Neurological Physiotherapy

Physiotherapists often specialise in different hospital departments to gain the experience and practice needed to provide the best possible patient care. Neurological physiotherapists essentially facilitate the treatment of a host of neurological conditions, many of which have adverse effects on range of motion or co-ordination. The aim with neurological physical treatment is to restore functionality as much as possible and deliver improved quality of life and self-sufficiency.

Examples of neurological conditions and how they benefit from physiotherapy

• Brain injury or damage - Your brain controls every aspect of your being, including motor skills and coordination. It has a remarkable capacity to heal, but depending on the extent of the injury, this recovery process needs to be facilitated by a physiotherapist for a full rehabilitation. The presentation of any brain damage is hugely variable depending on which regions of the brain have been affected and can include a range of motor dysfunctions.
• Cerebral Palsy – CP (Cerebral Palsy) is actually an umbrella term describing a number of different motor conditions that cause disabilities in term of motor function. The cerebrum is affected in these conditions, and it is damaged during brain development at any point between pregnancy and approximately three years of age. These disorders tend to present with various symptoms like postural and movement difficulties which are a physiotherapist’s concern. Other diagnostic symptoms include perceptual difficulties and problems in communication.
• Chronic pain – The causes of chronic pain are many, but regardless of cause, its persistence is extremely debilitating. Where traditional pain killers fail, a physiotherapist can isolate the cause of your pain and treat it using a range of techniques at their disposal including massage, acupuncture, mobilisation, hydrotherapy, or electrotherapy.
• Dementia – Dementia is a disease affecting more and more people in the country as the population of elderly people increases. One of the unpleasant effects of dementia, a degenerative disorder of the brain, is a loss of coordination and motor function. A physio can assess where exactly you need help (which is important as this condition will affect everyone differently) and do their best to promote both your general health and independence. They will do this both by offering exercises to increase your range of movement, but also by assessing your home environment and adjusting it to your needs.
• Parkinson’s disease – Parkinson’s is a deficiency of a particular neurotransmitter called Dopamine that leads to a the gradual degeneration of a part of the brain called the
• Substantia Nigra - This results in a tremor that worsens as the disease progresses, causing a loss of fine motor control and coordination. It is in these areas that physiotherapy can help.
• Spinal Cord Injury – Spinal cord injuries can have terrible consequences, of which paralysis is probably the best known and most feared. Your spinal cord, along with the brain, composes your central nervous system, responsible for relaying messages from the brain to where they need to go in the body. Physiotherapy is vital to restoring lost functionality after an SCI, while how successful they are depends on the extent of the injury and symptoms.
• Stroke
–Strokes are a very common cause of neurological dysfunction. They can be caused by any one of a broad range of factors, but essentially what happens is that blood flow to the brain is obstructed, resulting in increasing damage to brain tissue the longer the affected region is deprived of the oxygen and nutrients carried by blood. Depending on where the injury occurs, loss of movement, temporary paralysis, or difficulty in speech or coordination can occur.

Physiotherapy of neurological conditions

Physiotherapy can help restore normal motor function, improve coordination and muscle strength, as well as the range of movement available. Your physio will also correct any postural or positional difficulties to aid in day to day life, aiming to facilitate day to day living as best as they can.

Neurological physiotherapy as a specialist practice is based around a number of principles that reflect the goals your practitioner wants to achieve and how they plan to do so. The Bobath approach or concept is the first of these, and was originally developed for conditions affecting the central nervous system like children with cerebral palsy or victims of car accidents. Essentially this approach focuses on exercising the nervous and muscular systems to improve motor function. The focus here is to restore normal movement.

The Carr and Shephard concept aims to make physical therapy task orientated. Meaning that functional ability is restored by this, and the patient’s active involvement, helping you to relearn and practice basic and essential functions, while simultaneously training the muscles and neural pathways you use to adhesive these tasks.

The Brunnstrom approach tries to build mobility sequentially by recruiting muscles synergistically. This concept is based on the idea that a damaged nervous system has effectively regressed after or during injury, and hence the best way to treat this is actually by reversing this process and sequentially recruiting more and more muscles to work together and restore function. This method has had noted success in stroke rehabilitation.

Finally the conductive education approach adopts the ‘mind over matter’ philosophy, and is based on a body of literature that emphatically proves the importance of mental attitude when it comes to recovery. This concept uses education as a tool, utilising problem solving and learning tasks to restore functionality.

Physiotherapists conduct their own assessments to establish how best to conduct your rehabilitation. Based on their findings, experience, and research they will use one more of these four concepts or approaches to help you recover.

What does a neurological physiotherapist do?

A neurological physiotherapist attempts to restore mobility as much as possible by using a host of different exercises and routines to improve muscular strength, core stability, balance, posture, and through these, self sufficiency. Neurological disorders often result in muscular atrophy or the loss of coordination, and a physio will attempt to restore these using strengthening and stretching routines, hydrotherapy, and electrotherapy. Your physio will be constantly monitoring your progress and making adjustments according to how you’re coping. Muscular training is only part of restoring functionality however, and your physio will probably incorporate relevant coordination exercises and skills to restore movement by means of practicing daily actions, e.g. walking, changes of posture.

A common consequence of neurological disorders is spasticity, an abnormality in muscle tone which is experienced as a tightness which limits functionality. To improve on this, your physiotherapist uses cold therapy, stretching (either done by you or your therapist via manipulation), increasing activity, and if necessary, advice on how to use Botox to alter muscle tone.

Physical therapy can also address other aspects of neurological disorders. Sensory problems can develop, particularly in the periphery, pain issues are common and drug management might not be enough or might be unsuitable, and fatigue is often an issue following a prolonged rest and recovery period. An experienced physiotherapist is more than able to assess what exactly you need, and how best to deliver it.

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