Advance Rehab Centre

Freezing of gait in Parkinson's disease

Wed, 08 May 2013 08:37:48 GMT

What is freezing of gait?

Freezing and Freezing of gait (FOG) is a term of often used in Parkinson Disease. It is clinically defined as “a short, episodic absence or noticeable reduction of forward progression of the feet when trying to walk”. This is most often described as having your feet stuck to the ground and looks like you are taking lots of short, shuffly fast steps before being able to step out normally again. This phenomenon is due to several deficits and not just a motor problem.

FOG is a common problem/symptom in PD and can affect up to 50% of the population. Unfortunately as the disease progresses up to 80% of people with PD in the advance stages will have issues with FOG. FOG has significant affects on mobility and can cause falling, people cannot move their feet on initiation and the body continues forwards causing a loss of balance out off the base of support. This impact on mobility can dramatically reduce your independence and hence quality of life.

There are several activities and environments that can trigger FOG, the most frequent are;

Turning – especially on the spot or turning to sit down.
When trying to start walking.
Passing through doorways, crowed spaces or change of surface on the floor.
Negotiating obstacles and narrow spaces.
Dual tasking – trying to walk and do something else, talk, rushing to answer the phone.
Emotional factors also can contribute for example stress and anxiety

All of the above involve a change/adaptation of the gait pattern which in turn has a higher demand on your attention levels. There has been significant research now confirming that cognitive decline is very closely correlated to FOG. On further examination it is apparent that global cognitive decline is pronounced in freezers much more than in people with PD who don’t freeze. Several domains of executive functioning have been found to be affected. This is why people with FOG can’t just change their walking with simple commands or increased concentration.

The risk of freezing increases significantly with activities that involve duel tasking, or doing more than one thing at the same time. This may be trying to find coins in your pocket or trying to have a conversation with someone when you walk. Many of the above factors are of cognitive origin and this demonstrates the increased demand on cognition.

Freezing does not only occur in gait, there may also be motor blocks that resemble freezing in the upper limbs. This confirms that FOG is generic in nature which has implications on the timing and amplitude of repetitive movements in both lower and upper limbs.

Research Evidence - Can Physiotherapy Help?

FOG is only assisted by PD medications (dopaminergic) up to a certain point and then there seems to be no further improvements. Gait rehabilitation aims to use alternative neural circuits to maintain / improve gait by several different strategies;

External cues – markers on the floor, metronome
Internal cues – Think Big
Gait rehab – amplitude training, forced use

The aim is to change your automotive motor control to an external / attention demanding control. There is supporting research that physiotherapy can reduce FOG with cueing, although there is a risk that people can become dependent on cueing.

However consolidation and appropriate fast retrieval of these strategies is needed to see an improvement in day to day life. Which means a sufficient cognitive function is required to lean and perform. As discussed earlier people with FOG can have impaired cognition and executive function which means retrieval of methods/strategies may not work when required.

If you have Parkinson’s and not been assessed by our team please contact us for an appointment, the earlier you learn how to effectively use the above strategies, retrieval may be much easier if FOG becomes a symptom.

Cognitive aspects of freezing of gait in Parkinson’s disease: a challenge for rehabilitation. 2013. Heremans, E., et al. Journal of Neural Transmission

How to walk again after a stroke

Tue, 07 May 2013 10:37:16 GMT

Firstly the goal of being able to walk again post stroke is not realistic for every stroke client and is dependent on many variables including; severity of the stroke, motor recovery, cognition and medical history. However for those that are working towards the goal of walking again are you doing enough? How much is enough? Does it really matter how often you walk or for how long?

There is now research to support the answers to all those questions, to improve walking you must be practising walking, this can either be on a treadmill, with body weight support, assistance from therapists or carers or aids. Large amounts of repetitions are critical to enhance plastic changes in neural circuits. Repeated task specific practice during motor skill acquisition has been shown to increase dendritic growth, synaptic strength, number and neuronal activity in the brain or spinal circuits, resulting in long lasting alterations (improvements) to motor performance. Evidence shows that there needs to be at least 1000 to 2000 steps per therapy session or at least 2000 steps per day at home (2000 steps is approximately 1km for fairly normal stride pattern) to produce significant changes or improvements in your walking.

Walking at a speed that is 85% of predicated maximum HR is also needed to see change, another target is to take 80 steps per min to achieve change. Increased neural activity is needed to drive the muscular and cardiovascular systems. High intensity activity may increase synaptic connectivity strength. This has been seen in both animal and human studies where short bursts of high intensity stimulation to the nervous system results in rapid and sustained increases in synaptic efficacy. In high intensity exercise endogenous neuromodulators facilitate performance in the spinal and supraspinal circuits. So when walking more significant improvements are made when training at higher speeds.

Results are the same whether the walking has been on a treadmill or overground. However our bodyweight support treadmill offers the ability to walk safely reducing the risk of falls. It also ensures that you are working hard enough to achieve the 85% of you predicted heart rate max to ensure the neuromuscular adaptations. It is much easier to slow down and reduce your effort levels when walking overgound, however the treadmill keeps going at a set speed so you have to keep working hard.

If your goal is to improve your walking you need to be walking approximately 2000 steps a day and walking at a speed that is challenging your cardiovascular system (making you breathless) several times a week.

Hornby et al, 2011, Topics in stroke rehabilitation. Importance of Specificity, amount and the intensity of locomotor training to improve ambulatory function in patients post stroke.

MS drug said to improve walking in Stroke

Wed, 17 Apr 2013 05:18:19 GMT

There has been much in the news lately about how the drug AMPYRA, used to treat MS, has been shown in a phase II trial to improve walking in people with chronic stroke. From the content that I have read, I am not sure exactly how this is happening as there is no clinical data in the news articles and I havent been able to locate the original article yet.

What we do know is what the MS drug is currently used for. It is reported that Ampyra improves walking in people with demyelination, as seen in MS, by blocking the leakage of potassium from the nerve. This helps to improve nerve conduction and ultimately how effective the messages are in getting from the brain to the muscles. How this applies in stroke we can only extrapolate as the damage to nerves that you get from stroke and MS are very different, even the type of stroke that you have (haemorrhagic verses embolitic) will change the type of damage to the nerve.

In the news articles, statements have been made about how the drug improves walking speed and function on a scale called the Functional Independence Measure (FIM) verses those on a placebo medication. It is certainly interesting and we look forward to further clinical trials to see if they can improve quality of life and mobility post stroke.

To read one of the articles, click this link.

Back at home after home based rehab following Stroke.

Fri, 05 Apr 2013 01:38:48 GMT

Angus is an 84 year old patient who had a stroke in June 2012. Initially following his stroke Angus had no movement in his left upper and lower limb. He was also unable to sit unsupported. Angus had 7 weeks inpatient rehabilitation and it was felt he had reached his potential and was discharged. Due to Angus’ social support system he was unable to return home and was discharged to an Aged Care Facility in August 2012.

Since September 2012 I have been treating Angus for 30 minutes four times a week – three times a week at home and once at the centre. He had two weeks off over Christmas but apart from that has had physiotherapy the entire time.

On his initial assessment Angus required moderate assistance of two people to stand and transfer and could walk a few steps holding onto a rail and maximum assistance of one person. He mobilised independently in a one-arm drive wheelchair. At this stage Angus still had no movement in his left upper limb. Angus’ goals were to return home and be as independent as possible ideally walking with a stick.

During our time together, Angus and I have explored a number of different treatment modalities including but not limited to;

Lower limb strengthening exercises
Bed mobility practice
Gait re-education
Set-up of his home environment
Body weight support on the treadmill
Balance exercises
Stairs practice
Upper limb strengthening exercises
Pablo upper limb training software

Angus is currently walking independently with a quad stick and is progressing towards independent mobility with a single point stick. Angus is now living at home and is independent with all his transfers. Angus now has movement in his left upper arm and is able to get his hand to his mouth.

Angus is extremely motivated and works exceptionally hard both within the therapy sessions and with his own independent practice at home. Angus practices all his exercises more than once a day and strives to reach his goals.

