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Neurological physiotherapy: how it works

Photo: Australian Physiotherapy Association
Over the past ten years, recognition of physiotherapy as an integral part of treatment for numerous medical conditions has increased tremendously.

As the profession continues to advance, a diverse range of specialist streams have developed, requiring additional qualifications and an advanced set of specialised skills.

“Neurological physiotherapy is one such stream, where therapists have undertaken further training in treating neurological conditions like stroke, brain injury, multiple sclerosis, motor neuron disease and Parkinson’s," says Australian Physiotherapy Association specialist neurological physiotherapist Melissa McConaghy.

“What differs in the approach of a neurological physiotherapist, among many things, are often the context in which they work, and how and what they do. 
“Restoration of functional ability is what we have historically focused on – helping people to walk again, dress independently or maintain capacity with a degenerative condition.”

More recently though, there has also been a focus on supporting people to self-manage and promote a better quality of life through ongoing exercise adherence, equipment and environmental set-up, aids and assistive technology and integration with a multidisciplinary team.
 
Ms McConaghy says much of what a neurological physiotherapist does fits into three broad categories: movement analysis and skill acquisition, prescription of aids and equipment, and education and training to establish a model of self-management.

“Movement analysis and skill acquisition involves training someone to re-learn a skill and improve or maintain their functional capacity – this might include training someone how to transfer from a chair to a bed independently following a stroke so that they can then toilet or get to bed on their own.

“Following on from this example might be the prescription of aids or equipment to enhance the ability of that individual to transfer to the bed both effectively and safely.

“Long-term, in most situations, the view is to facilitate a situation where the patient and their family and support network can self-manage with appropriate education, set up and follow-up.

“In the same stroke example, a home exercise program, carer training and strategy training might help that individual to continue improving independently with scheduled review sessions to adjust and modify as appropriate. In the case of neuro-degenerative conditions, these categories may be skewed differently.”

As the importance of neurological physiotherapy has become more understood, early intervention is now recommended following a neurological insult or diagnosis of a neurological condition.

The earlier the right intervention is received, the more independence and ability someone is likely to achieve or maintain for longer.

“Early intervention also highlights the capacity for a NP to identify and mitigate issues before they affect function and quality of life in many cases.”

While the benefits speak for themselves, the treatment process can be difficult for patients.

“Neuro rehab delivered by a neuro physio is designed to be challenging,” says Ms McConaghy.

“Without both physical and cognitive challenges, a person is unlikely to make meaningful gains.”

Neuroplasticity is a term used in neurological rehab to drive functional change, describing the ability of the brain to re-wire itself, depending on the stimulation the person receives.

“Challenging stimulation that is appropriate and relevant is designed to create lasting functional change that can be transferred across multiple environments.

“Stimulation that is not challenging (or absent due to sedentary behaviour) is maladaptive and can lead to further secondary complications independent of the neurological condition.”

One of the most exciting gains in neurological physiotherapy is its impact patients with Parkinson’s Disease.

Parkinson’s is the second most common neurodegenerative condition and is estimated to affect up to 80,000 people in Australia and more than 10 million worldwide.

“The effects are both physical and non-physical and affect most domains of life such as mobility and movement, sleep, mood, cognition, bodily comfort and quality of life. It is a very heterogeneous and complex condition and no two people are ever the same,” says Ms McConaghy.

Physiotherapy plays a vital role in helping people achieve their best life possible after diagnosis – to slow the disease progression and in many cases improve their symptoms in the early stages.

“Not only are physios experts in prescribing neuro-active exercise to help people move better, we can provide appropriate education to give people confidence and build self-efficacy - essential tools required for longer-term behaviour change and exercise adherence.”

“Over the last decade, best practice intervention for Parkinson’s has moved away from a compensatory movement strategy approach in the later stages of the disease to a more modern approach incorporating neuroplastic training principles in the very earliest stages following diagnosis,” says Ms McConaghy.

“There has never been a better time for physiotherapists to equip themselves with these new skills and to face an increasingly enthusiastic consumer base.”

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Nicole Madigan

Nicole Madigan is a widely published journalist with more than 15 years experience in the media and communications industries.

Specialising in health, business, property and finance, Nicole writes regularly for numerous high-profile newspapers, magazines and online publications.

Before moving into freelance writing almost a decade ago, Nicole was an on-air reporter with Channel Nine and a newspaper journalist with News Limited.

Nicole is also the Director of content and communications agency Stella Communications (www.stellacomms.com) and a children's author.