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.

Stroke
  According to the World Health Organization (2016), 15 million people suffer stroke worldwide each year. Of these, 5 million die and another 5 million are left permanently disabled.
During a stroke, or Cerebrovascular Accident (CVA), blood supply to certain regions of the brain is limited, leading to cell death. Consequently, certain motor functions of the body are lost. Some of the associated impairments of stroke can however be recovered through physiotherapy, which stimulates other regions of the brain to compensate for what has been lost through a process call neuroplasticity.
As well as gait impairments, stroke can cause the following impairments in the upper limb:

• Subluxation (partial dislocation)
• changes in sensation
• contracture
• swelling
• co-ordination problems
• weakness
• altered muscle power
• changes in muscle tone
• hand dysfunction
• single-sided blindness / single-sided avoidance of use

 (Walker et al., 2016)


 
Physiotherapy management helps to maximise function, minimize impairments, minimize pain and prevent further complications by re-educating your motor control. Starting physiotherapy early is shown to have better outcomes in the long term (Harwood R, Huwez F, Good D., 2011).


At Phyioimpulse we provide the following treatment for your limitations, including:

• Strength training
• Aerobic training  - which has been shown to assist neural function (Mang, Cameron S. et al., 2013)
• Hand-eye coordination training
• Motor-learning training
• Gait (walking pattern) rehabilitation
• 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*.
 
Unfortunately, outcome potential varies from case to case depending on the severity and region of stroke (CVA) 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.
 
* 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:

• Harwood R, Huwez F, Good D. (2011). Stroke Care: A practical manual. New York: Oxford.
• Mang, Cameron S. et al. (2013). “Promoting Neuroplasticity for Motor Rehabilitation After Stroke: Considering the Effects of Aerobic Exercise and Genetic Variation on Brain-Derived Neurotrophic Factor.” Physical Therapy 93.12, 1707–1716. PMC. Web. 15 June 2016.
• Walker, W., Ritchie, L. Lowe, R. Buxton, S. and Hytros, M.. (2016). Stroke. Available: http://www.physio-pedia.com/Stroke. Last accessed 15th June 2016.
• World Health Organization (2016) .Global Burden of Stroke. The Atlas of Heart Disease and Stroke. MacKay J, Mensah GA. 

​
Bath Physiotherapy
01225 683007