Angus is now working towards independent mobility unaided and to increase functional use of his left arm. He is in the process of attending a spasticity clinic for Botulinum toxin to assist with his upper limb function. I look forward to continuing to work together and striving to reach his goals. Well done Angus

JobAccess—help and workplace solutions for the employment of people with disability

Tue, 19 Mar 2013 02:03:52 GMT

I recently had a fantastic experience with the Australian government funded company known as Job Access. I have been in the Australia for just under a year and slowly getting to know about all the support services available in this country for my therapy clients. I was directed towards JobAcess as I had a young client in their early 20’s who was recently diagnosed with a neurological condition and was concerned with how they could stay at work.

I browsed the JobAccess website and was quite blown away with all the different support and advice they supply in a range of areas for both the employer and employee and the different funding schemes that are available. I contacted them to discus my client and they were exceptional helpful on the phone and sent through all the application forms and information instantly via email while I was speaking to them.

JobAccess is a government funded information and advice service which offers help and workplace solutions for people with disability and their employers. It has been set up to support and assist people with disability to find employment or stay employed.

JobAccess is able to assist you and provide information for how to prepare yourself to start looking for a job, how to interview and how to access help after you have found a job. They can also assist you in maintaining your job or changing your skills once you are employed. JobAccess can direct you to several free services to help you find a job, keep a job or manage a return to work after accident or injury. Many of these services offer ongoing support for people with disability. They are also able to direct you towards the best resources regarding appropriate study, training and apprenticeship course for a career you may want.

There is also financial assistance available; help to pay for the cost of workplace modifications and several programs available to help your employer with wages, training, and other options. There is also advice and help to set up your own business if this offers you the flexibility you need to start work or return to work.

Many people with disabilities, especially those who acquire their disability during their employment lifetime struggle to return to work and often suffer a form of loss of self identify as often their role at work is reflective of who we are. There is a constant drive towards equal opportunities especially in the work place but often it feels like an uphill struggle if you don’t have the support both regarding knowledge and finances. Please visit their comprehensive, easy to use website and a free telephone information and advice service where you can access confidential, expert advice on the employment of people with disability.

http://jobaccess.gov.au/Home/Home.aspx

Phone 1800 464 800 for expert advice

Body Weight Support Harness over Treadmill Training

Tue, 19 Mar 2013 01:51:21 GMT

The ability to walk is most often the primary goal for people following a stroke. Physiotherapists have many skills in their toolbox that they can use to work towards this goal – one of which is body weight support treadmill training.

Body weight support (BWS) is a harness system that supports a percentage of an individuals’ body weight, therefore unloading the lower extremities. The BWS can be used overground or placed over a treadmill.

Using a treadmill allows an individual to walk at a pre-determined speed, and as we say at Advance Rehab Centre ‘the treadmill stops for no one!’ Following a stroke your step length can vary dramatically; usually being shorter on the unaffected leg. This can be due to an inability to take weight and load the effected lower limb.

Evidence has shown that higher intensity of practice, such as more repetitions, results in better outcomes after stroke. Implementation of a treadmill as a treatment modality may be a way of increasing the number of steps taken, therefore leading to a higher intensity of practice.

Studies have been carried out comparing treadmill training with overground walking both with and without BWS with varying results. One study compared treadmill training with and without BWS. Both groups walked on the treadmill with one having 40% BWS and the other without the BWS therefore taking 100% of their weight. This study concluded that the group who used the BWS had a significant increase in overground walking speed, endurance, balance and motor recovery, especially those who were more impaired initially. This study also reported less learnt compensatory strategies with using the BWS. An increase in mobility with BWS treadmill training has been shown in people at different stages after their stroke; both initially and more than 6 months after.

Using the BWS allows the therapist to concentrate on lower limb positioning and foot placement. Many people following a stroke are able to walk quicker on a treadmill with BWS than overground.

There does need to be more research comparing overground walking with and without BWS as well as clearer duration of training to achieve optimum intensity and results.

At Advance Rehab Centre we have a BWS which has been custom built to stand over the treadmill. Our patients often take their first steps in the BWS on the treadmill at the centre.

Join the fight against stroke

Fri, 15 Mar 2013 00:24:28 GMT

The National Stroke Foundation (NSF) has launched the Fight Stroke Campaign to raise awareness of stroke. They want people to understand what stroke is and why it desperately needs attention. The campaign is also about securing funding from the Federal Government for stroke services across the country, not just for the NSF.

Despite being Australia’s second biggest cause of death and a leading cause of disability amongst adults, stroke has never received federal budget funding for implementation of a comprehensive stroke strategy. In order to be a success, the campaign needs the support of as many people as possible. We are urging you to support this campaign.

You can do so by firstly signing up to the campaign at www.fightstroke.com.au - it only takes 30 seconds. When you add your name, you will be assisting the Foundation to amplify the voices of all Australians who care about making stroke a health priority for everyone.

You can help even further by:

Writing to your federal MP to tell them why stroke deserves better funding
Making noise in the media by writing to the editor of your newspaper or calling into talkback radio
Getting your friends, family and colleagues to sign up to the campaign

There is more detail on how you can do all of this at www.fightstroke.com.au

The NSF are proposing the Australian Government provide $198m in funding over three years for a comprehensive Australian Stroke Improvement Program. If adopted the Stroke Improvement Program will result in significant improvements to the way stroke is managed in Australia. As a package of measures these policy solutions will deliver an improved stroke management framework with:

Higher community awareness about stroke leading to faster diagnosis and treatment.
Better detection and management of community health risk with lower incidences of stroke and other major diseases.
Improved standards of stroke care resulting in fewer deaths and lower levels of disability.
A comprehensive approach to caring for and supporting stroke survivors as they recover in the community.
Significant costs savings to the Australian public.

All the proposals within this policy document are based on evidence, reviewed and summarised in NHMRC Clinical Guidelines. Information and inspiration has also been drawn from stroke care reform in the UK – specifically in London where highly cost effective changes to stroke care and management were implemented with significant reduction in morbidity and mortality and associated cost savings.

Product Review- Sara Steady by Arjo Huntley

Thu, 14 Mar 2013 23:12:42 GMT

As physiotherapists we often encounter clients who can stand with some help, but cannot safely pivot or step top move from one location to another, such as from bed to wheelchair or bed to commode.

The Sara Stedy is a relatively simple piece of equipment, but for the right client it certainly does the job – providing a safe and simple, yet active, way for someone to transfer. It is very simple to use, with no electrical parts. It basically consists of a foot plate, on which the patent stands, a knee brace, which supports the leg position, and a rail, which the patient can use to help stand using one arm or both arm. Once stood, two flaps behind the patient are rotated down to form a seat, which the patient then perches on. The whole unit is on wheels and can then be moved to the new desired location. To sit down the process is reversed – the patient stands and the flaps are rotated out of the way, ready to sit down at the new location.

http://www.youtube.com/watch?v=tmAqTzUYSuA

The Sara Stedy is an updated version of the old Stedy model. It’s basic operation is the same, but they’ve added a few improvements which were badly needed. The legs of the Sara can now be moved wider and narrower to access chairs and commodes of different widths – the previous model did not have adjustable legs which made numerous seats inaccessible because you simply could not get close enough. The flaps now rotate out instead of flipping up making them easier to move in and out whilst the patient stands, and also provides more space to access chairs with arms.

To use this equipment successfully the patient requires the following:

Sufficient trunk control and sitting balance to be independent and safe in a perched sitting position, and to sit unsupported if transferring to a bed
Ability to stand, even if requiring some support through the knees
Ability to follow instructions, prompts, or gestures consistently, to participate actively in the transfer

Advantages

Allows more frequent use of active standing and sit to stand practice through the day during routine cares
Easy to use
Requires one carer to assist the patient to transfer in most cases

Disadvantages

Whilst the design has improved, it can still be tricky to access some chairs

I have two nursing home resident clients who are using this particular piece of equipment. Both have had strokes with dense weakness down one side, and both have progressed to a point where they can stand with the help of one person and a rail in therapy. One gentleman was step transferring with heavy help of two carers in an unsafe manner, but is now able to transfer safely with one carer using the Sara Stedy. Another is a lady who was not performing any standing and instead transferred using a sling hoist, requiring the help of two carers. Both these clients are now standing daily as part of their regular care routines with help from one carer, which means they are engaging in frequent, safe practice of standing away from the therapy environment.

