Advance Rehab Centre

Recovery after stroke- media release

Wed, 16 May 2012 11:58:11 GMT

Researchers at Stanford University School of Medicine have discovered a possible new target for drug therapy to improve recovery after stroke.

Currently the only medical management available to reduce impairments following stroke involves the use of clot-busting drugs, but this must be administered within the first few hours of symptoms – something which is difficult to achieve, and is only suitable for some patients. This drug, tPA, only serves to limit the initial damage by restoring blood flow to areas of the brain affected by a clot. A loss of blood flow results in cell death and loss of function. This approach doesn’t help the brain to re-establish lost connections between surviving nerve cells, which is vital for recovery. Improving function after stroke is achieved by re-establishing lost synapses and forming new ones, which is the basis of rehabilitation therapy.

Scientists have identified a matched set of molecules in the brain that when eliminated aided recovery from stroke, even days after the event. These molecules typically help to regulate the brain’s capacity for forming, strengthening, weakening and eliminating connections between nerve cells. They inhibit the readiness of connection between nerve cells, called synapses, to grow stronger or weaker in response to experience. To learn new skills and maintain neural pathways the brain needs these connections to be constantly strengthened, or in the case of those that produce less desirable outcomes, weakened. However, excessive flexibility is thought to increase risk of conditions such as epilepsy and schizophrenia.

The researchers genetically engineered mice to lack these particular molecules, identified as “K” and “D”, which are types of MHC molecules. They also repeated the study removing the receptor to these molecules, called PiriB. The mice were trained in several athletic tasks (appropriate tasks to mice, of course!). Researchers then induced strokes by cutting off the blood supply to a region of the brain involved in motor performance. A week later, the mice without the “K” and “D”, or without the PiriB, recovered their athletic skills significantly better than the normal animals, and also had a smaller stroke affected area. Sprouting of new nerve fibres in stroke affected areas was more abundant in the deficient mice too.

Achieving the same effect by removing the receptor is clinically important, as receptors are good drug targets as molecules can be created that will bind and lock to them, stopping their normal activity.

Whilst this presents an exciting avenue for further research, there is still a long way to go. Researchers need to develop a drug which is capable of specifically blocking only the PiriB receptor molecule and study its effects. Early research often shows promising results on mice, but does not translate to humans.

However, the approach of targeting recovery after stroke would potentially have wide reaching implications, as it could be appropriate for a far wider range of individuals than tPA, and possibly other neurological conditions.

To read the full article, visit http://www.sciencedaily.com/releases/2012/03/120321131852.htm

Custom equipment for people with disabilities

Wed, 02 May 2012 04:26:56 GMT

TAD Disability Services is the only charity in NSW which designs and builds personalised custom equipment to enable people with disabilities to lead more independent lives. TADNSW has four main services:

The Custom Designed Equipment Service designs and constructs devices that are not 'commercially accessible' for people with disabilities from all age groups.
Freedom Wheels is a popular service that creates the highly customised bikes that allow people with a disability, mostly children to ride a bike.
The Computer Support Service refurbishes donated computers and sells these at very affordable rates to people with disabilities.
The George Winston Communications Service is responsible for communicating "the TAD story" to disability networks, stakeholders and the general public.

For more information check out the website at www.tadnsw.org.au

The Paralympics, London 2012, is fast approaching

Wed, 02 May 2012 00:27:20 GMT

The 2012 Olympics and Paralympics in London are fast approaching. This year the Australian Paralympic Committee is preparing to deliver an Australian Team to the 2012 London Paralympic Games of approximately 165 athletes and 140 officials (total Team size of 305). This will be the largest Team Australia has ever sent to an away Paralympic Games. As of 2010, the Summer Paralympics include 20 sports and disciplines and about 420 events.

Athletes who participate in Paralympic sport are grouped into six major categories, based on their type of disability.

Amputee: Persons with a partial or total amputation of at least one limb.

Cerebral palsy: Persons who have a non-progressive neurological disorder resulting from cerebral palsy, traumatic brain injury, or stroke, or similar disabilities affecting muscle control, balance or coordination.

Intellectual disability: Persons who have a significant impairment in intellectual functioning with associated limitations in adaptive behaviour.

Les autres: From the French for the others, this includes persons with a mobility impairment or other loss of physical function that does not fall strictly into one of the other five categories. Participants include those with dwarfism, multiple sclerosis or other disabilities.

Visually impaired: Persons who have a non-correctable vision impairment ranging from partially sighted to total blindness.

Wheelchair: Persons with a disability that requires them to compete using a wheelchair. This includes most athletes with spinal cord injuries as well as other athletes who require wheelchairs, including some lower limb amputees, persons with polio, and other disabilities.

This is a time when we all get a little or a lot, spurred on to get out there and work up a sweat. So for those with a disability what are some of the sporting options out there?

Boccia - is a precision sport, similar to bocce.. The sport is competed at national and international level, by athletes who require a wheelchair because of physical disability. It was originally designed to be played by people with cerebral palsy but now includes athletes with other severe disabilities affecting motor skills.

Goalball -is a team sport designed for blind athletes. Participants compete in teams of three, and try to throw a ball that has bells embedded in it into the opponents' goal. Teams alternate throwing or rolling the ball from one end of the playing area to the other, and players remain in the area of their own goal in both defence and attack. Players must use the sound of the bell to judge the position and movement of the ball. Games consist of two 12 minute halves (formerly 10 minute halves). Blindfolds allow partially sighted players to compete on an equal footing with blind players

Wheelchair rugby (known as quad rugby in the United States) is a team sport for athletes with a disability. Wheelchair rugby is played indoors on a hardwood court. The rules include elements of wheelchair basketball, ice hockey, handball and rugby union. It is a contact sport and physical contact between wheelchairs is an integral part of the game. It has little in common with Rugby football except for the name

Wheelchair tennis is one of the forms of tennis adapted for those who have disabilities in their lower bodies. The size of courts, balls, and rackets are same, but there are two major differences from pedestrian tennis; they use specially designed wheelchairs and the ball may bounce up to two times. The second bounce may also occur outside of the field.

