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ARC Functional Neurological Disorders Clinic & Anna's trip to The Functional Neurological Disorders World Conference, Scotland 2017

 So having now had a chance to bounce back from the jet lag, I wanted to share something of my recent quick trip over to Scotland to the amazing city of Edinburgh where I was lucky enough to attend the 3rd International Conference of Functional Neurological Disorders. 


For a long time now, this has been a special interest area with neuro rehab for me. To get the chance to meet the world experts was a once in a life time opportunity. It is my mission to provide the best therapy for clients with Functional Neurological Disorders in our city of Sydney.


Functional Neurological Disorders refer to a wide variety of presentations whereby individuals experience often disabling symptoms such as impaired movement, sensation, speech, pain, fatigue, seizures and a number of other possible symptoms either in isolation or combination. They are group of neurological disorders that have generally been poorly understood and therefore poorly managed, until recent times. The increasing interest and knowledge of them was evidenced by an audience of more than 500 health professionals attending the Edinburgh 3 day conference with lively discussion, some amazing case studies presented and a suggested framework for helping these individuals.


Historically back during the the 1st World War,  Functional Neurological Disorders were termed 'War Neuroses' or 'Shell Shock' with reference to the presentation of some soldiers with mysterious symptoms during or following service though these terms were later replaced with terms such as 'Psychogenic Movement Disorders' and more recently 'Conversion Disorder'.  


The consensus of professionals and individuals     involved and literature now is in favour of using the term Functional Neurological Disorders and this is reflective in part of the recognition that whilst psychology and psychological stressors may play a big part in the way these presentations manifest it is not always the case and it is the function of the individual that is affected and so treatment strategies are also moving towards addressing these movement disorders directly with therapies such as Physio, Speech Therapy and Occupational Therapy. For some individuals Psychological input and support will continue to be extremely valuable however it is has been found that for some an active education and rehabilitation approach can achieve excellent outcomes. 


Already having a strong interest in this area, this was a huge opportunity for me to hear from and meet with a large number of the leading experts in this field from all over the world and from a variety of professions including Neurologists, Rehabilitation Specialists, Psychiatrists, Psychologists, Physiotherapists, Occupational Therapists and geneticists to name but a few. 


Here in the clinic we are now excited to further develop the service that we can offer for this patient population and are delighted to have been able to make some great contacts overseas (and closer to home) whom we hope to continue to collaborate with in setting up a program which is in line with the best of what the international community can currently recommend. It's an exciting opportunity for us and we will keep you updated as the service progresses.


Please contact us if you, or anyone you know, has been diagnosed with a Functional Neurological Disorder. I would love to complete an assessment and help you.


And just in case you were wondering, it wasn't all work and no play! It was great for me to return to the UK and Edinburgh is a fantastic old city to wander through the streets enjoying the architecture, the atmosphere, the local old pubs and amazing traditional food!  The conference itself was held in the very grand Assembly Rooms in the heart of the city and you really couldn't have asked for a better setting. 


All in a all a wonderful experience with lots of new food for thought and plans to put into action. Watch this space!

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And the Gold Star goes to Warren Boyd

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Mary is on the move

Mary suffered a stroke during an operation to repair a broken hip. When we first met Mary, she had just started standing with physical assistance and was only able to tolerate sitting for short periods. She could only get out of the house in a wheelchair.

Find out what Mary can do now. 

Categories: Gold Star Award, Stroke recovery, Home based rehabilitation

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Let's Talk About Mental Health

Here we are again talking about the wonderful benefits of exercise, this time turning our attention to mental health disorders which affect so many people. As Exercise Physiologists, we can help support the exercise and lifestyle components of treatment for people with a mental health condition. This has been proven to improve quality of life for those suffering from mental illness such as depression, anxiety, post-traumatic stress disorder (PTSD) and much more.

Mental health disorders are multifactorial and each need to be addressed to achieve optimal outcomes. So, what are the factors that an Exercise Physiologist can help with?