Strength training in neurological rehabilitation

Thu, 14 Mar 2013 23:53:15 GMT

So most of us have had a go at some form of strength training whether it is hitting the big weights at the gym, doing some sit ups watching TV or carrying the shopping in from the car. However what really is strength training and are we doing it correctly to see any results or benefits. When properly performed, strength training can provide significant functional benefits and improvement in overall health and well-being, including increased bone density, muscle, tendon and ligament strength and toughness, improved joint function, reduced potential for injury and improved balance. It can also have an impact on cardiovascular and metabolic health.

1. Exercise selection

There of hundreds of different ways, types and methods of strength training out there and if you go to gym there will often be lots of different machines to work different parts of your body. Choosing the type of strength training that is most effective for you in your rehabilitation program is a matter of working backwards from your goal. Do you need to train for endurance, power or function? Do you have very weak muscles that need to be supported or very strong muscles that lack coordination? Your strength training program will depend on many of these factors and your neuro physio will be very helpful in setting you up with the most efficient program for you to continue, either in therapy or outside as an individual program. Three to five exercises may be plenty to focus on in a session, any more may become too time consuming and you will not be able to work at the required level of intensity needed to over load and see improvements.

2. Frequency of training

Evidence shows that depending on what type of strength training you are doing, 2-4 times a week is best. The rest periods between strength training sessions can not be underestimated, especially in weak muscles. If you are working hard in each training session, more rest may be required. Research shows that muscles continue to build fibers and become stronger for up to a week after a workout that is performed to muscle failure. This means if you perform an exercise until you physically cannot do it anymore you are likely to get better strength gains- this comes with a caveat in muscles that are under undue strain during everyday activities such as in conditions like polio, MND, Muscular dystrophy for instance.

3. Number of sets

The majority of research confirms that if you can do one set to exhaustion, that is probably enough if you are looking at pure strength gains. It is common to perform 2 or 3 sets and continue to load the muscles, however, again this will depend on what you are trying to achieve and why the muscle is weak in the first place.

4. Number of repetitions

The number of repetitions you do in each set will again depend on if you want to achieve in your strength training program. Is your focus on strength, power or endurance gains? Higher repetition sets stimulate the slow twitch muscle fibers and promote muscle endurance. Lower repetitions (at a higher intensity) activate the fast twitch muscle fibers and can increase strength and muscle size. You may need a combination of these strength training features for optimal functional outcomes and your therapist may chose to vary your training methods. In theory, the weight must be heavy enough that you reach fatigue at the last repetition of your set in order to promote muscle growth. For example if you want to build pure strength with a sit to stand activity, you may need to hold additional weights or wear a loaded weight vest that is heavy enough that you are only able to complete approximately 10 reps before you are fatigued and have to stop. If you are training for strength endurance, you may need to perform sit to stand without weights but do significantly more repetitions..... this may be 50 reps. Your therapist may also which to introduce 'power' training techniques which add an element of speed to your repetition. All strength training in neurological conditions is best done with close therapy monitoring in the early stages, both to avoid injury as well as to ensure you are getting the most out of your hard work!

5. How important is form/technique?

You must perform your chosen exercise with the correct technique or you will not achieve the result you are hoping for and run the risk of injuring yourself. Common mistakes include; rushing, moving too quickly, your weight being too heavy or your technique being slopping. It can be easy to cause injury to your back and joints if you do not do use correct techniques and graduate your program. Strength training gains can often be seen quite quickly, in a matter of weeks, as your muscles become more efficient at producing force, however it generally takes 10-12 weeks before you see significant improvements in muscle strength, especially if you are looking for growth in muscle tissue.

6. Do you need equipment?

It really depends on what you want to achieve... training against your own body weight can be very effective for functional strength training and endurance training. Additional weights or machines may be required though if you are training for muscle growth.

7. How to get started?

If you have a neurological condition, you may need to get some expert advice and an individually prescribed program from a neurological physiotherapist or neurologically trained exercise physiologist. The assessment will take into consideration your current health status, any associated medical conditions, therapy goals, training logistics and any other issues you may have. Once your program has been prescribed, it will also need to be monitored as you progress to make sure that you are getting the most out of the program and to avoid injury. Strength training can be a very valuable rehabilitation tool and there is alot of evidence supporting it, so contact ARC now to get your program started!

Is Constraint Induced Movement Therapy for you?

Tue, 26 Feb 2013 00:19:52 GMT

What is CIMT?

CIMT is a form of therapy aimed at increasing the function of an upper limb following stroke of neurological damage. It involves the restraining of the unaffected or “good arm” for periods during the day.

What does it involve?

Studies have varied on hours of restraint per day and length of therapy. Traditional CIMT involves the person performing supervised structured tasks with the affected limb 6 hours a day for 10 days over a 14 day period, in addition to wearing the restrictive mitt or sling for 90% of waking hours . However compliance with this protocol has been found to be very difficult for many patients. One form of modified constraint induced movement therapy that has been found to be effective in improving functional reach and grasp, involved massed practice of the affected limb 2 hours a day for 10 days, in addition to wearing the restrictive mitt or sling for 6 hours a day for 2–3 weeks.[8] Practitioners say that stroke victims disabled for many years have recovered the use of their limbs using CIMT. However, it has been shown that receiving CIMT early on (3–9 months post-stroke) will result in greater functional gains than receiving delayed treatment (15–21 months post-stroke).[9]

Who can do CIMT?

In order to participate effectively in a CIMT programme you will need to have 10degrees active extension at the joints in the fingers and 20 degrees active extension at the wrist. If spasticity is present your arm should be able to be moved through available range of movement with minimal difficulty. If pain is present it should not interfere with movement (less than 4/10 on a pain scale).

The main skills needed to successfully participate in CIMT are patience and determination. Not being able to use your stronger arm is frustrating and to keep doing it for 10-15 days can require a lot of determination.

People with balance problems should be cautious attempting CIMT as their “good arm” is restrained and not available to save them in a fall. Cognitive or language impairments may also make understanding and therefore compliance with the programme difficult.

What if I don’t have that amount of movement?

There are other options for upper limb training for arms with minimal activity.

Electrical stimulation – A current is applied to the target muscles to stimulate a muscle contraction ie wrist and finger extensors to open the hand. In order to gain any functional change the client must work with the stimulation doing tasks such as picking up and releasing a ball, and ideally in an intensive programme.

Saebo ‘s Functional Dynamic Orthotic- This is a piece of equipment which is worn on the affected hand for 2 x 45min sessions a day. The orthosis assists in opening the hand allowing the wearer to participate in an active, intensive programme of upper limb tasks.

Physiotherapists at Advanced Rehab Center can assess and advise you on the best treatment options for you.

Hereditary Spastic Paraplegia- Tim's story

Mon, 25 Feb 2013 03:59:50 GMT

After attending the HSP Workshop in Adelaide in November 2011 and participating in the “Managing and Maintaining Mobility” presentation given by neurophysiotherapist Tamina Levy, on my return to Sydney I decided to pursue neurophysiotherapy as treatment for my HSP condition. I was a little sceptical at first as I had seen numerous physios in the past who were not familiar with HSP so maintaining a positive belief that this treatment would be of benefit to me was my first challenge.

The first step was to find a neurophysio in Sydney. I was working in Chatswood at the time so I wanted to find a practice that was close to my office. After running a search on the Australian Physiotherapists Association’s website at www.physiotherapy.asn.au for physios close to Chatswood who specialise in neurology treatment, I came across Melissa McConaghy at the Advance Rehab Centre in St.Leonards (www.archealth.com.au) and promptly booked in an appointment.