There are three categories; Men, Ladies, and Quads and each category has singles and doubles tournaments. Quads is the category for those with quadriplegia and it is sometimes called Mixed especially at Paralympic Games. Quads players can hold rackets taped to the hand and use electric-powered wheelchairs.

Paralympic swimming is an adaptation of the sport of swimming for athletes with disabilities. The majority of rules for Paralympic swimming are the same as those for able-bodied competitions. Significant differences include the starting position and adaptations allowed for visually impaired swimmers. Competitors may start a race by standing on a platform and diving into the pool, as in able-bodied swimming, or by sitting on the platform and diving in, or they may start the race in the water. In events for the blind and visually impaired, people called "tappers" stand at the end of the pool and use a pole to tap the swimmers when they approach the wall, indicating when the swimmer should turn or end the race. Competitors in these events are required to wear blackened goggles, so that partially sighted swimmers compete at an even level with those who are totally blind.

For further information on what sports may suit you contact:

Wheelchair Sports NSW: www.wsnsw.org.au

Wheelchair Sports NSW is based in Sydney. They provide a wide range of wheelchair sporting programs and events for athletes of all ages and skill levels, in Sydney and across various regional centres of NSW. Currently we cater for 14 different sports including; Athletics, Tennis, Basketball, Rugby. Whether you are new to wheelchair sports, an elite athlete or you are interested in becoming one of our valued sponsors, volunteers or donors, there's something here for everyone.

NSW Sports Federation: http://www.sportnsw.com.au/epages/ecornerhosting.sf/en_AU/?ObjectPath=/Shops/sportnsw/Categories/Membership/%22NSW%20ADS%22

Sports Connect: http://www.ausport.gov.au/participating/disability/get_involved/pathways

Sports CONNECT is a national framework that develops pathways for people with disability to get involved in sport, by creating and developing relationships between sports and disability organisations.

Spinal Cord Injury- Why hydrotherapy is worth getting wet!

Wed, 02 May 2012 04:41:09 GMT

........"After having spinal surgery in 2008 and starting a journey into the unknown world of paraplegia, the one sport that I enjoyed, swimming became a distant memory.

With physiotherapy, strong motivation and positive mind the path from a wheelchair to crutches slowly evolved. As I began gaining some muscle strength things started to improve.

But thanks to hydrotherapy and some wonderful tuition my dream of returning to the pool may soon become a reality again. Even the thought of getting into the pool was scary but after a little convincing I thought I would give it a go. Initially the sensation of the water affected my spasticity and I needed some hand holding and a few flotation devices to balance, but after just a few weeks I was able to let go of the poolside and actually take a few steps unaided. It was remarkable! With each session my confidence grew and I was able not only to walk but also squat and even walk backwards.

There are so many benefits to hydrotherapy to aid spasticity and stiffness. The heated water provides me with the buoyancy I need to relieve the muscle fatigue and pain. The water allows me to increase my muscle strength in a way that is not possible in the gym and the biggest advantage is the ability to regain some balance. The heated water relaxes your body and allows better circulation and flexibility. Now after only a few months I am starting the process of swimming with the aim of getting in a normal pool very soon.

I cannot sing the praises of hydrotherapy and swimming skills enough, why not give it a try and see what it can do for you??"......

To speak to Rob Wynn directly about his experience, please contact the office on 9906 7777. Peta Kilgour is an accredited swimming coach and runs swim skill training at Advance Rehab Centre for people with neurological conditions on Monday, Tuesday and Thursdays. To make an appointment, please call the office on 9906 7777.

Different Strokes. Support for young people following a stroke

Mon, 16 Apr 2012 00:48:55 GMT

Different Strokes-Young Acquired Brain Injury is a club for stroke survivors from 15 to 35 and their carers that provides mentoring, support and information. The age range isn’t so so strict. Please contact us to discuss. This may be the group for you.

We may be tackling the issue of coping with study, the beginning of a career or a young family and an inability to pursue active interests such as sports or travel. Often our friends and family find it difficult to understand or empathise with lengthy periods of incapacity, hospitalization and rehabilitation and on going physical limitations.

It’s hard to fully understand that a stroke can happen to someone so young. But the issues faced by someone who has had a stroke at aged 25 are quite different to those of someone who is 60.

Different Strokes-Young Acquired Brain Injury aims to address this point of difference.

Different Strokes-Young Acquired Brain Injury currently meets at St Davids Uniting Church, Haberfield on the 2nd Saturday of the every second month, from 11 am to 1pm. We have a coffee/lunch on the 2nd Saturday of the alternate month. Please contact us to confirm the dates for this year.

We also have a monthly online forum during the first week of the month to cater for those who cannot get to our face to face meetings.

This is what some of our members have had to say:

“It was quite a shock to me when they started referring to what had happened to me as a stroke. Like most people I thought that only happened to older people”.

Alexis

“DS made me realise that I wasn’t the only one with these problems and gave me hope for the future.”

Glenn

“I had a brain haemorrhage at 14. Now I have someone to talk to about my experience”

Sarah

For more information, please contact Lara Friedman at friedmanlara@gmail.com or Glenn Jackson at glennjackson@westpac.com.au or see www.differentstrokesclub.org.au

Botox for Multiple Sclerosis

Mon, 16 Apr 2012 03:23:19 GMT

Botox is a botulism toxin (neurotoxin) which can be injected into muscles to eliminate wrinkles, treat migraine and muscle pain and can be used to treat the problems associated with spasticity.

Spasiticity is very common in MS and is the result of an imbalance in the central nervous system caused by the disease affecting the brain and/or spinal. These involuntary muscle contractions cause muscle spasms and stiffness, which, over time may lead to decreased range of motion of the arms or legs. This limitation of range of motion can affect the ability to take care of ones daily needs (e.g. maintain hand and axilla hygiene and ability to dress) and affect the ability to weight bear and walk.

