CVA / Stroke

A stroke occurs if an area of brain tissue is deprived of its blood supply causing brain cells to lose their supply of oxygen. This is usually caused by a blockage or burst blood vessel. Without oxygen, brain cells can become irreversibly damaged within minutes.

Unlike other cells in the body, if brain cells are irreversibly damaged then they are unable to heal themselves. The brain, however, is very adaptable and areas of the brain are capable of learning new tasks to compensate for the areas that have been damaged. Physiotherapy encourages this learning and to help the body re-learn normal movement patterns.

There are two types of stroke:

Ischaemic (90%) (blockage within an artery)
Haemorrhagic (10%) (ruptured blood vessel causing bleeding into the brain)

Effects of a Stroke

Common physical effects:

• Reduced mobility
• Weakness or paralysis (usually on one side of the body)
• Reduced sensation
• Neglect to one side of the body
• Swallowing difficulties
• Speech and/or language difficulties
• Incontinence
• Fatigue
• Post stroke pain
• Foot drop

Common non-physical effects:

• Mood changes
• Perceptual problems
• Cognitive difficulties
• Behavioural changes

Stroke Physiotherapy Treatment

Around half of stroke survivors are left with significant disability. The brain is, however, very adaptable and, with physiotherapy, recovery can take place over a period of years. Patients often have a rapid period of recovery in the first few months after a stroke followed by a slower recovery over the following years. To gain the maximum recovery, physiotherapy treatment should be continued once you leave hospital.

Neurological stroke physiotherapy can help:

• improve balance and walking
• increase ability to roll / move in bed / sit / stand
• reduce muscle spasms, pain and stiffness
• increase strength
• retrain normal patterns of movement
• increase affected arm and leg function
• increase energy levels
• increase independence and quality of life
• reduce the risk of falls

Multiple Sclerosis

Multiple sclerosis (MS) is a disease of the central nervous system (the brain and the spinal cord).

In MS the conductive outer coating of many of the nerve fibres is damaged. The body can repair the damage to some extent but often small scars are left and the nerves do not function quite as they did before. As MS affects different areas within the central nervous system it is described as multiple, and the small scars which arise can be described as areas of sclerosis. This is how the name multiple sclerosis arises.

The cause of MS is unknown. It is thought that it may be due to a small defect in the body’s immune system. MS is a relatively common disease. It most often affects young adults; over 70 per cent of affected people experience their first symptoms between the ages of 20 and 40.

Once diagnosed, MS stays with you for life, but your symptoms can be well managed by specialists.

There are 4 types of MS:

• Relapsing-remitting
  Relapse remitting MS is characterised by unpredictable attacks followed by periods of months or years with no new signs of disease activity. The effects of the attacks may be permanent or may resolve. When deficits always resolve between attacks, this is known as benign MS.
• Secondary progressive
  This is the most common type of MS. Secondary progressive MS refers to symptoms of initial relapsing-remitting MS, who have a gradual neurologic decline between attacks without any definite periods of resolution of symptoms.
• Primary progressive
  Primary progressive MS is characterised when no resolution of symptoms is seen following an initial attack. A gradual decline occurs continuously without clear attacks.
• Progressive relapsing
  Progressive relapsing MS is characterised by a steady neurologic decline but also suffer attacks.

Effects of MS

Multiple sclerosis (MS) can cause a variety of symptoms. These include:

• Sensation changes
• Muscle weakness
• Muscle spasms
• Movement difficulties
• Reduced coordination and balance
• Speech or swallowing problems
• Visual disturbances
• Fatigue
• Acute or chronic pain syndromes
• Bladder and bowel difficulties
• Cognitive impairment
• Depression

MS Physiotherapy Treatment

Physiotherapy treatment for MS is mostly exercise based combined with ‘hands on’ physiotherapy. Our experienced physiotherapists understand that MS affects everyone differently and your goals will be unique to you.

Physiotherapy should commence as soon as possible following an initial attack to allow you to reach your full potential and limit the progression of your symptoms. Hospitals are restricted to providing only a few sessions. At PhysioActive we are able to provide physiotherapy assessment and treatment as soon and as often as is required.