At my first appointment we had a chat about my condition and what was it that I was hoping to achieve from the consultation. I explained some of the symptoms that I had such as the gait, muscle stiffness and weakness and that my long term objective was to improve my walking style. At the time I was struggling to walk 200 metres without resting so any improvement to this distance would have been worthwhile.

Melissa then examined me, instructing me to do various exercises whilst I was in both standing and sitting positions. Using markers along the length of the room, I then walked up and down whilst Melissa assisted by other members of her team, identified my major areas of weakness. To be sure, when I stopped walking she asked me to do some more exercises that would highlight to her the exact symptoms that cause the gait and spasticity to occur. I then sat down again with Melissa and she explained to me the findings from her initial assessment (using medical terms and plain English):

· Weakness of hip flexors bilaterally – The hip flexor muscles are located in the front of your leg, above the thigh muscles, and they act to bring your leg up towards your trunk.

· Rectus femoris spasticity bilaterally - The rectus femoris is situated in the middle of the front of the thigh. Rectus femoris spasticity is one of the main causes of reduced knee flexion in swing phase, commonly known as stiff knee gait.

· Hamstring spasticity bilaterally – Hamstring tightness and stiffness makes it difficult to move your leg backward and bend your heel back to your buttocks. Stiffness in the hamstrings can also prevent normal range of motion in the hip or the knee joints.

· Calf spasticity bilaterally – In HSP, calf spasticity is usually the cause for symptoms such as foot drop, high arches and hammer toes.

The initial consultation finished with an exercise program for me to do at home before my next follow up program. The exercises were focused on lifting my knees to build strength in my hip flexors, stretching my hamstrings and raising my calves.

At my next appointment, Melissa reviewed my ability to complete the exercises given to me the week earlier. We both noticed significant improvement in not only number of sets and repetitions for each exercise but also flexibility and range. From these results, this convinced me to commit to a long term neurophysiotherapy program of 8 weeks. After another hour of intense exercises, this session finished with Melissa taking a video of me walking from both side and front angles.

Each consequent consultation got harder and more difficult. The sessions became more demanding and challenged me not only physically but also mentally. In addition to the hip flexor, hamstring and calf exercises, we worked on other exercises including leg presses, cycling, squats, lunges, stepping up/over and sitting techniques. In between sessions I was doing my own personal training and repeating the exercises at the gym.

After week 4, Melissa introduced me to orthotics. She arranged for Darren the orthotist to visit from Melbourne who presented me with a range of products to try that are specifically designed to prevent foot drop and dragging of the feet. After trying all products including the electronic device WalkAide, I found the Noodle AFO to be of most benefit. This type of AFO is constructed using lightweight carbon fibre material and is designed to improve gait efficiency. Darren measured my foot and ordered the AFO to my measurements. I only ordered the AFO for my left leg as both legs would have been too much an adjustment for me.

By week 6, I was feeling less stiffness and more strength in my legs than I had been in a while. I was training hard in the gym and walking much longer distances. The walking distance between home and railway station and railway station to the office was far easier to complete and required less cardio effort. Even my family and friends were noticing differences.

The next week my new AFO had arrived and I couldn’t wait to try it on! It fitted with ease and the difference it made was immediate. I felt less weight on my legs, more balanced and had improved gait efficiency due to better feet clearance off the ground. At the end of this session, Darren brought out the video again and he filmed me with and without the AFO. He also timed me walking over set distances, with and without the AFO, and my times were close to 20% faster with the AFO on!

I finished the program after 8 weeks with a review from Melissa of my achievements to date. The program helped to maintain movement in my hip flexors, reduce spasticity in my hamstrings and calves and improve my gait. The biggest achievement for me was that I could manage to walk over 500 metres with relative ease.

Today, close to 12 months since finishing the program, I still maintain the exercise plan by training 4 to 5 times a week at the gym. I doubt very much that I would have been able to travel to Europe for 5 months last year had it not been for the program. As a progressive condition, I believe that we have to stall the rate of progression to achieve a longer period of mobility and keeping active will help us get there.

From my journey, I found visiting the neurophysio to be an investment in my long term mobility and formed part of my personal HSP management plan. I wish for all HSPers to share similar success stories! The photo is of me and my dad swimming in the Cole Classic in February 2012.

Thanks for reading my story,

Tim Xiros

PD Warrior Instructor Training

Mon, 25 Feb 2013 05:38:06 GMT

Congratulations to four new PD Warrior Instructors who joined us for the PD Warrior training day on Feb 10 and 11th.

Russell Tuckerman,
Martin Kwasner
Susan Cottrell
Jonathan Poon

There are now 10 accredited PD Warrior Instructors in Australia!!

We all agreed the workshop was pretty intense with a lot of content to get through over the two days. From a trainer's point of view I was very excited about how much enthusiasm the program drew from all therapists involved. PD Warrior from a therapist's point of view involves a big 'mindshift' from what is known as traditional therapy to what is actually possible in helping people with Parkinson's disease.

A huge thanks also goes to the seven wonderful volunteers with Parkinson's disease who joined us over the two days to help the new instructors with their techniques. There is nothing like hearing from a patient directly how a therapy treatment impacts on their life and what gives them the most benefit.

So, we now have four PD Warrior sites open around Australia.....to find out the closest location to you, please visit www.pdwarrior.com/locations. If you are interested in becoming the next PD Warrior site the next accreditation workshop is going to be held on August 10th and 11th. For more information please contact Melissa McConaghy directly at melissa@archealth.com.au

Therapist view on treating Parkinson's disease

Mon, 25 Feb 2013 05:04:07 GMT

I recently joined Advanced Rehab Centre in late August 2012 and have been amazed at the different techniques we use in our management of Parkinson’s disease. I have had the pleasure of working with some people with Parkinson’s disease and have had great results that I wanted to share.

Mr A came for an assessment in November having been diagnosed with Parkinson’s Disease in 1999. He was taking multiple medications and had undergone deep brain stimulation. However, he continued to have many problems especially with his walking and fine motor skills of his hands such as getting money from his wallet. Mr A walked with a stick and had problems in narrow spaces and doorways and often froze in these situations, finding it very difficult to get moving again.

Mr A attended our PD Power programme at Advanced Rehab Centre and attended 3 sessions a week for four weeks. Below are some of his results:

	Before	After
PDQ-39	33/156	17/156 ( the lower the better)
10 metre walk test with dual tasking	1min23 91 steps	7.72 seconds 14 steps
6 minute walk test	287 metres	433 metres
360 turn	8.47 seconds 31 steps	4.78 seconds 14 steps

Since completing his four week course Mr A is now able to walk into a cafe, order his coffee and pay without freezing or having any problems. Mr A is now attending PD Warrior Circuit programme at the centre, twice a week and I look forward to seeing him in the gym working hard and achieving his goals.

Tilt Table Product Review

Mon, 25 Feb 2013 04:54:13 GMT

A tilt table is a special plinth, or padded table, which is able to tilt and passively bring someone to an upright posture. To stand using a tilt table the patient starts lying down on the table and is then strapped down firmly with straps, usually 3 – at the chest, pelvis and just above the knees, and the feet positioned on a foot plate.. An electric motor then tilts the table anywhere from the flat position through to standing (most models tilt to around 80-85 degrees, just off full vertical), depending on what the patient is able to tolerate. Standing in this manner is completely passive, meaning the patient does not need to produce any effort or muscular activity to remain in this position. Active exercises can play a part in using a tilt table, which can be set up to work leg muscles along with trunk, arm and breathing exercises. Tilt tables are most often used in acute, hospital based care and rehabilitation, but are less commonly used in the community. Reasons for this include cost, space, practicality of use, time issues and real life benefits. However, for some clients regular use of a tilt table can be an important part of their daily routine. For more information on the benefits of prolonged standing, follow this link:

http://www.archealth.com.au/post/1252140-standing-after-spinal-cord-injury

I have been working with a client for whom prolonged standing is an important part of her daily routine. She has a spinal cord injury and over the past year we have been exploring different equipment to assist her in standing, such as standing frames, none of which have met her needs adequately, until we tried a tilt table. Like all equipment they are all a little different and we had an opportunity to try a few different models – here’s what we liked and disliked about each, based on this individual clients needs and preferences.