The Botulinum Toxin is injected into the specific muscle and effects begin to appear after one to two weeks. The injected muscles should then relax. The relaxation of the specific muscle can relieve any discomfort caused from the stiff muscle and with training from a neuro specialist physiotherapist can improve the ability to use the affected body part and ability to take care daily needs. If effective this process can be repeated at six months.

Not everyone with MS suffers from spasticity and this case Botulinum Toxin injections are of no use. Injections of Botulinum Toxin may also not be a good choice of treatment if the spasticity affected muscles are widespread or large muscle groups.

Botulinum Toxin is not cure for MS but rather a part of the overall management plan to help optimise movement and function. A neuro physiotherapy assessment prior or immediately following injection is highly important to help maximize the effect of the intervention and help decide if the treatment will help a patient in the first place.

Here at Advance Rehab Centre we have built strong links with local Neurologists to help with assessing the need for Botulinum Toxin Injections in clients with MS and help maximize the affect following the intervention through a stretching, strengthening and functional re training programme.

Parkinsons' disease open day- Are you a PD Warrior?

Mon, 16 Apr 2012 00:58:16 GMT

Check out the video from the Parkinson's Disease open day on Saturday 14th April....... http://youtu.be/__kYc7GLnvc

We had a great day sampling some of the GET MOVING! exercise program for people with Parkinson's disease. Exercise is medicine for people with Parkinson's disease. Our program is based on the principles of LSVT BIG and is the only centre in Australia offering this progressive style of exercise for Parkinson's disease. The program is a whole body, intensive exercise program that includes strength, flexibility, balance, fitness and amplitude style exercises....and most importantly.....it is great FUN!

Our Saturday PD warrior circuit is starting Saturday 21st at 10am. Sign up today and get two for the price of one. For more information,call the office 9906 7777 to secure your spot. There are only limited places.

WalkAid for foot drop in MS

Tue, 10 Apr 2012 03:34:16 GMT

Foot drop can be a common problem in many neurological conditions including Multiple Sclerosis. Damage to the myelin coating of the long nerves that carry messages to and from the brain to the foot can be affected in MS. This can lead to impaired muscle activation which leads to loss of strength, stability and coordination, and sometimes sensation. Symptoms of foot drop may be foot dragging, tripping, scuffing the toes, having difficulty walking on uneven ground such as grass and falls. Walking can become both unsafe and inefficient with foot drop.

WalkAide is one of a family of Functional Electrical Stimulation (FES) devices that helps people with foot drop to walk. Electrical Stimulation is a method often used in rehab to innervate a muscle or a group of muscles to cause localised contraction. Used functionally, electrical stimulation can be very helpful in foot drop to lift the foot at the right time when the leg swings through to enable sufficient toe clearance. This makes walking safer and more efficient.

The WalkAide system is a very sophisticated type of FES that utilizes patented tilt sensor technology to analyse the movement of the leg and stimulate the appropriate nerves, prompting the foot to lift with every step. The gentle electrical impulses produced by WalkAide activate the muscles to raise the foot at the appropriate time during the step cycle, creating a more natural and efficient walking pattern.

All types of FES are applied directly to the skin and are non-invasive. They take relatively little time to set up and can be ‘test driven’ immediately to see if FES can improve your walking. In our clinic, we find that the MS population tend to benefit greatly from FES facilitated gait, more so than many other neurological populations. The WalkAide machine itself is small and remains attached around the base of the knee when walking. Any style of footware can be worn, you can even go barefoot!

WalkAid, and any type of FES should be administered and trialled by a qualified physiotherapist or orthotist and used in conjunction with a strengthening and stretching program specific to improve your walking.

For more information please contact Advance Rehab Centre on 9906 7777 or office@archealth.com.au

Gentamicin and link to loss of balance

Wed, 04 Apr 2012 02:51:10 GMT

Gentamicin is an antibiotic drug used to treat certain types of bacterial infections. It is widely known in the medical community that Gentamicin can cause impairments in the vestibular operating system leading to problems with balance. Recent media reports have referred to a recent study supporting evidence that this drug can cause permanent loss of balance. The study looked at more than 100 patients who were treated at a balance disorder clinic at Royal Prince Alfred Hospital between 1988 and 2010 after having the antibiotic gentamicin. Six of the patients at the balance clinic had developed balance problems after one dose.

Certain doses of this drug can be toxic to the sensory cells of the ear, and can vary greatly in their effects on hearing versus balance. Gentamicin can cause permanent damage to the vestibular apparatus of the inner ear, usually if taken at high doses or for prolonged periods of time, but there are well documented cases in which gentamicin completely destroyed the vestibular apparatus after three to five days.

Side effects of gentamicin toxicity vary from patient to patient. Side effects may become apparent shortly after or up to months after gentamicin is administered. Symptoms of gentamicin toxicity include:

* Balance difficulty

* Bouncing, unsteady vision

* Ringing in the ears (tinnitus)

* Difficulty multi-tasking, particularly when standing

If you have any concerns about this drug, it is best to discuss these with your GP. Balance disorders can be assessed by our Neurological Physiotherapists at Advance Rehab Centre and it is important that if you have a vestibular impairment that you learn strategies to compensate, rehabilitate and improve your balance.

Read more: http://www.smh.com.au/national/health/doctors-prescribe-potentially-dangerous-antibiotic-too-freely-study-finds-20120402-1w8sf.html#ixzz1qwZxl6zF

New Stroke treatment in the news

Mon, 02 Apr 2012 04:27:53 GMT

Recently there have been reports in the news about a treatment for acute stroke having a “Lazarus –like” effect on patient recovery (www.abc.net.au/news/2012-03-22/stroke-study-makes-treatment-breakthrough/3905512). For obvious reasons this has caught the attention of a number of our Stroke clients who are keen to know more about this treatment and if it can help them.

