Orthotics are appliances that are used to improve the function, alignment and mobility of a particular area of the body. These include splints, ankle-foot-orthoses (AFOs), braces or insoles. The NICE guidelines recommend that patients with a neurological condition should be considered for an orthotic assessment as early as possible to promote optimal independence and function. They can also reduce pain and improve a person’s confidence.
Here are a few commonly used orthotics:
Lower Limb
Ankle- foot-orthosis

• Commonly used for foot drop
• Facilitates moving the ankle upwards (dorsiflexion)
• Reduces injury and falls
• Improves mobility and function
• Increases independence 

​Please get in touch if you would like an assessment from our specialist neurological physiotherapist to advise on the best orthosis for you. 

Thinking of starting running but don't know where or how to start?
 The NHS Choices 'Couch to 5k' is a free running plan for absolute beginners helping you gradually work towards running 5km in just 9 weeks!

• The programme involves 3 runs a week
• There is a different schedule for the 9 weeks
• Weekly podcasts that are free to download that talks you through the training sessions as well as playing music.
• The sessions start of very slowly and start with a mixture of walking and running to help you build up your fitness and stamina.

Once you have achieved running 5km you may even feel that you want to start running further and there is also the 5K+ series to help you keep running regularly and develop your ability further!
Running has so many health benefits such as:

• Running regularly will improve the health of your heart and lungs. It can also help you lose weight, especially if combined with a healthy diet.
• There's evidence it may help increase bone density in some people, which can help protect against bone diseases like osteoporosis.
• There are also mental benefits of running. Taking on the challenge of Couch to 5K can help boost your confidence and self-belief, as you prove to yourself that you can set yourself a target and achieve a goal.
• Running regularly can also be a great stress reliever and has even been shown to combat depression.

So if this interests you please visit the NHS choices 'Couch to 5k'  website for more information and links to the free podcasts:
https://www.nhs.uk/LiveWell/c25k/Pages/couch-to-5k.aspx
 

​A stroke is a sudden neurological event caused by a clot in the blood vessels supplying the brain (ischaemic stroke) or a bleed in the brain due to weakened blood vessels (haemorrhagic stroke). Both types of stroke restrict blood supply and oxygen to brain tissues and can cause a variety of different symptoms. These include:
 

• Muscle weakness
• Muscle spasm (spasticity)
• Decreased sensation 
• Neglect of one side of the body
• Difficulties with mobility & other activities of daily living
• Difficulties with balance
• Problems with speech and swallowing
• Pain
• Fatigue
• Cognitive impairments
• Reduced independence

 
Neurological Physiotherapy at Physioimpulse
 
Our specialist and experienced neurological physiotherapists can help to maximise your recovery and potential following a stroke. Our physiotherapists are able to use a number of specialist treatments to ensure you can reach your rehabilitation goals and regain independence as soon as possible.
 
Physiotherapy treatment may include:
 

• Hands on facilitation techniques
• Graduated strengthening exercise programmes
• Gait re-education
• Stretching and positioning
• Moving and handling techniques
• Support choosing the correct and safest equipment or walking aids
• Fatigue managements programmes
• Tailored cardiovascular exercise programmes
• Transfer practise 

Martin was a very active man in his mid 40’s who loved any outdoor adventure sports including rock climbing, mountaineering and bouldering. He was highly successful in his career and owned a small advertising company, which he thoroughly enjoyed. Martin had a left middle cerebral artery stroke (MCA), which meant that the right side of his body was affected. Initially his main symptoms were:

• Complete paralysis of his right upper limb and lower limb
• Difficulty forming words and sentences (expressive dysphasia)
• Difficulty understanding other people (receptive dysphasia)
• Unable to swallow safely (dysphagia) so had to be fed through a tube in his stomach (PEG)
• Unable to sit up and maintain his own balance
• Unable to keep control of his head and neck
• A hoist had to be used to safely transfer Martin from the bed to a specialist chair
• Unaware of the right side of his body (neglect)
• No sensation in his right arm, very minimal sensation in his right leg

 
Early days
 
Martin spent a total of 10 months in hospital, which included time in an acute stroke unit and then in a neuro-rehabilitation unit. During this time, some progress was made and Martin started to use an electric standing hoist to be transferred from his bed to the chair. This meant that his right leg had sufficient power in it to be able to take weight through it when using the hoist with the carers. His right arm had started to be able to joint in with daily tasks such as eating and washing but needed assistance.
 