SX Tilt Table:

Advantages:

· Great for larger / bariatric patients – weight limit of 200kg and a bigger width of table

· Best for comfort around the backs of the ankles with lots of padding

· Built in angle reader makes positioning more precise

Disadvantages:

· Wider body adjusts strap positioning, limiting some arm movements and reducing comfort

· Bigger unit – takes up more space

Fortress (BASIX)

Advantages:

· Dual adjustable foot plates

· Can attach activity table directly to this unit

· Manual angle lower lever in case of power outage

· Tilt range 0 to 87 degrees

· Built in angle reader makes positioning more precise

· 200kg user limit

Disadvantages:

· Foot rest adjustment to predetermined angle only

· Buttons on the controller are not labelled

· Controls less precise and the angle accelerated faster at near vertical and tended to lurch the client forwards

Fortress Alititude

Advantages:

· Dual adjustable foot plates

· Can attach activity table directly to this unit

· 2 section bed – can double as regular plinth with head of bed raised (i.e. to support sitting)

· 180kg user limit

· Judged as the best for comfort by the client

Disadvantages:

· No angle reader built in

· Can tilt to below neutral – i.e. head down

· No manual lower

And the winner? For this particular client the Fortress Altitude was her preference.

Remember – advantages and disadvantages will vary between users relative to their needs and preferences. When looking at a piece of equipment, particularly something this large and costly, it is always best to try a few different models first, and then trial your favourite over at least a few days to make sure it meets YOUR needs.

Goal Setting for Rehab

Mon, 25 Feb 2013 04:24:55 GMT

‘Obstacles are those frightful things you see when you take your eyes off your goal’

When you come into the centre or are assessed by a therapist in your home they will always ask ‘what are you goals? What do you want to achieve from therapy?’

Goals are valued statements and should be meaningful to the person that makes them. Goal setting is an important part of your initial assessment in order for your therapy to have the best outcomes. The therapist’s objective in this process is to establish how to best meet your needs. It also allows treatment to be focused on measuring an individual’s improvements or progress.

Goal setting should be collaborative between the client and the therapist. In many clinical settings clients feel they are passive bystanders in their treatment, however clients need to be active co-planners. Collaborative goal setting increases a client’s adherence to their goals, which in turn increases client’s satisfaction with therapy and enhances goal attainment. If goals are purely made by the therapist they may not be valued by the client leading to a decreased interest and motivation in therapy. Being involved in goal setting not only provides client participation it has also been shown to empower clients. When goals are made together this ensures that both the client and therapist are working towards the same end goal.

Key points in goal setting

Write it down and keep it in sight – a written goal represents a real commitment and without this commitment a goal is only a dream. Keeping it in sight provides a constant reminder what you are working towards.
Make the goal meaningful to you not the therapist – intrinsic goals are more inspiring and have rewards that are meaningful to you. Make sure you are selecting a goal for the right reason not for others.
Make the goal believable – imagine you can do it, have self belief in your ability
Make the goal measurable – this allows you to measure your progress

At the end of your initial assessment your therapist will write down your goals (in collaboration with you of course)and hand you a treatment plan; take this home and keep it in sight for that constant reminder of why you are doing all your exercises and practicing of tasks.

So before you come in to see one our therapists at Advance Rehab Centre or at home with Mobile Rehab Innovations, make sure you have asked yourself ‘What do I want to achieve from therapy?’

Reliable Internet Information for people with Spinal Cord Injuries

Mon, 25 Feb 2013 04:11:41 GMT

The International Network of SCI physiotherapists (SCIPT) is a not-for-profit initiative of physiotherapists worldwide. They also provide great reliable resources for people with Spinal Cord Injuries. Although the internet provides a wealth of information, it can often be hard to know what is from a reliable source and how trusted the information can be. SCIPT have a fantastic page of useful internet links, most are aimed at physiotherapist and health professions, however the ones listed below are aimed towards the spinal cord patient.

All information has come from http://www.scipt.org/links.php

Patient - Family Teaching Manual for people with SCI

details: This website contains a manual that provides information on the many aspects of and dysfunctions relating to spinal cord injury for the patient and their family.
URL: http://www.spinalcordcenter.org/consumer/manual.html

Spinal Tips

details: This website contains tips and tricks for people with SCI to promote an active life and independence.
URL: www.spinalistips.se

Apparelyzed - Spinal cord injury peer support

details: This website provides general information on spinal cord injury. It also contains discussion forums on various issues for various people involved and general resources related to SCI.
URL: www.apparelyzed.com

The Queensland Spinal Cord Injuries Service, Australia

details: This is the website for The Queensland Spinal Cord Injuries Service, located in Brisbane, Queensland, Australia. It contains a lot of educational material and other things.
URL: www.health.qld.gov.au/qscis/default.asp

New Zealand Spinal Trust - Patient education

details: This is a patient educational booklet put together by the New Zealand Spinal Trust.
URL: www.nzspinaltrust.org.nz

Motivation Australia

details: Motivation Australia is the Australian branch of Motivation, with a specific focus on the Asia Pacific Region including rural and remote Australia. Motivation Australia is particularly involved in the provision of appropriate wheelchairs in less resourced settings.
URL: www.motivation.org.au

Spinal Hub

details: This is a website written for the SCI community. It contains loads of useful information for people with SCI. Some of the content about general medical and nursing issues would be very appropriate for PTs.
URL: www.spinalhub.com.au

SCI - U

details: SCI-U is a series of 10 multimedia courses about learning to live with spinal cord injury. The courses have been designed to give you the information you need to live a healthy, active life. They were developed by people who live with SCI, in collaboration with researchers and clinicians.
URL: www.sci-u.ca/

d-Ability

details: d-Ability.org is a place to explore and learn more about life\'s possibilities following a disabling injury or illness. This site provides links to the websites of people and organisations from across the world - people with a multitude of backgrounds, abilities, skills and experiences to offer.
URL: www.d-ability.org/

Gilly Davy

Senior neurological physiotherapists

In the news....Polio eradicated?

Mon, 25 Feb 2013 03:50:42 GMT

The end of 2012 was supposed to be a moment when the world could celebrate having eradicated the polio virus. Unfortunately three countries remain where the transmission of polio has never been interrupted. These are Afghanistan, Pakistan and Nigeria with cases in Nigeria reaching a three year high with more than 100 cases in 2012.

The Bill and Melinda Gates Foundation, as well as Rotary International, are pouring significant money and effort into the global campaign to end polio. Unfortunately there are barriers to vaccination in Nigeria. A misconception is that the jabs are a family planning method that will ultimately stop the children from giving birth when they want to. Even small drops in vaccination levels among children can lead to large outbreaks. People have also stated that they would prefer to focus on ‘more important diseases’ such as Malaria.

The polio is normally similar to the flu, however in about 1% of cases, it can cross the blood/brain barrier. When this happens the virus can invade the nervous system, and cause paralysis in hours. Survivors often have wasted limbs and severe weakness which can have long term affects on mobility, function and independence. That is why eradication is so important.

Polio was made a notifiable disease in all States and Territories of Australia in 1922. Major polio epidemics occurred during the late 1930s, early 1940s and the 1950s. It is estimated that a minimum of 20,000–40,000 individuals developed paralytic polio in Australia between 1930 and 1988, which means that up to 2 to 4 million people were originally infected with the virus. The actual number of people infected by the virus is unknown.

Polio has now almost certainly been eradicated from Australia. The most recent case of polio, caused by wild poliovirus, was in 1978. Vaccination programs beginning in the late 1950s have prevented new infections in Australia. For this reason it can be difficult to find Specialists who deal with patients with Polio as they have long retired. Living with the late effects of polio (or Post Polio Syndrome) requires specialist attention.

