudden episode of either new symptoms or a worsening of existing symptoms that continues for longer than 24 hours and is separated from a previous attack by at least 30 days.

There is currently no known cure for the disease. Once a relapse is determined, the most suitable treatment response must be considered by a medical professional. Rehabilitation and physiotherapy is important to assess any changes in your function (mobility, balance, pain, fatigue) and address these changes with a program suitable to your stage and symptoms.

Functional Neurological Disorder (FND) is a highly complex neurological condition which can present in different ways. In FND there is no structural damage of the brain, nervous system or muscles, however there is a problem with the functioning of the nervous system and how the brain and body send and receive signals, resulting in abnormal movement.

The two most common symptom groups of FND are;

· Functional Motor Disorders (FMD)

These can include a range of symptoms, such as: ­ limb weakness, ­ tremor (shaking), ­dystonia (abnormal posturing),­ gait disorders and difficulty swallowing.

· Dissociative Attacks/Events (DA)

Dissociative attacks involve altered movements, sensations and states of consciousness that can look like epileptic seizures but are not caused by abnormal electrical discharges in the brain. This can be a response to a combination of physical (including sensory overload), mental and social stressors.

People who suffer from FND can often have other symptoms such as: chronic pain, fatigue and difficulty with memory and concentration.

Patients with Functional Motor Disorders such as limb weakness, gait problems, dystonia or tremor can benefit from physiotherapy, with the aim to retrain movement patterns and restore normal automatic functioning.

Your Neuro Balance Physiotherapist will assess your symptoms and how you perform day to day activities to design a tailored exercise program in line with your goals. Exercises are prescribed to help retrain movements and endurance. Engaging and practicing the tailored program will help neuroplasticity in the brain. This is the brains ability to form new neural connections in response to new situations or changes in your environment.

Motor Neurone Disease (MND) is a neurodegenerative disease that causes rapidly progressive muscle weakness. The disease affects nerve cells (motor neurones) that control the muscles that enable you to move, speak, breathe and swallow.

Early symptoms are often mild. They may include stumbling due to weakness of the leg muscles, difficulty holding objects due to weakness of the hand muscles and slurring of speech or swallowing difficulties due to weakness of the tongue and throat muscles.

There is no cure or standard treatment for MND. Physiotherapy and rehabilitation are an important part of the multidisciplinary support and care recommended for people with motor neurone disease.

Your Neuro Balance Physiotherapist can develop management strategies for you at home aimed to maximise independent mobility, and prescribe exercise to improve posture, prevent joint stiffness and spasticity, slow muscle weakness and atrophy. They can provide pain management strategies and advice as well as providing relevant education and training to family and carers. Symptomatic and supportive treatment can also help people be more comfortable in their homes while maintaining their quality of life.

Guillain-Barre Syndrome (GBS) is an autoimmune disease where the body’s immune system begins to attack the peripheral nervous system (both motor and sensory nerves) causing weakness or paralysis, abnormal sensations and pain.

It can present in many different ways however first symptoms include varying degrees of weakness or tingling sensations in the legs or hands. In many cases this spreads to the upper body and in severe cases leads to almost total paralysis. GBS can be dangerous if the muscle weakness affects the chest muscles responsible for breathing. Other variants of GBS present with gait ataxias, and reduced sensation and balance.

The symptoms can occur quite rapidly over hours to days or slowly over weeks. Most patients reach peak weakness within the first 4 weeks. It is a rare disease and the cause is not known but GBS is usually triggered by a preceding viral or bacterial infection.

Some medical therapies can reduce its severity and increase a patient’s recovery. Plasmapheresis and intravenous human immunoglobin are the therapies most commonly used. Physiotherapy is an integral part of the recovery and management of GBS.

Your Neuro Balance Physiotherapist will assess you and design a therapy and exercise program in line with your goals. Your Physiotherapist can help minimize pain, increase strength and endurance and prevent secondary complications and overuse damage to muscles and joints while improving posture, balance and mobility and restoring daily functional activity at home. Your Physiotherapist can also provide recommendations, education and training to family or carers when needed.

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you're spinning or that the inside of your head is spinning.

BPPV causes brief episodes of mild to intense dizziness. It is usually triggered by specific changes in your head's position. This might occur when you tip your head up or down, when you lie down, or when you turn over or sit up in bed.

Although BPPV can be bothersome, it's rarely serious except when it increases the chance of falls.

The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:

· Dizziness

· A sense that you or your surroundings are spinning or moving (vertigo)

· A loss of balance or unsteadiness

· Nausea

· Vomiting

Activities that bring about the signs and symptoms of BPPV can vary from person to person, but are almost always brought on by a change in head position. Some people also feel out of balance when standing or walking. Abnormal rhythmic eye movements called nystagmus usually accompany the symptoms of BPPV.