Unfortunately, as Martin’s progress was relatively slow, he was discharged to a nursing home after 10 months of rehabilitation and looked after by carers 24 hours a day. Martin had been severely affected by fatigue but after 6 months in the nursing home, decided to start physiotherapy again to see if any further progress could be made.
 
Our specialist neurological physiotherapist, Katie, started seeing Martin twice a week at the nursing home. A thorough assessment was carried out and a treatment plan and individualised goals were set between them. Treatment varied and included:

• Work on alignment and awareness of Martin’s right side of his body
• Weight- bearing exercises for the upper and lower limb
• Supported standing practise
• Sitting balance exercises
• Stretching and positioning

 
After another 6 months, Martin was able to stand independently and step around to a chair using a specialist quad stick for support. He had also started taking a few steps.
 
1 year on
 
Martin’s mobility and balance progressed to such an extent that he was able to return home after a year of being discharged to the nursing home. He initially needed carers 3 times a day to support with showering, meals and shopping and was independent with all of his transfers and mobility including his stairs.
 
He is now independent with all of his activities of daily living and just has a cleaner to help with his housework once a week (which he is very pleased about!). Martin can drive an adapted car and go out independently to meet friends and socialise. He is still continuing with physiotherapy, which now even include sessions in the local climbing centre!
 
It is often reported that recovery gains start to significantly slow down after 6 months following a stroke and no further changes can be made after 2 years. Martin’s story is an important example that everyone should be treated as an individual rather than a statistic. In the right environment and with specialist rehabilitation, improvements can continue to be made for many years. 

​

Great reminder of how intricately made our body is. Keep this system healthy with regular exercise and as its Xmas why not have a little glass of red ;-)

Watch this short video during which Stuart Galise explains our biomechanics assessment and how orthotics can reduce spinal and lower limb pain.

When you feel pain in your lower back it can be a guessing game as to what caused the
sudden onset of discomfort. Is it a bulging disc, is it sciatica or just a muscle strain? The fact
of the matter is, it could be any of those conditions as many of the signs and symptoms over-
lap, meaning the internet could give you all sorts of diagnoses.
When someone says they’ve got a disc problem, what does that mean? Well a disc contains
a tough outer circle of connective tissue with a softer gel-like structure inside, which acts as
a shock absorber between each segment of the spine. Prolonged poor posture when sat at a
desk, or heavy lifting during manual labour can put the disc under pressure to a point where
the inner gel-like structure bulges towards the spinal canal. This mechanism can compress
sensitive structures (such as nerves) around the spine which cause pain and discomfort,
(including numbness, tingling, weakness) in the lower back and legs.

​The good news is Chiropractic treatment can ease pain and restore the normal integrity of the damaged disc by using gentle mobilisation techniques in situ with functional exercises. During the initial consultation, your Chiropractor can accurately diagnose these symptoms using a variety of orthopaedic and neurological tests and apply the findings to the history of your complaint.
 
Maruti, R. et al (2016) Chiropractic Distraction Spinal Manipulation on Postsurgical Continued Low Back and Radicular Pain Patients: A Retrospective Case Series. Journal of Chiropractic Medicine 15(2) pp.121-128.

Chiropractic, like other manual therapies, are very effective for treating conditions involving muscles and joints in the body, however many people don’t realise exactly how far muscle pain can travel. There are many muscles in the head and neck, and they can all cause pain which often presents as a headache.
Admittedly there are many causes for headaches, such as dehydration, stress and altered eyesight. Despite this, a high percentage of people I see have headaches which are caused by muscular tightness in the head and neck, of which the majority are relieved after chiropractic treatment.  

Office workers and other professions which involve sitting for long periods of time, adopt a posture including rounded shoulders and forward head carriage which increases the curvature of the neck. By using a combination of massage and manipulation, the muscles that were tight and tender previously relax and lengthen, providing more freedom and movement which in turn reduces both tension and the pain we get accustomed to for such a long period of time.
But then you’re reliant on treatment, right? Definitely not, exercises will be introduced during the treatments which help boost the longevity of your pain free activities. Of course there is an option to maintain treatment every so often in order to target any specific aches and pains, but that is a discussion to be held between yourself and your Chiropractor, to agree a plan of action that suits you.


​Jull, G., et al., (2002) A randomized controlled trial of exercise
and manipulative therapy for cervicogenic headache.
Spine 27(17): p. 1835-43;
discussion 1843.