The drug in question is Tenecteplase. This drug has been commonly used in the past for the treatment of acute heart attack and is associated with a reduction in mortality in this patient group. Heart attacks are caused by a blood clot blocking or reducing blood flow to an area of heart muscle and therefore starving it of oxygen. If given within 3 hours of the heart attack, Tenecteplase binds with the blood clot and dissolves it, allowing the blood to flow again and significantly reducing the amount of damage done to the heart muscle.

Stroke can occur in two ways, an ischemic stroke is caused by a blood clot reducing or stopping blood flow to an area of the brain and thus starving it of oxygen and causing death of neurons. The second form is a hemorrhagic stroke where a blood vessel bursts, reducing blood flow beyond the broken vessel and again starving neurons of oxygen.

In a trial at Newcastle University, NSW ,the drug, Tenecteplase, was trialed on 75 patients presenting with ischemic strokes. As with heart attacks, the drug was given within 3 hours of the onset of the stroke, with the aim of dissolving the blood clot causing the ischemic event. It is reported a number of these patients made significant improvements or recovery from their symptoms.

The drug is still in its trail stage with use in strokes but initial results are promising for the future ischemic stroke population. For everyone else the only proven way to improve function following a stroke is through practice and repetition to lay down new pathways and rearrange existing ones. Whilst the evidence shows the sooner therapy starts the better the outcome, it is never too late to start.

Here at ARC our exercise programs are revolutionary because they include intense, high effort functional activities that are commenced as soon as possible after your stroke and use the latest research and literature. So to maximize your recovery call the Advanced Rehabilitation centre on 9906 7777 for an assessment and independent consultation

National April Falls Day- April 2nd

Tue, 27 Mar 2012 06:35:19 GMT

It is now well-known that as we age, bones become more fragile, mobility changes and vision deteriorates. As a result of this we are seeing falls, trips and slips occur all too often in the homes of older people. Recent data from the NSW Health ‘Prevention of Falls and Harm from Falls among Older People’ committee states that ‘No other single cause of injury, including road trauma, costs the health system more than falls’. This statistic highlights the need for us to act- by raising awareness and providing services to assist older community members improve their safety and stay on their feet at home.

Effective falls prevention strategies require a team approach, which includes the client at risk of falls, the occupational therapist, and physiotherapist and in many cases the client’s family as well.

Common risk factors include:

- Poor mobility, lack of exercise and incorrect walking aid

- History of falls

- Incontinence or urinary frequency

- Steps without rails

- Cluttered furniture and/or furniture in walk ways

- Un-secured floor coverings and mats

- Poor lighting

- Inadequate footwear

- Obtruding cords and cable

- Pets

As a team we look at:

- The client’s medical history, health conditions and medications that may increase the risk of falls

- The client’s physical abilities, including their balance, mobility and vision

- The home and community environments to identify risks

Falls prevention recommendations and strategies can include:

- A Physiotherapy program, including structured exercise and balance training

- Minor home modifications including installation of rails at steps, removal of floor mats and minimizing furniture

- Major modifications, including installation of a ramp, replacing bath tub with shower recess

- Equipment prescription, such as a new walking aid, shower chair or new footwear

At Advance Rehab Centre we are celebrating National April Falls Day on the 2nd of April 2012. So, if you know someone who is at risk of having a fall, contact us today. We provide comprehensive falls prevention services to ensure you stay on your feet!

Cognitive problems in Parkinson's disease

Tue, 27 Mar 2012 03:37:32 GMT

Parkinson's disease is widely recognised and understood as a movement disorder which affects motor control, balance, speed and coordination. Features include tremor, rigidity, slowness in movements (bradykinesia), freezing episodes, uncontrollable movements (dyskinesia), postural instability and gait changes. There is increasing attention to the non-pharmacological treatments available such as physiotherapy and even brain surgery designed to reduce the impact of the motor symptoms. However, the non-motor consequences- namely changes in thinking and emotion are less known and understood, and treatments for these aspects of the condition remain elusive.

For many people living with Parkinson's, changes in thinking skills can accompany motor changes, underpinned by many of the same dopamine-dependent neural processes. The changes in cognitive function can include reductions in mental flexibility, problem solving and speed of processing, as well as visual spatial deficits and short term memory problems. These can all contribute to reduced quality of life and function (including ability to work, manage finances and drive), as well as carer strain and burnout.

It is important to note that not all people with Parkinson's disease will experience changes in their thinking skills, and like with motor symptoms, the nature and degree of these changes varies widely from person to person and can be related to age, length of illness, medication and many other factors. Parkinson's Disease Dementia (PDD) is defined only in the context of significant decline in cognition impacting on function. PDD is estimated to affect around 20-30% of people with Parkinson's over time.

In a neuro-rehab setting, cognitive rehabilitation programs provided by the rehabilitation therapist aim to assist a person in the use of internal or 'restorative' techniques and external or 'compensatory' techniques to reduce the impact of cognitive deficits or decline.

Restorative techniques focus on strategies to improve cognitive functioning and can include computerized drills and repeated prompting to improve memory, spaced retrieval or vanishing cues. Compensatory techniques provide strategies that organise information to improve recall and learning and provide instruction in self-management. Examples may include the effective use of dairies, calendars and external cues or aide memoirs, procedural training to learn increasingly more complex behaviors.

A very recent article in the journal Parkinson's Disease, 2012 by Calleo, Burrows, Levin, Marsh, Lai and York reviews the literature to date and asks the question: How effective are cognitive rehabilitation programs for Parkinson's? The review narrowed its search to one main area of cognition; executive function (higher-order thinking skills encompassing ability to plan, organise, sequence, abstract and think flexibly). Reviewing the four best studies to date which have employed a mixture of computerised and manual cognitive training exercises, study participants with Parkinson's demonstrated improvement in their executive function (and in some cases attention and speed) test scores following the cognitive rehabilitation intervention. In one study, improvement was maintained over six months without further training. However, the authors caution that the studies were limited by their small sample size and did not address the question whether the improvements would translate to functional improvement in day-to-day life.