Symptoms can include the following:

unaccustomed fatigue unrelated to activity
decreased strength and endurance
pain in muscles and/or joints
an inability to stay alert
new muscle weakness and atrophy
muscle and joint pain
muscle spasms/twitching
respiratory and sleep problems
swallowing or speaking difficulties
cold and/or heat intolerance

If you have a history of polio and have noticed any of the above symptoms which are affecting you mobility, function or independence call Advance Rehab Centre for a free 10 minute consultation with our physiotherapy team. We run the only Polio clinic in NSW staffed by a team of orthotists, physiotherapists, occupational therapists and speech pathologists.

Paralyzed Woman's Mind Controls Robotic Arm

Mon, 25 Feb 2013 04:07:43 GMT

A paralysed woman has been able to control a robotic prosthetic hand using her thoughts. This woman, struggling with tetraplegia, has obtained a level of movement and control with the hand comparable to people without any impairment. The research came from a team of experts at the University of Pittsburgh and was published Online First in The Lancet.

Until now, a patient with this type of prosthesis has never experienced control and movement to this extent. Therefore, this report symbolizes a major breakthrough in the development of robotic prosthetic limbs controlled by the mind.

The team implanted two microelectrode arrays (a microelectronic tool that attaches brain cells to electronic circuitry) into the left motor cortex of the patient in February of this year. The participant was a woman aged 52 years who received a diagnosis of spinocerebellar degeneration thirteen years prior to the study.

Spinocerebellar degeneration is a rare, inherited disease in which structures in parts of the brain and spinal cord that are responsible for coordination and muscle movement degenerate, and in time, lose function. However, the patient observed in this study is now considered tetralpegic - paralyzed from the neck and below - due to the progression of her disease. She cannot, therefore, move her arms or her legs voluntarily by herself. The scientists connected the electrode arrays in the woman's motor cortex to a robotic hand, and according to the researchers, the movement of the joint and wrist was similar to a human hand.

In order to help the patient learn to use the device, she participated in training for 14 weeks. On the second day of her schooling, just 14 days after implantation, the patient was able to move the prothetic hand on her own, without the help of a computer. Professor Andrew Schwartz, lead author of the study, explained:

"In developing mind-controlled prosthetics, one of the biggest challenges has always been how to translate brain signals that indicate limb movement into computer signals that can reliably and accurately control a robotic prosthesis. Most mind-controlled prosthetics have achieved this by an algorithm which involves working through a complex 'library' of computer-brain connections. However, we've taken a completely different approach here, by using a model-based computer algorithm which closely mimics the way that an unimpaired brain controls limb movement. The result is a prosthetic hand which can be moved far more accurately and naturalistically than previous efforts."

The woman was involved in extensive training and a testing program which lasted for more than 3 months. The experts hoped that by the end of her program, she would be able to finish assignments showing that she could control the prosthesis over seven degrees of freedom (three-dimensional translation, three-dimensional orientation, one-dimensional grasping).

With the help of her training, the patient was able to finish all of the assignments with a success rate of 91.6%, and she completed the tasks 30 seconds faster than she did at the beginning of the trial.

In order to confirm that the woman's improvement was clinically significant, for the first time, the team used standard tests, known as Action Research Arm Tests (ARAT), which are normally used to evaluate limb function after people suffer from stroke or other paralyzing incidents.

The researchers added that the next steps to better this prosthetic would be to include sensory elements (for example, help the person distinguish between hot and cold or smooth and rough), and to include wireless technology (eliminating the necessity of wires that connect the patient's head and their prosthesis).

Professor Grégoire Courtine of the Swiss Federal Institute of Technology Lausanne (EPFL) wrote: "This bioinspired brain-machine interface is a remarkable technological and biomedical achievement. Though plenty of challenges lie ahead, these sorts of systems are rapidly approaching the point of clinical fruition. Through concerted efforts, and by ensuring that various different strategies available are optimally combined, these kinds of prosthetics might soon become revolutionary treatment models for sensorimotor paralysis."

Watch some footage of the lady achieving her goal of feeding herself: http://www.youtube.com/watch?v=QVhJuwfNTC4&feature=player_embedded

This article was taken from: http://www.medicalnewstoday.com/articles/254161.php

2012 Year in Review for ARC

Mon, 17 Dec 2012 03:01:29 GMT

MERRY CHRISTMAS!! FROM THE TEAM AT ADVANCE REHAB CENTRE

As the holiday season approaches, we'd like to take this opportunity to thank you for your continued partnership in 2012. It is clients and referrers like you who make our jobs a pleasure and keep our company successful. May your holiday season and the new year be filled with much joy, happiness and success. We look forward to working with you in the coming year and hope to be able to assist you further in your rehabilitation. Happy holidays!

ARC YEAR IN REVIEW…………………………

2012 has been a very busy year for Advance Rehab Centre! We have welcomed 6 new staff to our growing team of 25, opened three new clinics at ARC and launched our PD Warrior program across two sites in Sydney. We have continued to partner with many wonderful community organisations that have seen us help over 1000 new patients this year and provide over 300 treatment sessions a week.

Early in the year, Louise Ringland went on maternity leave, introducing baby Maisie to the team. Due to dramatic growth in the business we also welcomed senior neuro physios Lyndsay Hendry (in ARC), Aimee Barnes (MRI in the east and ARC) and Sabine Pinner (Northern beaches MRI) to the team in January and February.

In May we welcomed another senior neuro physio Gilly Davy (ARC) to the team. Sadly, in July, Darren Pereira closed his neuromuscular orthotics Sydney practice to devote more time to his family in Melbourne. On Darren’s recommendation, we were very happy to be able to partner with Bernard Baddorek who joined our team to take up Darren’s work in October.

In July, Shelly Phillips went on maternity leave and we welcomed baby Oliver to the team. In July, Melissa McConaghy got married in Tahiti and is expecting her first child in April next year. In August, Emma Lee (MRI inner west and ARC), senior neuro physio, joined our team. We also continued our partnership with Optimal Speech Pathology and their wonderful speech pathology services this year and welcomed Helga Hemberger, clinical psychologist as a consultant. This takes the total number in the team to 25!

In April this year, we also launched the PD Warrior program. With demand increasing quickly we grew from 3 circuit sessions to 5 a week within a number of months. Our Alexandria satellite site opened in October and we are planning to launch a Northern Beaches satellite site in February next year. There was so much interest generated in PD Warrior that Channel 10 picked up our story and ran a story on the National News! PD Warrior was then picked up by the Mosman Daily, North Shore Times, Parramatta Advertiser and the Manly Daily! In 2013, PD Warrior is becoming a licenced program with the vision of this becoming a national program for people newly diagnosed with Parkinson’s disease. We have several trial sites ready to go throughout NSW with the first training workshop to start in February 2013.

ARC has also introduced several other services and features this year including the SaeboFlex monthly clinic for dynamic hand splinting following stroke and brain injury, the Walk-aid clinic held every two months for electrical stimulation in gait, and the Pablo Plus which is interactive computer software package to assist with re-training upper limb after stroke and brain injury. ARC also purchased the Motomed bike for the gym in May. In July, Gilly Davy, who is a certified Nordic Walking Instructor also started a weekly Nordic Walking clinic.

In April this year, ARC partnered with FRESH TRACKS, a charity devoted to raising awareness of young Australians living with Acquired Brain Injury. The plan in 2013 is to support them in raising awareness, raising funds and providing the specialist rehabilitation services desperately needed by this population.

ARC continued its partnership with Northern Sydney GP Network (which recently became the Sydney North Shore and Beaches Medicare Local) and their ACAI program. We were recently invited to provide our thoughts on the gaps we currently see existing in the delivery of primary health care services on the lower north shore. Our main comments were on lack of suitable transportation and continuum of care from public to community settings and the integration of specialist and allied health services. It is anticipated that programs such as ACAI will continue into the new year funding therapy for people in low level residential care on the North Shore as well as several new initiatives.

We also continued our partnership with Community Care Northern Beaches this year and participated in both the Enable Me trial and the Enable Me 2 trial helping to support people staying at home through specialist allied health intervention. These were both great initiatives and we hope that they are re-instated in 2013.