​Ashia is a student triathlete and a regular in the Physio Impulse Clinic. After an early swimming career plagued with injury, she made the switch to triathlon in 2015 and progressed quickly into the Elite ranks. Her 2016 season culminated with a win at the Age Group Sprint World Championships Qualifier in Llandudno and a top 10 under 23 finish at the British Elite Championships."

We are happy to be sponsoring Ashia and helping her to stay injury free this season!

Good Luck for your upcoming competitions!
​

Parkinson’s, or Parkinson’s disease (PD,) is a progressive, neurodegenerative condition.
Parkinson’s most often occurs after the age of 50 and is one of the most common nervous system disorders of the ageing populations. The condition is caused by the slow deterioration of the nerve cells in the brain, which create dopamine. Dopamine is a natural substance found in the brain that plays a major role in our brains and bodies by messaging, and therefore communicating across various systems.
Some non-motor aspects (sleep problems, low mood, constipation and loss of sense of smell) occur several years prior to observable motor symptoms develop. Physiotherapists are most often involved in the mid stages of the condition, once balance and mobility become affected, but it can be helpful if they can assess and advise people soon after diagnosis in order to maintain activity and prevent problems.
Prognosis
The American Academy of Neurology notes that the following clinical features may help predict the rate of progression of Parkinson’s:

• Older age at onset and initial rigidity/hypokinesia can be used to predict (1) a more rapid rate of motor progression in those with newly diagnosed Parkinson disease and (2) earlier development of cognitive decline and dementia; however, initially presenting with tremor may predict a more benign disease course and longer therapeutic benefit from levodopa
• A faster rate of motor progression may also be predicted if the patient is male, has associated comorbidities, and has postural instability/gait difficulty (PIGD)
• Older age at onset, dementia, and decreased responsiveness to dopaminergic therapy may predict earlier nursing home placement and decreased survival
  
  

Impairments of Parkinson’s disease
Basal ganglia dysfunction affects the automatic (involuntary) nature of our movements. This includes:

• Impaired performance of well-learnt motor skills and movement sequences
• Problems maintaining sufficient movement amplitude
• Difficulty in performing more than one task simultaneously (dual-tasking)
• Difficulty in shifting motor and cognitive sets
• Slower mental processing
• Perseveration (repetition) in thought and action

 
Unfortunately, outcome potential varies from case to case depending on the severity of your symptoms and it is important to understand your prognosis from the offset. At Physioimpulse we make sure to discuss your goals and activities to ensure that you can achieve maximal participation in your daily activities.
At Physioimpulse, we aim to help support you in the following ways:

• Maintain and improve levels of function and independence, which will help to improve a person’s quality of life
• Use exercise and movement strategies to improve mobility
• Correct and improve abnormal movement patterns and posture, where possible
• Maximise muscle strength and joint flexibility
• Correct and improve posture and balance, and minimise risks of falls
• Maintain a good breathing pattern and effective cough
• Educate the person with Parkinson’s and their carer or family members were appropriate
• Enhance the effects of drug therapy

(Ramaswamy et al., 2016).
At Phyioimpulse we provide the following treatment for your limitations, including:

• Strength and balance training
• Aerobic training 
• Hand-eye coordination training
• Motor-learning training
• Gait (walking pattern) rehabilitation
• Visual cueing
• Auditory cueing
• Attention training
• Proprioceptive neuromuscular facilitation (PNF) re-education
• Caregiver training of home exercises where appropriate
  
  

At Physioimpulse in Bath, we use standardised evaluations and validated assessment tools to measure your progress and ensure that your goals are realistic, achievable and tailored to your needs*.

* N.B.: We are a private OUTPATIENT clinic; we do not have supportive hospital equipment on site such as respiratory aids, walking aids, cranes, harnesses or additional supportive devices you would expect to find in a hospital environment. Our Bath Sports Centre and Phase One clinics are wheelchair accessible; however, please check with your GP and/or consultant that you and/or your care patients are suitable for outpatient rehabilitation before attendance.

Ref.

• Ramaswamy, B., Walker, W., Lowe, R., Thomas, E. and O'Reilly, N. (2016). Parkinsons Physiotherapy - Management and Interventions. Available: http://www.physio-pedia.com/
  Parkinsons_Key_Evidence_and_resources. Last accessed 15th June 2016.
• Ramaswamy, B., Walker, W., Lowe, R., Buxton, S. and O'Reilly, N. (2016). Parkinsons Disease. Available http://www.physio-pedia.com/Parkinsons_Disease. Last accessed 15th June 2016.