PHYSIOTHERAPY

The Physiotherapy Team specialise in the management and rehabilitation of spinal injuries, neurological conditions and complex disabilities. They help rehabilitate patients to as near their former function as possible; to show them that life does go on, albeit differently; and to encourage them to realise their potential. Some of the conditions treated include:

• Spinal Cord Injury
• Stroke
• Head injury
• Parkinson’s Disease
• Multiple Sclerosis
• Transverse Myelitis
• Neuropathy
• Ataxia
• Muscular Dystrophy
• Balance problems

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Physiotherapy for spinal cord injuries

In a spinal cord injury there is impaired sensation or movement preserved below the level of injury which can affect an individual’s functional ability. Everyday activities may become more difficult and new strategies must be learnt and put in place in order to maintain as much as independence as possible. The level of function an individual may achieve will be dependent on where the spinal cord was damaged. This will be specified and explained to you during your assessment by a neurological physiotherapist.

A spinal injury can change someone’s life and it is important that they can still live an ordinary life which includes socialising, recreation and working. From the assessment, the physiotherapist and individual will discuss the potential for improvement and targets will be made to facilitate this. Areas considered will include:

1.    Mobility and wheelchair skills
2.    Hand function
3.    Bed mobility and transfers
4.    Carer training
5.    Vocation
6.    Recreation

The individual will have targets which all health professionals will work towards but there will also be specific areas for physiotherapy to work on. These can include:

1.    Muscle strength and joint range of movement
2.    Respiratory function
3.    Mobility
4.    Spasticity management
5.    Movement and postural education
6.    Fitness and stamina

Rehabilitation after a spinal cord injury is highly important so the individual can be educated and treated holistically to manage their condition alongside normal life.

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Physiotherapy following a stroke or head injury

A stroke or head injury affects different people in different ways. The most apparent changes are often in the way that someone moves, highlighted when the individual attempts tasks that they took for granted prior to the stroke e.g. eating, washing, walking. This can lead to frustration, emotional distress and increased dependence upon other people.

In order to maximise the impact of rehabilitation, it is important that the individual considers the ways in which their injury has affected them and is able to identify specific areas which they would like to improve. The physiotherapist can then discuss these needs, formulating them into targets which are aimed to be achieved within reasonable and realistic timescales. Often, the wishes of the individual may not be compatible given the deficits that the injury has caused, in which case the physiotherapist will offer their professional advice and support regarding targets that may be more realistic.

A neurological physiotherapist can assess the changes that have occurred in the way someone is able to move and identify the components that need to be addressed in order for the movement to become more efficient. The assessment will take into account the relationships between all areas of the body, even if it seems that only one limb has been affected.

Areas considered include:

• Posture
• Balance
• Muscle length and tightness
• Muscle Power
• Alignment of joints
• Movement patterns

This is different to musculoskeletal or sports physiotherapy as intervention will involve the physiotherapist facilitating the client to experience more appropriate ways of moving through either exercise or hands on guidance. These are then repeated so that the new movement may replace the previous, less functional pattern. Often, rebuilding movements will involve sessions working on very specific parts of the movement rather the task as a whole. Whilst this can be frustrating, it can result in the overall movement becoming much more efficient. The physiotherapist will always explain the purpose of the session and the movements or they are striving to achieve.

Common areas that physiotherapy can assist clients to improve

• Balance
• Walking
• Strength
• Dexterity and hand function

We work closely with other members of the multi-disciplinary team to ensure any improvements are carried through into as many activities and daily tasks as possible.

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Functional electrical stimulation bike:

This is a therapeutic activity that uses transcutaneus electric current to initiate muscle contractions of paralysed lower limbs in persons who have sustained spinal injury or have been affected by stroke and other conditions.

The RT300 is a leading electrical stimulation cycle:

Key Benefits:

Reverse muscle atrophy
Improve local circulation
Increase range of motion
Reduce muscle spasm

while leg cycling, stimulate up to 10 muscle  groups in one or both of your legs and your trunk

while arm cycling, you can stimulate up to 10 muscle groups  in one or both of your arms  and your trunk.

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Bioness L300

Bioness is an innovative medical device that aid individuals in the recovery from central nervous system disorders such as stroke, multiple sclerosis, spinal cord injury, cerebral palsy, traumatic brain injury and other. This product uses electrical stimulation to help people regain mobility and independence, to improve quality of life and productivity.

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Standing facilities:

Tilt table ( suitable for newly injured patient as initial start for verticalization up to 90°

Electric Oswestry frame (suitable for verticalization of paraplegic and patients with weakness of lower limbs)

Grandstand provides a wide range of adjustments to align the body in its natural standing position in high level spinal cord injuries.

Manual standing wheelchair provides maximum independence in mobility for daily activities for reaching, lower limbs weight bearing, pressure relief, postural benefit, psychologically important eye contact in communication etc.......