Further research is needed. Taking into consideration the variability of symptoms people with Parkinson's experience which impact on physical, emotional and cognitive function, the authors conclude that future cognitive rehabilitation programs should aim for ﬂexibility and individualisation, considering in particular each person's cognitive strengths and weaknesses. The full text article is freely available and can be found here: http://www.hindawi.com/journals/pd/2012/512892/

Reference: Calleo, J., Burrows, C., Levin, H., Marsh, M., Lai, E. & York, M. K. (2012). Review Article. Cognitive Rehabilitation for Executive Dysfunction in Parkinson's Disease: Application and Current Directions. Parkinson's Disease, Article ID 512892, 6 pages.

Follow this blog for further information on the role cognitive rehabilitation for Parkinson's and other neurological conditions. - Helga Hemberger

Stroke services failing to provide

Wed, 14 Mar 2012 09:00:30 GMT

A report into stroke services across Australia released in October 2011 showed a major failure to provide best practice care in acute and follow up services.

Stroke is a leading cause of death and disability worldwide, with over 60,000 strokes occurring each year in Australia. Prompt access to specialised treatment units have been shown to reduce deaths and lessen impairments. Yet many Australians are unable to access these units. A report into stroke services across Australia showed many stroke victims are cared for outside of these units – a staggering 42% were unable to access specialised stroke unit care.

Being in hospital is merely the beginning of a stroke survivor’s journey. Rehabilitation and planning for leaving hospital are vital to improving life after stroke, yet over a third of hospitals do not assess their patients’ need for further rehabilitation as standard practice. Four out of 10 hospitals did not give stroke survivors a plan for care after leaving hospital. Two thirds of hospitals had no protocols for reviewing patients after discharge, and one third did not provide any after discharge contact information.

But there is hope. Services like ‘Early Supported Discharge’ are enabling people with mild to moderate strokes to return home sooner with appropriate home based therapy and nursing support in place. Private community based rehabilitation services are also increasing as specialised facilities emerge to fill the gap not currently provided by the public health system.

At ARC we are seeing a growing number of clients with ongoing rehabilitation needs who are discharged home early post stroke and looking for hospital substitution options. We have now made a difference in the lives of over 4000 people. It is often stressed that most improvement is made during the first 3-6 months after stroke, but we frequently see clients with potential to improve their daily function and quality of life way beyond this time frame – years and in some cases even decades later!

Our focus is not on merely helping our clients to recover function enough to live an assisted or independent life, but to aid them in their recovery to achieve the best outcome possible. Our intensive stroke programme is proving increasingly popular and is gaining impressive results. We offer intensive treatment, usually in a one to two month blocks, designed to help survivors achieve their goals and improve their daily life. Treatment can be carried out in our purpose built rehab centre and in your own home, or in a nursing home. It’s never too late!

Product Review: Tailwind for training weak arms after stroke.

Tue, 13 Mar 2012 11:33:44 GMT

Chronic arm weakness and hemiparesis is a leading cause of functional disability after stroke. It can limit the ability to dress, shower, groom and eat independently. At the clinic, we have been investigating ways to increase the amount of upper limb therapy people are doing by providing independent training programs at home. We came across the Tailwind, and have been trialling it at the clinic for the past two weeks.

The Tailwind was developed by researchers at the University of Maryland Medical School and has recently been launched in Australia. We wanted to see if it could be used to increase the total amount of training for people who have suffered a stroke as part of a home based program. In addition to studying the effects on strength and increased activity in stroke survivors, much of the literature has also looked at the Tailwind’s application to rehab in people with traumatic brain injury, cerebral palsy, and other brain injuries.

The Tailwind was developed to “provide the bilateral arm movement and repetition needed to realize arm recovery and improvement”. Seated at a table, the user moves two handles along resistance-free tracks, to the rhythm of an auditory cue. After repeated exercise sessions, the user will be able to move his affected arm farther and farther out along the track. The Tailwind utilizes a "sound-to-brain" neural pathway retraining method to improve strength and overall activity.

Some of the positive features of the device include the easy installation and set-up. It is easy to manipulate the ‘arms’ to change the angle and resistance of arm movement, as well as the target distance. With the right set-up, the device is a neat way to increase exercise in the affected arm.

Getting the right set-up proved to be difficult however in six of the eight people we trialled the device on. The T handles are appropriate for someone with good grip strength, but very awkward for someone with minimal grip or wrist strength. In most cases we needed to strap hands around the handles, sometimes with additional wrist braces. This reduces the capacity for independent training at home, especially when we are looking at equipment that can help people with a very weak arm.

Overall, we are grateful to Orthocare for the opportunity to trial the device and suggest that it would be best used by stroke survivors with good grip strength and who are wanting to target shoulder strengthening.

Polio Australia Newsletter out now

Wed, 14 Mar 2012 08:29:46 GMT

Best Exercise for Arthritis

Tue, 13 Mar 2012 10:43:04 GMT

Hydrotherapy, or “exercise in water” is a form of therapy that can be use for a variety of conditions, particularly those conditions where pain is the main concern. Latest research shows that Hydrotherapy at a moderate to high intensity can be beneficial to those with arthritic joints (both Rheumatoid Arthritis and Osteoarthritis). Benefits may include reducing joint pain, improving strength, mobility and function, as well as positive psychological gains.

Hydrotherapy allows those with arthritic joints to work at a higher intensity than possible on land due to pain restrictions. This occurs pdue to the buoyancy of the water which provides support to the joints and reduces joint strain by minimising weight bearing. Hydrotherapy is often used following joint replacement surgery, and more and more, prior to surgery. Prehab can maximize function and strength, speed recovery times and possibly delay the need for surgery.