As well as improving your general health, neuro-physiotherapy can help:

• Improve balance and walking difficulties
• Reduce muscle spasms and stiffness
• Increase strength
• Retrain normal patterns of movement
• Increase energy levels
• Reduced bladder or bowel problems
• Increase mood
• Educate about MS and your symptoms
• Reduce risk of falls

Parkinson’s Disease

Parkinson’s disease is a progressive neurological condition affecting activities such as walking, talking, and writing. It is named after Dr. James Parkinson, the London doctor who first identified Parkinson’s as a specific condition.

Parkinson’s disease occurs as result of a reduction of nerve cells in the part of the brain known as the substantia nigra. These cells are responsible for producing a chemical known as dopamine, which assists in the transmission of messages sent to the parts of the brain that co-ordinate movement. With the significant reduction in the number of dopamine-producing cells, these parts of the brain are unable to function normally.

Effects of Parkinson’s Disease

Common motor symptoms seen in Parkinson’s disease are:

• Tremor – usually begins in one hand (the first symptom for 70% of people with Parkinson’s disease).
• Slowness of movement – people with Parkinson’s disease often find that they have difficulty initiating movements or that performing movements takes longer.
• Stiffness or rigidity of muscles – people with Parkinson’s disease often find that they have problems with activities such as standing up from a chair or rolling over in bed.
• Postural instability – leads to impaired balance and falls.
• Gait and posture disturbances:
• Shuffling gait
  • Decreased arm swing
  • Stooped, forward-flexed posture
  • Gait freezing – occurs in tight, cluttered spaces, doorways or when initiating gait
• Other motor symptoms:
  • Fatigue
  • Mask-like, expressionless face with infrequent blinking
  • Micrographia (small, cramped handwriting)

Various non-motor symptoms may also be experienced, for example:

• Sleep disturbance
• Constipation
• Urinary urgency
• Depression

Parkinson’s Disease Physiotherapy Treatment

Physiotherapy is very important in the management of Parkinson’s disease. People with Parkinson’s disease usually have mobility problems and are often at high risk of falls. PhysioActive aim to increase mobility and advise on changes to the home environment to increase independence and safety.

Independence is increased with:

• Balance, stretching and strengthening exercises and provision of walking aids and equipment.
• Your physiotherapist will assess how an individual performs activities such as; walking, going up and down stairs, getting out of a chair and getting in and out of bed.
• We can teach patients, their family and carers, special strategies on how do deal with common symptoms of Parkinson’s. Family and carers often find this advice and the practical handling techniques particularly helpful, in relation to helping individuals out of bed, walking and overcoming freezing.
• Home visit to advise on safety changes that may be required
• A specific falls prevention programme can be created to be completed between physiotherapy sessions to increase safety and reduce risk of falls.

Spinal Cord Injury

A spinal cord injury is a disturbance of the spinal cord that results in loss of sensation and/or mobility. This disturbance, or area of damage, is commonly referred to as a lesion.

There are two common causes of spinal cord lesion:

• Trauma (road traffic accidents, falls etc.)
• Disease (spina bifida, tumours etc.)

Spinal cord injuries can be organised into two categories:

• Complete lesion – no function, voluntary movement or physical sensation below the level of the lesion. Both sides of the body are always equally affected.
• Incomplete lesion – the effects are variable dependent on the severity of the lesion. An individual may have more functioning or movement on one side of the body than the other, or may be able to feel parts of the body that cannot be moved.

