Neurological and Surgical

Neurological and Surgical condition : Neurological physiotherapy plays a very important ant role in  treatment of the nervous system, including the brain, spinal cord and all the peripheral nerves to the face, body, arms and legs. Where there is damage to part of the nervous system, whatever the cause be it disease, surgery or accident a specialist physiotherapist working within the field of neurology can help.
When the nervous system is damaged there may be difficulty controlling movement in any part of the body. The movement that is present may be poorly coordinated or weak, and individual muscles may feel weak and floppy or very tight with spasms or tremor. Along with movement disorders there may be impaired sensation, such as temperature or feeling. In addition there may be problems with speech and swallowing, vision may be altered. Some patients will experience mood changes, together with altered ability to concentrate and remember things.
There are a wide range of conditions a Neurological Physiotherapist may treat including :

  • Stroke.
  • Multiple Sclerosis.
  • Head Injury.
  • Parkinson’s Disease.
  • Spinal Cord Injury.
  • Motor Neurone Disease.
  • Myopathies & Dystrophies.
  • Cerebral Palsy.
  • Post operative surgery to the Brain & Spinal Cord.

Physiotherapy treatment will follow a full physical assessment together with a detailed history of the patient’s past and current medical condition. Often there will be consultation with family and carer as to current problems in order that appropriate aims of treatment may be decided upon. There will then be goal setting followed by a period of treatment, during which the changes will be constantly monitored in order that treatment can evolve to meet the needs of each individual. Home and work environment are important in addition to individual lifestyle. Treatment may be carried out in a clinic or home setting to try and accommodate the needs of each patient, their family or care arrangements or schooling if appropriate. Treatment is specific to each individual, and may involve many different ways to overcome movement problems such as stretching, balance and walking practice if appropriate, postural awareness and control, respiratory assessment and re-education, functional use of the upper limbs as well as facial muscle exercises.

There is close liaison with each patients GP and specialist where necessary, in addition to working with other specialists in rehabilitation e.g.; Speech and Language Therapists, Occupational Therapists and Dieticians.
Treatment programmers may vary from one to two sessions per month to an intensive course of two per week for several weeks. Patients are sometimes

placed on review appointments so maintenance can be evaluated. Also in some cases there will be disease changes which dictate therapy intervention. All this is discussed with individual patients as well as family to ensure all parameters are considered.
Patients will be encouraged to monitor their progress, and home exercises may be appropriate. Walking aids will be recommended where necessary together with any splints for hands or feet to maintain flexibility.
Physiotherapy can offer advice at any stage of a condition, sometimes early treatment can prevent problems becoming more serious. In some cases conditions worsen over time, there can still be gains by having physiotherapy to improve quality of life and promote some independence.

PHYSIOTHERAPY FOR STROKES: 
The onset of stroke is usually sudden, with the maximum disability at the outset. There is often hemiplegic or paralysis of the muscles on one side of the body. There may also be disturbances of speech and swallowing if the paralysis affects the right side of the body.
Recovery is related to the site, extent and nature of the lesion within the brain, and the pattern of recovery varies with each patient.
Physiotherapy aims to maximize all aspects of recovery, in order to limit residual disability and prevent secondary complications. The therapist will identify and measure the disorders of movement before planning and discussing appropriate treatment with each patient and their family.
Carer support is of vital importance, and this can include education, counselling in addition to access to support agencies.
During the process of recovery which may take months, the physiotherapist may also work closely with other professionals such as a Speech and Language Therapist, Occupational Therapist and Dietician in order to maximise the efficacy of the rehabilitation programmed.

PHYSIOTHERAPY FOR MULTIPLE SCLEROSIS:
Multiple Sclerosis is an inflammatory, demyelinating disorder. It is the major cause of neurological disability in young adults characterised by episodes of recurrent discrete relapses, interspersed with periods of remission when recovery may be either complete or partial.
Physiotherapy for this group of patients needs to be flexible and responsive in order to meet the needs of each individual as they change over time. The underlying principle for any therapy programme is to build on and extend the patients abilities. Each patient will constantly be monitored throughout any treatment programme, and the goals adjusted according to the stage of the disease. These goals will be agreed by the therapist, the patient and relevant carer or family.
Early intervention is desirable in order that the patient is aware of changing ability and therefore can access therapy at appropriate stages of the disease. Often early treatment regimens will focus on exercise and general stretching to maintain good balance and reduce compensatory strategies. Many patients will liaise with the physiotherapist every 4 to 6 weeks to monitor progress and have intensive bursts of therapy when the need is more acute. There are many symptoms that can be addressed within a physiotherapy programme, including gait and balance problems, sensory disturbances, fine hand control and dexterity, stiffness and reduced power within the muscles as well as speech and swallowing difficulties.