ARC has also continued to offer a consultancy allied health service to New Horizons throughout 2012. All of our partnerships have resulted in significant benefits for many of our clients and has enabled them to access various funding and case management streams.

If you have signed up for our monthly newsletter you may be aware of the various grants that have been available this year through Spinal Cord Injury Australia and Brain Injury Australia. Many of our clients have been successful in the funding grants!

Melissa McConaghy has been busy presenting at several functions this year including the Young Parkinson’s conference, the Australian Physiotherapy Association NSW symposium and various support groups including Different Strokes. Lynn Tullock was invited to speak at Parliament house this year on Exercise and Parkinson’s disease. We have also hosted four evening lectures for health professionals and clients this year, often attracting up to 60 people per lecture. We look forward to this continuing in the new year.

For more information on what we are up at ARC, please sign up to the newsletter at www.archealth.com.au or our facebook page.

Identifiying the gaps in primary health care

Mon, 10 Dec 2012 08:53:40 GMT

Last week Melissa and I were invited to partake in an evening workshop along with other health care professionals with the aim to identifying the health needs of the area and gaps in services in the area. The workshop was a great opportunity to network with other professionals within the primary health care sector enabling us to build useful contacts which will help with our neurological client base.

The Sydney North Shore and Beaches Medicare Local is a new organisation that is part of the Commonwealth Health Reform. It’s role is to support primary health providers such as the team at Advance Rehab Centre by developing a network that assists in the co-ordination of services. Primary Health Care means the first point of contact people have with the health system which includes GP’s, physiotherapists and other allied health professionals and Community Health Services.

We suggested key points for health service development could be a single point of access for clients to gain information about community transport and wheelchair taxi services. This would improve clients accessibility to appointments and therapy services. We also suggested medical professionals expos where we come together on topics such as ‘Parkinson’s Disease’ or ‘Stroke’ where we can all share knowledge on services and in particular funding options for our clients. The more we can knowledge share, the more we can provide a good all round service to our clients.

If you are unsure whether you are eligible or can access funding for therapy following a neurological injury please give us a call here at Advance Rehab Centre.

Caring for the carer

Mon, 10 Dec 2012 00:55:06 GMT

Throughout my working life I have been continually amazed by the families and carers I have come across. Their level of care and commitment to their spouse/child/friend/loved one is often awe inspiring. However I am also often extremely concerned for the wellbeing of the carers, their devotion to their sick or disabled relative often comes at the expense of taking care of themselves and I find myself advising that “you have to take care of yourself because if you get sick who will care for your husband/wife”.

The following tips are adapted from www.webmd.com/healthy-aging/ss/slideshow-avoid-caregiver-burnout. However, by talking to your health care providers they can also advise you on ways to reduce the burden, this maybe through equipment, manual handling training, or advice on local support.

Tip 1: Take Time for You

It's easy to get burned out when caring for a loved one, whether it's a special-needs child, a spouse with a chronic illness, or a frail older person. Taking time for yourself everyday -- even just a few minutes -- is one way to help you recharge. Try yoga before breakfast, slip out for a 20-minute walk, go to the movies, or pursue any hobby you love. Reducing your stress will make you a better caregiver.

Tip 2: Know Your Limits

You can't provide good care if you feel overwhelmed and stressed out. Make a list of all the tasks you need to do in a week, including dressing and bathing a loved one, appointments, exercises, cooking, and household chores. Brainstorm which ones someone else might be able to do. Learn when to say no, and set boundaries so you can take care of your family -- and yourself

Tip 3: Stick to a Routine

A daily routine can be a lifesaver. It can help you feel in control rather than stressed and lets your loved one know what to expect. The consistency of a daily routine is especially important for people with a brain injury or dementia, because it provides a sense of security and helps them maintain their abilities.

Tip 4: Ask for Help

Even a few hours "off duty" can help you recharge. Make a list of family, friends, or neighbours to call when you need a break. A private carer or adult day care center can give you a breather while your loved one enjoys some social activity. Your local council should be able to advise you on Aged services and Disabled services in your area.

Tip 5: Get Enough Sleep

Most caregivers who say their own health has gotten worse blame loss of sleep. Relaxation exercises, such as deep breathing, may help you at bedtime. If your loved one sleeps during the day but is awake much of the night, try to take naps. You may need to hire an aide or ask a friend or relative to stay with your loved one overnight so you can get a good night's sleep.

Tip 6: Join a Support Group

No one understands your situation better than another caregiver. Look for support groups related to your loved one's illness, if possible. Meeting with others whose loved one presents similarly to your loved one will allow you to socialise in public without having to explain or excuse behaviours and increase your confidence to explore new places/experiences. Your local council may have a full listing or look online. Or consider joining an online community, where you can connect with others, ask questions, vent frustrations, and share ideas.

Tip 7: Use Timers and Reminders

Technology can be a caregiver's best friend. Buy pill boxes that sound an alarm when it's time for the next dose, or try a smart phone app or an online medicine reminder. They can send an automated text or phone call to you or your loved one when it's time for their medication. Pill organizers are a low-tech option that allow you to portion pills in little drawers by day, meal, or hour.

Tip 8: Get an Emergency Alert Device

Consider an electronic "help" button for when you can't be there. It's called a personal alarm, and it's worn like a pin or a necklace. Most connect to the phone system. Some work like a walkie-talkie, so the wearer can talk to an emergency operator at any time. Some will notify a family member or call 000, depending on your preference. You will need to pay a monthly fee for the service.

Tip 9: Set Up Cameras and Sensors

To chat with your loved one or keep tabs when you can't be there, consider setting up a webcam -- a video camera connected to the Internet. Video chat applications can also help to involve distant family members in care decisions. If your loved one might wander away, you can install sensors that alert you when a door is opened.

Tip 10: Let Animals Assist

Consider bringing a well-trained cat or dog in for a visit. Spending time with an animal can be incredibly soothing to people who are sick or confined to home. Pets can lower blood pressure, reduce stress -- even make elderly people more alert. And seeing a loved one "perk up" can make you, the caregiver, happier, too.

Tip 11: Turn On Some Music

Music and art can spark fun shared moments for you and the person you're caring for. Familiar music can bring back memories and may lead to clapping or dancing. Art projects should be simple and safe but not too child-like. Painting or making a collage from magazines are two good options. And listening to music or working on an art project can be a great stress reliever for you, too.

Tip 12: Cope With Sundowning

People with dementia can become confused or agitated in the evening, so plan accordingly to minimize your own stress. Plan activities early in the day, and serve an early dinner. Turn the lights up in the evening. Check with a doctor about any physical or sleep problems that may be contributing to the sundowning effect.

Tip 13: Make It a Team Effort

Hold regular "family meetings" to discuss the latest medical news, daily caregiving needs, financial concerns, and your need for support. These meetings should include everyone who might be involved in caring for your loved one, including paid caregivers. Connect distant family members through a speaker phone or online video chat. Follow up with a written agreement and a calendar of tasks.

Tip 14: Draw on Workplace Support

Under the law, a full-time or part-time worker builds up their right to paid leave throughout the course of the year. By the end of the first year, a full-time worker will build up 10 days of paid personal carer's leave. A part-time workers get a proportion of this based on how many hours they work each week. Paid personal carers leave includes personal sick leave and leave required to care for a family member.

Contact the Fair Work Infoline on 13 13 94 to check out your rights to paid leave. So ensure you are taking care of yourself, this will allow you to be a happier, better carer.

Spinal Cord Injury- Promising developments

Mon, 10 Dec 2012 00:49:17 GMT

Scientists at Cambridge University in Great Britain have just succeeded in reversing paraplegic paralysis in dogs that had sustained spinal cord injuries (SCI) by injecting them with cells found in the lining of their nose.

In the back of the nasal cavity the olfactory ensheathing cells (OEC) can be found. These cells are responsible for prompting nerve cell growth and replacement in the olfactory system. In the experiment they took OEC lining the individual dogs nose and grew them in a laboratory for several weeks prior to being injected into the injury site in the spinal cord.