1. Negative balance in BDNF and neurotransmitters (endorphins) such as dopamine, serotonin, GABA, Acetylcholine (Ach), adrenaline and noradrenaline in the central nervous system (CNS)

       2. Negative lifestyle beliefs and behaviour

       3. Promote motivation through support, knowledge and accountability 



Endorphins are neurotransmitters that help regulate emotion, stress, anxiety and pain, while BDNF acts as the fertiliser of the brain that helps maintain and grow the brain circuits which allow neurotransmitters to travel. Low levels of BDNF have been associated with depression, anxiety, schizophrenia, OCD and poor memory.  Decreased levels of serotonin and noradrenaline are related to depression and anxiety. Decreased levels of dopamine have been linked to schizophrenia, ADHD and low motivation. Interestingly, reduced GABA levels are evident in people with personality and social disorders. All this may seem alarming but don’t worry, the good news is that there is an abundance of research showing how exercise can increase and sustain levels of BDNF and endorphins. In some instances, even more so than medication.

Aerobic exercise has been shown to best increase levels of BDNF in our bodies, as little as 30 min of jogging 3 days a week has been shown improve brain functioning. Even better gains have been shown with complex activity that require you to acquire a skill. For example, exercises that challenge your balance and thinking. Other research has shown that after 2 weeks of daily exercise, BDNF levels were 150% of baseline! Increased BDNF levels have also been shown to improve serotonin production which can be effective in treating depression. Not only does exercise increase levels of BDNF but also results in a rush of endorphins such as serotonin and dopamine. The message here is that aerobic exercise is essential in increasing levels of BDNF which in return results in improved signalling pathways for endorphins to work and transmit their happy signals.



My primary role as an Exercise Physiologist is to work with the patient to come up with strategies and goals together that will improve overall lifestyle. Patients with mental health disorders present with negative lifestyle beliefs and behaviour, either as cause (causing the disorder) or effect (result of the disorder), and this has several implications. Firstly, it’s easy to say that you need to exercise and it has all these benefits that will help you, but it’s no good if I can’t get the patient to exercise. Compliance can be a very difficult aspect in dealing with these patients and this is because of their negative attitude and belief towards exercise as well as the low motivation and apathetic nature of some of these mental health conditions. Secondly, negative attitude and beliefs result in poor behaviours such as not exercising, because of this it’s seen that people with mental illness are more likely to experience chronic health conditions such as diabetes, cardiovascular disease (CVD) or asthma. For example, people with schizophrenia have been found to be twice as likely to be diagnosed with cardiovascular disease than the broader Australian population. As such, CVD is a major cause of death for those with mental illness.

Ok, so we know that we have to get this population of patients to exercise and maintain a regular routine but how can we do it? Exercise Physiologists are not psychologists, but they are trained in sport/health psychology and motivational interviewing. One such technique we can apply to achieve positive behaviours is Cognitive Behavioural Therapy (CBT). CBT is an effective treatment for a range of mental health issues such as depression and anxiety. It helps the person identify negative thoughts and implement self-help strategies to reach their goals, i.e. desired behaviour (exercise). The main principle behind CBT is that thoughts and feelings dictate behaviour. Therefore, if we can change the way a person thinks about an issue into more positive then we can teach the person techniques and skills to alter their behaviour. For example, a person might think that if they ask how to use a treadmill that they may be ridiculed or asked about their condition and therefore will not use the treadmill. CBT will challenge that thought to a positive one and give a strategy of asking a trainer how to use it. Can also give strategy on how to respond if they are asked about their condition and don’t want to disclose some of it. The end behaviour is healthy safe use of the treadmill. Lack of motivation to exercise can also be due negative beliefs. Education is essential in changing one’s attitude and thoughts towards certain behaviours. Also, activity diary’s, step counts and proper goal setting are strategies implemented by exercise physiologists to change negative lifestyle behaviours.

Take home message is that many people with a mental illness are unaware of how important exercise is in treating their condition when combined with appropriate medication, therefore it is crucial that Doctors and patients are acknowledging the importance of Accredited Exercise Physiologists as part of a multidisciplinary treatment program. Exercise Physiologists help implement, support, guide and progress tailor made exercise programs promoting complience, enjoyment and promoting longevity and therefore influencing results!

ARC's Exercise Physiologists can come to you at home or your local gym to assess you and start a regular exercise program.

Categories: Feature Article, Home based rehabilitation

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Gemma's experience of upper limb Boot camp

Categories: Gold Star Award

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For Angela the sky is the limit!

Categories: Gold Star Award

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Categories: Feature Article, Home based rehabilitation

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Ready to plate up with William! Watch out Masterchef!

Categories: Gold Star Award

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 Meet Robert! An enthusiastic and witty ex-yachtsman approaching his 89th year.

Categories: Gold Star Award, Parkinson's Disease, Home based rehabilitation

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Improving the lives of people with neurological and complex therapy needs.