Simple tasks such as climbing stairs or standing up from a low chair can be worked on as an exercise in the pool at a much higher intensity and with less pain due to the surrounding water support. At Advance Rehab Centre our hydrotherapy pool is kept at around 34 degrees Celsius for a therapeutic effect, promoting blood flow to muscles and joints, assisting with overall mobility. We have a range of floats and assistive devices that can be used to add resistance for a challenging work out, as well as to provide gentle support for those less able.

Hydrotherapy is also beneficial for working upper limb arthritic joints such as shoulders, where the reclined position can be used, as well as floats to suspend the arms in the water to assist with joint range of motion. We have a lot of success with people coming to us after shoulder surgery, especially shoulder reconstructions and rotator cuff repairs. Rehab programs can often begin a lot earlier in the pool than in regular physiotherapy and can also assist with joints that are slow to respond to traditional therapy.

For those who suffer from arthritic pains, the Physiotherapists at Advance Rehab Centre highly recommend a course of hydrotherapy to reduce pain, swelling and to get you moving again. Call the clinic today for a consult 9906 7777.

Hemiplegic Shoulder Pain after Stroke

Mon, 05 Mar 2012 02:31:01 GMT

Good shoulder function is a prerequisite for effective hand function, as well as being able to perform multiple tasks involving mobility, ambulation and activities of daily living.

A common sequalea of stroke is hemiplegic shoulder pain (HSP), with some studies reporting incidence as high as 84%. The usual onset is 2-3 months post stroke. The pain can be intense and result in reduce functional recovery and, increased disability. The pain itself can have very real negative effects resulting in depression, loss of sleep, loss of self worth, anxiety and irritability.

Studies have failed to establish a strong cause and effect of HSP and so the cause is suspected to be multi-factorial. The most frequently suspected causes include subluxation (due to weakness of the rotator cuff muscles), trauma (often if the arm is pulled), contractures (due to prolonged positioning), complex regional pain syndrome, rotator cuff injury and spastic muscle imbalance of the shoulder joint.

Once established, HSP can be difficult to treat so early intervention is valuable. Assessment by a neurological physiotherapist will ensure you gain the best advise and treatment early after your stroke. Treatment can include education, slings and supports, positioning, functional electrical stimulation, range of movement and strengthening exercises. Minimise pain by preventing it in the first place and call the clinic for a consult.

Remote Training for People with Parkinson’s Disease – where there is a will there is a way!

Fri, 02 Mar 2012 06:36:23 GMT

Here in the Clinic I get several phone calls a week from patients as far afield as Mudgee and Canberra enquiring about our unique Parkinson’s Disease Mobility Program. In an ideal world we’d love all of our patients to complete a 1:1 program with our specialist physio team however we recognise that sometimes this is just not possible. Our philosophy here at ARC is to help as many people with Parkinson’s as we possibly can as we have seen the results of our intensive program which is based on new and exciting clinical evidence in neuroscience.

Recently I have treated a man from Mudgee who managed to stay at his daughter’s house in Sydney for 4 weeks. As well as a great holiday, he had the support network of people to help him with his exercises. He completed the program successfully and I have referred him to an exercise group in Mudgee so he can continue to be as active as he possibly can.

I am also due to follow up a lady who lives in Canberra. She managed to come to Sydney and stay at her daughter’s for a night which meant she could have two long sessions over two days to be taught her individual program. She has been back to see me once (managing to tie it in with a action packed weekend in Sydney!) for her program to be progressed and is due to come back and see me in another month. To help her stay on track I provided her with an exercise diary and she updates me on her progress over e mail.

For those lucky Sydneysiders then our intensive program works best, as we really make sure that your movement improvements take place during all of your everyday activities. However my last two remote clients have really proved to me that anything is possible and where there is a will there is a way! So whatever your, or a family member or friends situation is, we will really try and do the very best we can to provide you with a tailor made program which has been proven in the literature to be more affective then traditional exercises for people with Parkinson’s.

Whoever you are and wherever you live, take a trip to Sydney and we will do our very best to help you. Call us and explain your unique situation and we will help you sort out a plan of action! For more information please contact the office on 9906 7777.

Dual Task training in people with Parkinson’s Disease

Fri, 02 Mar 2012 05:24:31 GMT

A dual-task paradigm is a procedure in experimental neuropsychology that requires an individual to perform two tasks simultaneously, in order to compare performance with single-task conditions.

When performance scores on one and/or both tasks are lower when they are done simultaneously compared to separately, these two tasks interfere with each other, and it is assumed that both tasks compete for the same class of information processing resources in the brain.

For instance, reciting poetry while riding a bike are two tasks that can be performed just as well separately as simultaneously. However, reciting poetry while writing an essay should deteriorate performance on at least one of these two tasks, because they interfere with each other.

Difficulty performing more than one task at a time is a common and disabling problem experienced by people with Parkinson disease (PD). If asked to perform another task when walking, people with PD often take shorter steps or walk more slowly. There is uncertainty amongst physiotherapists about whether clinicians should teach people with PD to avoid dual tasking or whether they should encourage them to practice dual tasking with the hope that practice will lead to enhanced performance.

Here in the clinic we train people with Parkinson’s Disease to move BIG which is the opposite to their small and slow movements. As they progress we add more and more complexity to their exercises, making sure their BIGNESS does not deteriorate. Dual tasking is something we believe cannot be avoided in the real world and incredibly difficult to discourage in people with Parkinson’s. Because of this we think training dual tasking is vital whilst maintaining BIGNESS. This is no easy feat but most of our clients are up for the challenge.

We are now using MP3 players during therapy so our patients can dual task and exercise. This makes for an interesting looking gym environment!