Effects of Spinal Cord Injury

The effects of a spinal cord injury are dependent on the type and level of the lesion. Effects are seen below the level of a lesion and can present as a reduction or complete:

• Loss of sensation
• Loss of voluntary movement
• Loss of proprioception (awareness of joint position in space)
• Loss of bladder and bowel function
• Loss of sexual function

Individuals also commonly experience:

• reduced ability to breathe deeply and cough
• pain
• muscular spasms

Spinal Cord Injury Physiotherapy Treatment

Physiotherapy for patients with spinal cord injuries can include:

• Exercises and stretches
• Joint care
• Pain control
• Anticipating and minimising secondary complications
• Provision of equipment, orthoses, and wheelchairs
• Advice for you and those caring for you on handling techniques
• Teaching you how to use specialised exercise equipment
• Teach transfers (getting in and out of a wheelchair, bed, car, shower/bath and onto and off a toilet).
• Teaching wheelchair skills
• Breathing exercises and chest clearance techniques
• Referral to appropriate health professionals

The effects of physiotherapy can be:

• Increased quality of life
• Increased independence
• Increased muscle strength
• Increased energy levels
• Reduced pain and muscle spasms
• Reduced stiffness
• Reduced risk of chest infections

Traumatic Brain Injury

A traumatic brain injury (TBI) is caused initially by a blow to the head. TBI also includes potential complications seen after the initial injury caused by lack of oxygen to the brain tissues or increased pressure within the skull.

At PhysioActive we treat all types of injury including:

• Subdural haematoma
• Epidural haematoma
• Subarachnoid haemorrhage
• Intraparenchymal haemorrhage
• Intraventricular haemorrhage

Effects of Traumatic Brain Injury

Individuals can present with a huge variety of symptoms following a traumatic brain injury (TBI). These symptoms depend on the type of TBI suffered, its severity, the area of the brain affected and the extent of damage to the brain tissue. Common effects seen are:

• Physical Changes
  • reduced mobility
  • altered muscle tone – high /low
  • altered movement patterns
  • altered co-ordination
  • altered balance
• Chronic pain
• Dizziness
• Changes to normal body functions
• Cognitive deficits
• Speech and language problems
• Changes in sensation
• Perceptual difficulties
• Visual disturbances
• Increased or reduced hearing
• Loss of smell
• Loss of taste
• Seizures
• Social / emotional changes

Traumatic Brain Injury Physiotherapy Treatment

Many traumatic brain injury (TBI) survivors are left with significant disability. The brain is, however, very adaptable and, with the correct physiotherapy input, recovery can take place over a period of years. Treatment can help:

• improve balance and walking
• increase ability to roll / move in bed / sit / stand
• reduce muscle spasms, pain and stiffness
• increase strength
• retrain normal patterns of movement
• increase affected arm and leg function
• reduce or eliminate dizziness symptoms
• increase energy levels
• increase independence and quality of life
• decrease risk of falls

Cerebral Palsy

Cerebral palsy is caused by damage to the brain before, during or after birth. Often the exact cause of cerebral palsy is not known, but contributing factors can include infections, lack of oxygen, meningitis and pressure or blows to the head. The severity of the cause will affect the significance of the damage caused to the brain. For example, the longer a child is deprived of oxygen during birth, the extent of brain damage likely to be caused is increased.

Effects of Cerebral Palsy

Every person with cerebral palsy (CP) is affected in a different way. Depending on the area of the brain affected, the following symptoms may be present:

• Co-ordination and balance problems
• Difficulty maintaining and controlling posture
• Swallowing and talking difficulties
• Learning difficulties
• Epilepsy (one in three with CP also have epilepsy)

Spastic CP is characterised by:

• Weak, tight or stiff muscle groups
• Difficulty performing controlled movements.
• Difficulty / inability to stand unaided

Athetoid CP is characterised by:

• Involuntary, uncoordinated movements in the face, arms and trunk
• Difficulty eating and speaking
• Difficulty picking up objects

Ataxic CP is characterised by:

• Reduced muscle tone and poor co-ordination of movements
• Reduced balance and depth perception
• Trembling hands
• Unsteadiness during walking

Cerebral Palsy Physiotherapy Treatment

The main aim of neurological physiotherapy for cerebral palsy is to encourage patterns of normal, rather than abnormal, postures and movements.

Regular physiotherapy can:

• Increase mobility such as walking, crawling, rolling
• Facilitate normal development
• Improve co-ordination, balance
• Improve arm, leg and head control
• Normalise muscle tone
• Strengthen weak muscles
• Improve independence and quality of life

We aim to give your child the best care possible and can work alongside other therapists and carers to teach them the best ways to assist with moving and handling your child.