PHYSIOTHERAPY FOR HEAD INJURY:
Brain injury can be sustained directly as a result of trauma to the skull, as a result of surgery causing tissue damage, or due to violent head movement during an injury at speed. Head injury can lead to coma and result in physical and cognitive deficit.
Physiotherapy within this group of patients may continue for years post injury as the recovery process may take many months in addition to long term management of long term disability. The aims of any therapy programme are to maximise ability alongside limiting secondary complications.
Each patient is physically examined to enable an individual physical management plan to be devised. The assessment identifies problems, establishes goals and is essential for implementing appropriate care.
The physiotherapy goals are to:

  • Control posture, in lying, sitting & standing where appropriate.
  • Maintain range of movement at all joints.
  • Maximise remaining ability

There is usually close liaison with family and care staff to facilitate care at home. Overall objectives are to ensure the patient enjoys the best quality of life possible in addition to returning to as high a level of functional independence as their injury allows.

PARKINSON’S DISEASE:
Parkinson’s disease and the “parkinsonian syndrome” form a group of disorders characterised by disturbance of voluntary movement, balance and posture with tremor. The cause of Parkinson’s disease is unknown, whereas parkinsonian syndrome symptoms develop as a result of other neurological disease.
Common problems include slowness of walking, with balance disturbance, there may be occasional falls. There may be difficulty with fine manipulative tasks such as writing and shaving. Stress can exacerbate the symptoms. There are commonly postural abnormalities, with slight flexion at all joints; this can predispose loss of balance forwards in standing. Walking is difficult at times with shuffling steps and freezing when obstacles are present. Muscles are stiff and may be painful.
Physiotherapy early on in the disease is of benefit by implementing preventative exercises and identifying treatment priorities. Progress needs to be monitored and any deterioration targeted specifically. It is important to maintain postural symmetry as this is beneficial in balance and gait in addition to respiratory function and speech.
The family are often an integral part of physiotherapy on a daily basis, and are also of huge value in identification of problem areas. Therapy treatment needs to occur in the environment where everyday activity takes place; this increases the relevance of input. Periods of maximal drug efficacy can be the optimal time for therapy, but fatigue levels also need to be considered. There need to be regular review of home physiotherapy programmes, to assess compliance and benefits. Techniques to enhance postural awareness, promote range of movement and correct musculoskeletal impairment where possible need to be integrated within each physiotherapy regimen.

SPINAL CORD INJURY:
The spinal cord may be injured due to trauma, or more rarely tumour or surgery can lead to damage. The cord may be completely transsected resulting in a complete injury, or part of the spinal cord may be damaged leading to incomplete injury where the result may be varied.
Aims of rehabilitation are centred round each individual achieving their maximum level of functional independence. Prevention of secondary complications as a result of the level of injury is also of paramount importance. The level and severity of injury will dictate to what extent we can anticipate return of function, though this can continue many months after the date of injury. The higher the level of cord damage the more complex the needs of the patient with attention to many systems such as the respiratory system, speech and swallowing, the skin, the joints in addition to soft tissue structures and the digestion. Physiotherapy needs to encompass as many of these as is required in order to maximise potential recovery and assist with promoting the highest level of function possible within the limitations of the injury.
Advice on appropriate seating may be necessary with liaison to wheelchair services. Splints to maintain flexibility of soft tissues and joints are also often indicated.
Part of the role of the therapist is also to support the family and carer in daily management. Advice on handling may be appropriate, also to carry out daily stretches which can be beneficial to maintain joint range of movement.

HAND REHABLITATION: Hand Rehab specialises in providing physiotherapy and occupational therapy for hands.  And it’s not just hands that we treat.  Our speciality is in providing rehabilitation and treatment for all areas of the arm; specifically from the elbow through to the fingertips.

Our specialist area of physiotherapy includes treatments for: tendonitis and tendon injuries; carpal tunnel; joint injuries, nerve compression and nerve injuries; sprained fingers and thumbs; tennis and golfers elbow; arthritis and sports injuries.

We provide the full range of physio support and advice to ensure your recovery process can progress in an optimal manner.  We understand the importance of providing tailored support and advice to help you with your recovery plan.

Our Hand Physiotherapy Treatments

Our more specialized area of hand therapy includes the following:

  • Customized splints (where rest of the injured area is required to assist in the recovery process).
  • Tailored rehabilitation and strength improvement programmers.
  • Guidance and advice on both work and home based activities.
  • Rehabilitation exercises to assist your recovery process.
  • On-site recovery assistance treatments including massage, acupuncture, and joint/soft tissue mobilization.

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BURN:

Rehabilitation is an essential and integral part of burn treatment. It is not something which takes place following healing ofdrgeetasuri1 skin grafts or discharge from hospital; instead it is a process that starts from day one of admission and continues for months and sometimes years after the initial event. Burns rehabilitation is not something which is completed by one or two individuals but should be a team approaches, incorporating the patient and when appropriate, their family. The term ‘Burns Rehabilitation’ incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. The aims of burn rehabilitation are to minimize the adverse effects caused by the injury in terms of maintaining range of movement, minimizing contracture development and impact of scarring, maximizing functional ability, maximizing psychological wellbeing, maximizing social integration.

SPLINTING:

Splints are a highly effective method of helping prevent and manage burn contractures and are an integral part of a comprehensive rehabilitation programmed. A well-designed splintage programme incorporated with active and passive mobilization is essential to prevent and convert joint contractures and deformities.

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