Strength training in Stroke

Wed, 29 Feb 2012 02:28:28 GMT

Every year over 15 million people world wide suffer a stroke and of these at least a third will be left with significant physical impairment. One of the common residual impairments is spasticity of one or more limbs. Spasticity is defined as a velocity dependent increase in the tonic stretch reflex, ie the faster the muscle is stretched the greater the resistance and more reflex activity, it is often associated with underlying muscle weakness and results in difficulty with day to day functional tasks such as walking, dressing and eating. A recent study on chronic stroke (over one year) showed that on average, the affected leg was only 46% as strong as the healthy population and that the ‘good’ leg was only 64% as strong.

It is widely recognized that in the healthy population strength training has many health benefits such as:

· Improved muscle strength and size

· Improved mobility and balance

· Enhanced performance of everyday tasks.

However, historically it was thought that resistance exercises in the neurologically impaired population would lead to an increase in muscle spasticity and therefore be detrimental to functional ability. Following a stroke, people were advised not to include strength training in their therapy programs for fear that it would further increase their spasticity.

In stark contrast, research over the past 20 years has shown that muscle weakness may be directly responsible for compromised muscle function and that effortful activity or strength training does not exacerbate spasticity, in fact, strength training can reduce spasticity in most cases. This would indicate that high intensity activity, including strength training is an important part of rehabilitation after stroke.

Strength training after stroke is best supervised following a thorough assessment by a neurological physiotherapist to ensure correct prescription of exercise. Consideration needs to be given to primary and associated impairments, position, function, dosage, equipment, progression and history of muscle as well as outcomes. Strength training is as much about skill training; learning how to create efficient pathways from the brain to the muscle and recruiting muscle effectively to provide force, as physiological changes leading to growth and size of muscle. Examples of strength training in the neurological population may include use of an electrical stimulation machine and manual guidance for very weak muscles through to progressive resistance training with weight vests and addition of multiple muscle groups for stronger muscles.

If you have had a stroke and feel that a strength training program could assist you in your daily life, please contact the neurological physiotherapy team at Advance Rehab Centre. 9906 7777, office@archealth.com.au

Depression following stroke

Mon, 27 Feb 2012 06:07:34 GMT

Growing research into stroke treatment and rehabilitation has identified post stroke depression as the most common psychiatric consequence of stroke, with as many as two thirds of stroke survivors meeting clinical criteria for depression. Depression poses a serious barrier to quality of life and to stroke recovery, with depressed stroke survivors showing poorer rehabilitation outcomes when compared to non-depressed survivors.

There are several reasons post stroke depression occurs. The main factors suggested in research and seen in clinical practice are:

Depression is the consequence of the biological changes in the brain, where individual brain neurons and larger brain networks are undergoing a state of (chemical and physiological) transition. For instance, a relationship between a specific stroke region in the brain and depression has been found in people who have suffered left-sided strokes and experience dysphasia as a result (difficulties understanding people or difficulties finding words to express self). Strokes which affect the same brain region on the right side does not show such a relationship with depression.
Depression is the result of losses in physical function and mobility, speech, memory or other skills. For many, stroke presents one of the biggest (if not the biggest) adjustment to change in their personal circumstances they have experienced in life. Adjustment is complicated by the loss of function and role changes which are often substantial and can lead to negative and self-critical thoughts, low confidence, feelings of hopelessness and despair and withdrawal from daily life and activities.
Depression is the result of decreased participation in activities that promote good mood and well being like exercise, meaningful activity such as work, and socialising.

Very often, post stroke depression is a combination of these factors. Depression which occurs for more than three months is viewed as chronic.

Symptoms of depression can include:

Low mood
Tearfulness
Negative, self-defeating and critical thoughts
Feeling guilty or worthless
Recurrent thoughts of death
Increase or decrease in appetite
Sleep disturbance
Poor motivation
Loss of interest in activities
Feeling slowed down or restless
Concentration difficulties
Trouble making decisions
Anxiety may also be present

(Note: some symptoms may be directly related to the stroke but can also be signs of depression. Assessment by mental health professional is required).

There are effective, evidence-based treatments available for depression and you can access these from a variety of health professionals including GPs, psychiatrists, psychologists, occupational therapists, social workers and nurses. It is important to seek help as soon as early on as possible. Tell someone. This could be your GP, a rehab clinician, a friend or family member. Remember depression is a change in your emotional function, it is not a weakness. Support when getting advice and treatment will increase the effectiveness of your treatment and may speed up the time it takes for treatment to get started. Your GP will ask you a few further questions and discuss the treatment options. e.g., he/she may suggest you trial an antidepressant medication or refer you to a mental health practitioner such as a psychiatrist or psychologist, with a mental health care plan. If you see a private practitioner who is a Medicare provider, Medicare rebates are available for treatment of depression. For instance, you can receive up to 10 sessions of therapy per calender year with a psychologist or clinical psychologist.

A recent article in the news:

www.psychcentral.com/news/2011/03/16/better-management-of-depression-after-stroke-improves-functioning/24447.html

Information sheets on post stroke depression are available in the ARC waiting area. You can also go to www.strokefoundation.com.au and www.beyondblue.org.au for information and resources on post-stroke depression.

New genetic research into Parkinson’s may yield new insights into treatment techniques.

Tue, 21 Feb 2012 05:30:55 GMT

Whilst the cause of Parkinson’s disease remains unknown for the vast majority of sufferers, new research on the inherited form of Parkinson’s disease may offer the potential to yield new insights into treatments.

Parkinson’s disease is caused by the death of dopamine neurons within the brain. This occurs in the substantia nigra in the basal ganglia, a part of the brain responsible for co-ordinating smooth and balanced movement. Dopamine is a powerful neurotransmitter, a special chemical messenger that works within the brain to allow normal motor output. In Parkinson’s disease, the death of these dopamine cells results in the turning down of motor output, resulting in slow, stiff movements.