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Body weight support treadmill training

Body weight support treadmill training uses a harness connected to an overhead frame to support a person over a treadmill so that they can walk on it. The harness may just provide confidence by removing the risk of falling, or it may take some of the person’s weight. The harness and frame can also be used independently of the treadmill to promote balance and walking on land.

It can improve walking by allowing practice specifically and repetitively on that task as a whole.

Generally, those who benefit most from treadmill training are able to maintain their own posture in sitting and can stand with minimal assistance.

Stroke/ Head Injury/Parkinson’s Disease : It allows a greater number of steps to be taken in any one session*. It helps to practice the task for longer, possibly building endurance and enhancing speed of walking.

Spinal Cord Injury: In spinal cord injury there are two principles that support the use of treadmill training

1.    There is a circuitry for walking within the spinal cord that can be activated through walking on a treadmill.

2.    Repeated motion of the limbs in a walking pattern can promote strength, endurance and co-ordination.

In all conditions, patients require careful assessment by a specialist physiotherapist before determining if this is a suitable treatment modality for them. It is an adjunct to a holistic physiotherapy programme that considers all aspects of the patient’s needs. It is generally not given as a stand-alone therapy.

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Calliper training:

Callipers are orthotic devices worn on the legs which can be used by individuals with spinal cord injury to achieve a functional way of standing, exercising or walking, depending on the level of injury. There are different types of calliper and the most suitable one is selected in consultation between the specialist physiotherapist and orthotist.

Walkabout Orthotics

Walkabout are custom made, full-length callipers made of polypropylene with a device fixed between the thighs which can be worn under clothing. They hold the legs and hips in a good standing position and walking is achieved by transferring weight from one leg to the other. Walking aids such as a frame or crutches are used largely for balance rather than supporting the weight of the body.

How will I know if callipers will help me?

Anyone considering using callipers must attend a specialist assessment. This is because there are numerous ways of achieving the goal of standing and not everyone with a spinal cord injury can use callipers or finds them to be a practical solution. Physical factors also need to be considered including: level of injury, range of movement, stamina and previous experience of standing.


What Next?

Once it has been agreed that callipers are appropriate, the person will need to attend three fittings for casting, fitting and supply of the orthotic. This will be done by a specialist orthotist. They will then require tuition from a physiotherapist to learn how to use the callipers to their maximal potential. The number of tuition sessions required will be assessed and designed according to each individual and depend upon the eventual goal and progress made.

The programme may be completed as an outpatient, attending for each fitting and tuition session on an appointment basis. Alternatively, some people may prefer to become a resident at the centre and combine calliper training with addressing other needs specific to their condition e.g. management of bladder or bowel.

What may affect my ability to use callipers?

If you have not stood regularly as part of your routine then it is wise to have investigations to check for osteoporosis. This may not prevent you using callipers but will require caution. Also, you may have had some muscle shortening, particularly in your calf, knees or hips that will make getting into the right standing position to use the device very difficult. If this is the case, we may recommend an alternative programme of standing and stretching before progressing to the casting stage.

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Electrotherapy

The Physiotherapy Department is equipped with a BTL 5000, an advanced unit with many modalities for the application of electric current, ultrasound, laser and magnetotherapy.

Ultrasound

Ultrasound is high frequency sound waves, greater than 20,000 Hz. Therapeutic ultrasound is in the frequency range  of 0.9 - 3 MHz.

Ultrasound is used to:
break up scar tissue and adhesions reduce inflammation, swelling and calcium deposits create a deep heat to a localized area to ease muscle spasms (much deeper than can be achieved with a hot pack - up to 5 cm)  increase soft tissue extensibility prior to stretching and exercise facilitate healing at the cellular level speeds metabolism and improves blood flow reduces nerve root irritation at low intensities can speed bone healing.

It is vast list of diagnosis for ultrasound applications from muscular-skeletal conditions, neurological, orthopaedic and other conditions.

Laser (Light Amplification by Stimulated Emission of Radiation)

Indications:

1.    Open wounds
2.    Pressure ulcers
3.    Diabetic ulcers
4.    Surgical wounds
5.    Pain

Contraindications:

1.    Epileptic persons/persons with recurrent fits
2.    Persons with cardiac problems
3.    Persons using artificial pacemaker


Magnetotherapy

Magnetotherapy is a commonly used physiotherapy procedure in European countries. It has been proven to have long lasting benefits in the treatment of some conditions

The latest findings about physiological response of the organism to the electromagnetic field imply the following effects:

• analgesic effect
• trophic effect ( acceleration of healing and growth)
• myorelaxation and spasmolytic effect
• vasodilatation
• antioedematous effect

Notes: The electrotherapy methods above vary in application and frequency. Typically treatment can involve 5-7 applications varying in time from 2 minutes ( laser) up to 40 minutes (magnetotherapy).

The application of electrotherapy without any other intervention IS NOT as effective as when combined with other physiotherapy techniques and methods.

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Kineziology taping

This technique involves the application of tape to the skin.

Types of application:

• pain relief
• proprioceptive stimulation
• functional correction
• mechanical correction

 

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