Many of the dogs injected showed some form of improvement in lower limb movement compared to the control group that showed no change in motor recovery of the lower limbs.

Professor Robin Franklin, a regeneration biologist at the Wellcome Trust-MRC Stem Cell Institute and report co-author, said: 'Our findings are extremely exciting because they show for the first time that transplanting these types of cell into a severely damaged spinal cord can bring about significant improvement.

"We're confident that the technique might be able to restore at least a small amount of movement in human patients with spinal cord injuries but that's a long way from saying they might be able to regain all lost function'.

The transplanted OEC prompted regeneration of nerve fibers across the damaged area of the spinal cord but not to the higher centres, including the brain. This resulted in the return of some lower limb muscle recruitment and coordination, however it would have no effect on sexual function and bladder and bowel control.

However scientists are cautiously optimistic that the technique could be transferable to treating humans with SCI, although it does give some hope that research is progressing in the right direction.

Prof Geoffrey Raisman, chair of Neural Regeneration at University College London, who discovered olfactory ensheathing cells in 1985 said: "This is not a cure for spinal cord injury in humans - that could still be a long way off. But this is the most encouraging advance for some years and is a significant step on the road towards it."

Visit the link below for further information and video of Jasper the dog starting to walk again.

http://www.bbc.co.uk/news/health-20365355

How important is self-believe in rehabilitation?

Sun, 18 Nov 2012 07:48:22 GMT

Self belief is confidence in your own abilities, but how important is self belief???

Self belief has been shown to influence how we think, act and feel. Self belief about our capabilities to learn or perform tasks can play an important role in both motivation and learning of these tasks. Our ability to achieve a task depends on the interaction between behaviour, personal factors and environmental conditions. Ones own level of self belief can be a good predicator of success and achievement. A famous quote by Henry Ford states ‘Whether you think you can or can’t, you are usually right’. Self belief is about the word CAN. The opposite of self belief is self doubt. This is the little voice inside you that says can’t which is developed from negative thoughts and is strengthened over time.

So how do we build self belief?

Self belief is based on solid facts. Positive thoughts build self belief but need to be honest and realistic. The following four points can help build positive thinking;

1. Keep a record of achievements

2. Quality practice of tasks wanting to achieve

3. Understand your strengths

4. Utilise feedback from others such as family, friends, carers and therapists

If you keep a record of your accomplishments, strengths, practice and feedback you can review them and reflect in times of self doubt in order to realize how much you have already achieved.

How powerful is self belief?

Studies have looked into neurophysiological and neurochemical activity in the brain and have shown that beliefs and expectation can effect the regions of the brain involved in perception, movement, pain and emotion processing considerably.

Athletes are often coached about the importance of positive thinking and how it can influence them in an event. Take the 100 metres sprint as an example. Carl Lewis broke the record in 1988 running in 9.92 seconds and then broke it again in 1991running 9.86 seconds. Usain Bolt broke the record twice in 2008 running the race in 9.72 seconds and then 9.69 seconds. He then broke his own record in 2009 running 9.58 seconds. If these athletes didn’t believe in their previous accomplishments, strengths and quality training they may not have been able to break the world record. The question remains what else can Usain Bolt go onto achieve and what other athletes have the self belief to take the world record away from him.

So next time you’re in the rehab gym, have some self belief and remember the word CAN is much stronger than you think!!

MND- Best Treatment Approach

Thu, 15 Nov 2012 22:31:44 GMT

A multidisciplinary team (MDT) is a group of professionals who are involved in the treatment of a person with a clinical need. The role of the MDT is to work together to deliver comprehensive care that addresses as many of the patient’s health and other needs as possible. The MDT constantly assess and review the needs of the individual, provide information to the patient and family, and refer to other professionals or agencies as required. Communication within the team, patient, family and carers is paramount and is the fundamentals of the MDT approach.

The importance of a MDT approach has been researched in many different clinical settings and in recent years has become an approach used in the treatment of Motor Neurone Disease (MND) in the form of MND clinics. Having a large number of people with MND in a clinic setting leads to an increase in resources and clinical expertise that facilitate the management of what can be a rapidly progressive disease.

Studies in the past have shown that MDT clinics can improve the quality of life and prolong survival in other neurodegenerative diseases but one study based in Ireland has focused on the effect of an MDT clinic in the MND population. This study highlighted that a specific MDT clinic focused purely on the treatment of MND prolonged survival in comparison to attending a general neurology clinic, in particularly people with bulbar MND.

From my own clinical experience and talking with my patients they feel that a MDT approach gives them the information and support they need in what can be an ever changing disease.

Team members in the care of someone with MND include (but not limited to):

Neurologist
Respiratory physician
Nurse
Physiotherapist
Occupational Therapist
Dietician
Speech pathologist
Social Worker
Orthotist
Psychologist
Community Care worker
MND representative
Patient
Family
Carers

Specialist MND MDT clinics are available all over Australia providing a coordinated MDT approach to care and ongoing expert review from professionals who specialise in the management of individuals with MND. Details of these clinics are available through MND Australia (www.mndaust.asn.au).

If you have any questions regarding MND, or for details about an assessment please contact advanced rehabilitation centre and Emma will be able to assist you.

Treating Parkinson's disease- the therapist's perspective

Thu, 08 Nov 2012 05:31:57 GMT

If you had asked any of the ARC therapists two years ago how they feel about treating newly diagnosed Parkinson’s clients, chances are the response would be a shrug, a sigh and a despondent – “What can I do with them?”, and the patient would get a response of “Come back when you have more problems”. Physiotherapy was based around maintaining general strength, movement and fitness. As the disease progressed we would use balance training to help prevent falls, and compensatory visual or auditory cues to help overcome freezing. All in all, not very inspiring or proactive.

How things have changed! These days at ARC we see a high number of clients with Parkinson’s, from the newly diagnosed to advanced disease stages. We all have a new found enthusiasm for being able to make real changes to this group and have a big impact on their day to day lives.

The reason? We’ve changed the way we think. Before, treatment was about responding to changes and problems caused by the disease progression. But the simple fact is that most people with Parkinson’s have the ability to move better than they do in everyday life, they just need to re-learn how. Here at ARC we show you how to access that potential and aim to teach you how to find it all by yourself.

A lot of newly diagnosed clients come to us feeling they don’t really have any problems or difficulties. However, Parkinson’s disease is diagnosed by symptoms so we know that isn’t true. You may not think it is limiting your life but there are certainly problems, no matter how big or small. I’m sure most of our Parkinson’s clients will agree we go in search of problems like slow and small movements – be it walking or doing buttons, freezing, poor balance, difficulties with complex co-ordination or doing two different things at once. Bigger things like having the confidence to walk the streets at night, cut up steak in a restaurant, even go on an overseas trip. We want to know what things you’ve changed in your life because of Parkinson’s. To work on problems we have to know what they are! This can seem quite confronting in the short term – but trust me (and lots of our clients will back me up here), it’s worth it.

Research is showing just how big a role physiotherapy and exercising in the right way can have on the lives of people with Parkinson’s. Exercise is the only current treatment for Parkinson’s with disease modifying possibilities, which is HUGELY exciting for us as therapists. It won’t reverse the damage that’s been done, but it may slow down further damage and destruction of dopamine producing cells. We commonly use principles such as high effort, forced use and amplitude based training. We throw in extra complexities to tasks and give you two things to do at once – because that is how everyday life works. Our aim is to challenge you – whatever you’re fitness level – and empower you.

As one client put it:

“It’s about me taking control of the Parkinson’s instead of the Parkinson’s controlling me”

And what does this mean to us as therapists? Simple – we love to see our client’s doing well and living their lives. Watching someone realise how well they can move or participate in everyday tasks is almost as exciting for us as it is for you! We love it when client’s come back and tell us how well they managed getting dressed this morning, how they took the dog for a walk, got coins out of a purse, did the vacuuming, stood up from the low soft couch, turned over in bed (without the satin sheets!), washed the dishes…whatever! It is time for the Parkinson's revolution......are you doing enough?