The factors contributing to the death of these neurons is not yet fully understood, but is thought to be due to a variety of environmental, genetic and possibly ageing factors. In approximately 10% of cases the cause is known to be genetic, related to mutation in a gene called parkin.

The process underlying the death of these cells has been difficult to isolate as the brain is such a highly integrated, complex organ. However, a team of scientists in the US have replicated human dopamine neurons in a laboratory for the first time using the skin cells of Parkinson’s sufferers with the faulty parkin gene. Nerve cells from the Parkinson’s population showed changes in the way they handle dopamine compared to those of healthy controls.

The Parkinson’s cells showed increased stress caused by a build up of damaging molecules. In healthy cells, the parkin gene tightly controls the production of monoamine oxidase (MAO), keeping it at very low levels. MAO catalyses dopamine oxidation and can be toxic. In the cells with the faulty parkin gene, MAO was poorly regulated and expressed at much higher levels, causing the death of dopamine cells. The action of dopamine in supporting neural computation was also disrupted by mutations of the parkin gene.

When the normal parkin gene was given to the faulty cells the effects were reversed.

This research offers several implications for the development and testing of treatment therapies for Parkinson’s disease. Testing new treatments for Parkinson’s disease has always been a challenge. Animal studies have been fraught with difficulty as animal models with the faulty parkin gene do not develop the disease, possibly due to the differences in neural processing required for bipedal movement in humans and quadrupedal movement in most other animals.

By isolating these faulty cells the effects of potential treatments can be studied at the cellular level, and new research may be directed at drug therapies that could mimic the protective functions of healthy parkin genes.

For more information directly from the articles, visit these sites

http://www.bbc.co.uk/news/health-16913997

http://medicalxpress.com/news/2012-02-parkinson-disease-human-neurons-reveals.html

Helping prevent falls over 65 years old

Tue, 21 Feb 2012 05:52:16 GMT

Did you know that about one third of the population over the age of 65 falls each year, and the risk of falls increases proportionately with age? At 80 years, over half the population fall annually.

The risk of falling can be significantly reduced through a number of different ways. Removing obvious risk hazards such as curled edges on mats, wearing safe, supportive footwear, ensuring adequate lighting, and specific falls prevention exercises may prevent a serious fall.

Balance and Falls Prevention Classes are held twice weekly at Advance Rehab Centre where the focus is to strengthen deconditioned muscles and improve overall balance to reduce the risk of a fall. The classes are held in the gym area in a circuit setup so that clients receive specific exercises relevant to their own level of fitness and balance. The idea is to challenge one’s balance in a safe, supervised environment, so that improvements can be made.

If you know of any friends or family members who have fallen recently, it may be worth a visit to Advance Rehab Centre to be assessed by one of our friendly Physiotherapists!

Flexy foot improves walking sticks and crutches

Thu, 05 Jan 2012 10:00:27 GMT

Flexyfoot is an innovative and award-winning new product that revolutionises the humble walking stick and takes crutches to a whole new level.

Using patented air sprung technology, Flexyfoot provides:

• Improved grip and stability on all terrains
• Shock absorbency to reduce impact
• 360° rotation of the ‘foot’ to reduce wrist twist
• Longer life, easy-to-change replaceable ‘feet’
• Quiet, non-marking tread

Great on the Ground

Flexyfoot will always maintain full contact with the floor, no matter what angle the walking aid is used at, providing improved grip and stability on all terrains, and in particular with slippery and uneven surfaces. The Flexyfoot rubber tread can also independently rotate through 360°, so full ground contact is still maintained even when twisting or turning around.

Gentle on the joints

Flexyfoot’s patented design works like the suspension system on a four wheel drive. The flexible bellows absorb shock each time the walking aid contacts the ground so that forces transmitted to the upper body through the aid are always cushioned.

Easy to Fit

Flexyfoot looks a lot smarter than a traditional ferrule and is much easier to monitor for wear and replace when necessary. When the rubber tread is worn down to the wear markers (similar to those of a car tyre), the bellows and integral rubber foot are easily screwed off from the Flexyfoot collar and replaced.

Flexyfoot is really quiet on hard surfaces (great for wooden floors), and the special rubber tread won’t leave marks on the floor, like traditional ferrules do. The flexy foot has been flying off the shelf and we are getting some really positive feedback.

For more information, trial or purchase please contact the office 9906 7777.

Parkinson's disease is on the rise

Thu, 08 Dec 2011 12:34:59 GMT

There has been much interest in the clinic this week regarding the article printed in Body and Soul on Nov 27th about the rise of Parkinson's disease in Australia. I think it is great that awareness of the condition is being promoted in the broader print media because it is such a common neurological condition, and one that we see regularly in the clinic. It is however quite disheartening to read the article and see no reference to the significant benefits of exercise in managing the symptoms of Parkinson's disease. If we are going to raise awareness of the condition, surely we should also be raising awareness about effective management stategies that are not just limited to medications.

It is widely known that any exercise is better than no exercise for people with Parkinson's disease, and the earlier exercise is started the better. We also know from recent literature that the kind of exercise people do also makes a difference. Most importantly, it is the intensity and effort of the exercise that can make the biggest difference. In our clinic, people come in to exercise hard so they can continue to play hard. Exercise can have a profound impact on people's lives and daily function, as well as overall quality of life and extended participation in work and social activities. There is some evidence emerging that exercise can also positively influence the dose of medication required and this means exciting time for future research.

Sadly, very few people with Parkinson's disease are referred to a physiotherapist early on in the condition. It is usually when people start having difficulty with their mobility or falling that a physiotherapist may become involved in care. By this time, changes are much harder to make and require more intensive interventions.

I applaud the article for raising awareness of difficulties that people with Parkinson's disease have and hope that in future as people become better educated, exercise is considered along the lines of medicine on the front line of defence against this progressive condition.

To read the full article visit this link: http://www.bodyandsoul.com.au/health+healing/news+features/parkinsons+disease+on+the+rise,15761