Neuro Physio

We can help with a wide range of Neurological conditions like Stroke/CVA, hemiparesis , Parkinson , Guillain-Barre syndrome ,BS , Muscular dystrophy , Multiple Sclerosis ( MS) , Motor Neuron Disease and many more .A wide range of treatment techniques and approaches from different philosophical backgrounds are utilized in Neurological Rehabilitation. Research to support the different approaches varies hugely, with a wealth of research to support the use of some techniques while other approaches have limited evidence to support its use but rely on anecdotal evidence.

Facilitation Techniques
Facilitation and enhancement of muscle activity to achieve improved motor control are the key tenants to many of the techniques used in neurological rehabilitation, many of which also utilise neuroplasticity. The Rood Approach, theoretically based on the Reflex and Hierarchical Model of Motor Control .In addition to proprioceptive manoeuvres such as positioning, joint compression, joint distraction and the general use of reflexes, stretch, and resistance, the greatest emphasis is given on exteroceptive applications such as stroking, brushing, icing, warmth, pressure, and vibration in order to achieve optimal muscular action.

"Tapping is the use of a light force applied manually over a tendon or muscle belly to facilitate a voluntary contraction". Tapping is used to assess reflex activity with a normal response being a brisk muscle contraction. Rood recommended three to five taps over the muscle belly to be facilitated.

Passive Stretching - Fast/Quick
Stretch may be applied in a number of ways during neurological rehabilitation to achieve different effects. The types of stretching used include:
1. Fast / Quick
2. Prolonged
3. Maintained

The use of stretch for facilitation we employ a fast/quick stretch. The fast/quick stretch produces a relatively short-lived contraction of the agonist's muscle and short-lived inhibition of the antagonist muscle which facilitates a muscle contraction. It achieves its effect via stimulation of the muscle spindle primary endings which results in reflex facilitation of the muscle via the monosynaptic reflex arc.

Joint Compression
Joint awareness may be improved by joint compression which will lead to enhancing motor control. Receptors in joints and muscles are involved with the awareness of joint position and movement which are stimulated by joint compression. Joint compression can have both facilitatory and inhibitory effects.

Joint Compression of the joint surfaces facilitates posture extensors which are needed to stabilise the body. Compression can be applied slowly to inhibit muscle control or in jerky manner to facilitate muscle control. The application may be manually and/or by using weight bearing postures.

Joint compression can be achieved in two ways:
Light Compression: Normal body weight being applied through the long axis of the bone which is thought to inhibit (relax) muscle spasticity
Heavy Compression: Compression is greater than that applied by body weight which is thought to facilitate co-contraction at the joint undergoing compression.

Muscle Vibration

Muscle vibration has been used as a technique to reduce muscle tone and spasticity in individuals with neurological conditions. Vibrations of the muscle are thought to increase corticospinal excitability as well as inhibitory neuronal activity in the antagonistic muscle.

Muscle Vibration is generally applied to directly to the chosen muscle or tendon and may be applied in two ways; High and Low Frequency.

Vestibular Stimulation
The vestibular stimulation technique is a proprioceptive unique sensory system with multi-sensory function. According to the type of stimulus we can use the vestibular system to achieve many treatment alternatives.

Passive Stretching -Slow
Stretch may be applied in a number of ways during neurological rehabilitation to achieve different effects. The types of stretching used include:
1. Fast / Quick
2. Prolonged
3. Maintained

The presence of increased tone can ultimately lead to joint contracture and changes in muscle length. When we look at the use of stretch to normalize tone and maintain soft tissue length we employ a slow, prolonged stretch to maintain or prevent loss of range of motion. While the effects are not entirely clear the prolonged stretch produces inhibition of muscle responses which may help in reducing hypertonus, e.g. Bobath's neuro-developmental technique, inhibitory splinting and casting technique. It appears to have an influence on both the neural components of muscle, via the Golgi Tendon Organs and Muscle Spindles, and the structural components in the long term, via the number and length of sarcomeres.

Positioning is used widely to prevent the development of contracture in neurological conditions and to discourage unwanted reflex activity. After a neurological impairment, muscles can be affected in various ways, causing pain, spasticity, and problems with speed and range of motion. One way to minimize these effects is to properly support, position, and align the body. Proper positioning can be useful to minimize or prevent pain and stiffness that are commonly present post-impairment. It can also regain movement that was lost, or limit future problems with movement. In addition, proper positioning has been shown to increase awareness and protection of the weaker side of the body. Some common positions recommended following a stroke:

Massage uses pressure to direct venous and lymphatic flow back towards the heart. It is therefore important that the movement is always in this direction so that there is no undue pressure on the closed valves in the veins. These valves prevent backflow of blood by only allowing blood to move in one direction (i.e. toward the heart). As the pressure from the heart pumping subsides and the blood moves back, the valves close and prevent any further back flow.

Massage may also be used to stretch muscle fibres. In this case, the direction is not as important as the strokes are much shorter and therefore pressure in the wrong direction is not significant enough to cause damage.

Physical Activity and Exercise
Proprioception Neuromuscular Facilitation
Proprioceptive Neuromuscular Facilitation (PNF) is a set of stretching techniques commonly used in clinical environments to enhance both active and passive range of motion in order to improve motor performance and aid rehabilitation. PNF is considered an optimal stretching method when the aim is to increase range of motion, especially as regards short-term changes.

Aerobic Exercise
There is an increasing range of aerobic exercise options being accessed by people with neurological conditions. These range from aerobic exercise programmes (e.g. over ground walking or treadmill training programmes) and an array of sporting and exercise classes to the use of technology (e.g. virtual reality training). These options, supported by the growing body of evidence, present the therapist and patient with the ability to select a programme for an individual, which is timely and can be carried out in an appropriate environment.

Pilates is a system of exercises which has evolved from its use with elite dancers to enhance core, shoulder girdle and limb control. It can be both mat based and apparatus based, and is designed to improve physical strength, flexibility, and posture and enhance mental awareness . While Pilates is used widely for neurorehabilitation there is limited research on its effectiveness as part of rehabilitation for patients with neurological impairment.

Transcutaneous Electrical Nerve Stimulation (TENS) is a method of electrical stimulation which primarily aims to provide a degree of symptomatic pain relief by exciting sensory nerves and thereby stimulating either the pain gate mechanism and/or the opioid system.

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