BPPV is caused by a problem with your vestibular system in your ear, which controls balance. Inside the inner ear is a series of canals filled with fluid. These canals are oriented at different angles. When the head is moved, the rolling of the fluid inside these canals tells the brain exactly how far, how fast and in what direction the head is moving. BPPV is thought to be caused by little calcium carbonate crystals (otoconia) coming loose within the canals. Usually, these crystals are held in special reservoirs within other structures of the inner ear (saccule and utricle). It is thought that injury or degeneration of the utricle may allow the ‘crystals’ to escape into the balance organ and interfere with the fluid flow.

Most causes of BPPV are unknown (idiopathic), however sometimes BPPV can be caused by head injury, degeneration of the vestibular system in the inner ear due to ageing or damage caused by an inner ear disorder.

BPPV symptoms can subside with time, but it is important to seek treatment in the early stages to prevent falls or injury.

Your Neuro Balance Physiotherapist is experienced in the assessment and treatment of BPPV using Dix Hallpike and Epley’s Maneuver and will prescribe simple exercises for you to continue with after the treatment. The specialised positional manoeuvre aims to move the crystals out of the semicircular canal of the inner ear and into an area of the inner ear where they no longer cause dizziness.

Traumatic Brain Injury (TBI) is an alteration in brain function, or pathology caused by an external force. It occurs when an external force impacts the brain, and often is caused by a blow, bump, jolt or penetrating wound to the head.

The two most common causes of traumatic brain injury are falls, and road traffic accidents, which includes vehicle collisions, pedestrians being hit by a vehicle, vehicle-cyclist and car-motorcyclist collisions as well as bicycle and motorbike crashes.

Home based rehabilitation with your Neuro Balance Physiotherapist is appropriate for patients with TBI after their acute hospital and inpatient rehabilitation stay, who still need to work on independent living skills, walking, balance and strength, as well as ongoing prevention of secondary complications. Your Physiotherapist will take a thorough history and set a program to achieve your personalised goals. The therapy can take place at a patient’s home, within local community facilities like supermarket, gym, etc (pending access approvals).

Chronic Pain is pain that persists beyond the normal healing time of about three months.

Sometimes, it is not possible for doctors to pin point the cause of the pain and it can be frustrating not to have a diagnosis. Chronic pain is complex because it involves the nerves and nervous systems, including the central nervous system made up of the brain and spinal cord.

It is believed that chronic pain occurs because of changes to the nervous system which keeps the nerves firing and signaling pain, long after the expected healing time. The changes in the nervous system are unrelated to the original diagnosis or injury, if there was one. There are likely to be other precipitating factors with chronic pain including genetics, gender, coping strategies and previous episodes of acute pain. Chronic pain can be intense and unrelenting, and lead to various degrees of disability if it is not managed well.

Physical activity and movement are an important management strategy in people with chronic pain as it gives the nervous system and the brain a lot of feedback about the body and the environment. It helps to normalise the nervous system and reduce your sensitivity to pain. It may be that the limitation to your physical ability due to pain is your major concern. Graded exercise routines; where people slowly increase the amount of general exercise they perform to re-condition their muscles, over weeks and months, have been shown to help people with persistent pain.

Your Neuro Balance Physiotherapist will help you set goals and design an activity or exercise program in a graded individualised way so as not to aggravate your pain. They can also provide education and advice regarding pacing your activity.

Physical activity in older people is critically important in the prevention of disease, maintenance of independence and improvement of quality of life. Regular physical activity can bring significant health benefits to people of all ages and evidence is increasingly indicating that physical activity can extend years of active independent living at home, reduce disability and improve the quality of life for older people.

Older adult care is complex because it comes with multiple conditions requiring knowledge of many specialties. Older adults often develop multiple conditions under musculoskeletal, cardiovascular and neurological conditions.

It has been suggested that older adults engaged in regular physical activity demonstrate improved:

· Strength

· Balance

· Coordination and motor control

· Flexibility

· Endurance

Exercise has been shown to be effective in reducing the number of falls and the number of injuries from falls. This exercise can be home based and can include a mix of balance, gait training and strength training. Exercise must be challenging but safe.

Furthermore, some older people find that after a hospital admission they are not as strong or steady as before. This is called deconditioning, which is a process of physiological change following a period of inactivity or bedrest that results in a decrease in muscle mass, decreases of muscle strength by two to five percent per day, muscle shortening and the inability to perform daily living activities. The decline in muscle mass and strength has been linked to falls, functional decline, increased frailty and further immobility. Being out of your familiar home environment and routine can also contribute to deconditioning.

Your Neuro Balance Physiotherapist will complete a thorough assessment of your activities of daily living, balance and strength to design a targeted program to achieve your goals in a safe and supported environment. This could be in your home, street, local shops etc.