When you tell people you’re a Neuro Physiotherapist who works with people with problems of the brain or spine, the most common response is ‘So how DO you physio the brain?’. I imagine they’ve conjured up a great gory image of me getting my talons out to give these brains I’m working with a good heavy handed massage. Alas, no. Instead of getting stuck right in and manipulating the brain itself, Neuro Physiotherapists utilise the brain’s incredible ability to reorganise itself to help our patients move around more easily, and function more independently day to day.
Neuro Physiotherapists work solely with people who have suffered damage or trauma to their brain, spinal cord or nerves. This includes a vast array of both common and rare conditions including multiple sclerosis (where damage to the nerve coating in the brain and spine affects muscle movement, balance and vision), Parkinson’s Disease (where loss of nerve cells deep in the brain slow down movements and speech) and spinal cord injury (where trauma and inflammation of the spinal cord results in loss of feeling and movement lower down the body).
These different conditions affect young and old, rich and poor, women and men from all cultural backgrounds. It is thought that around 10 million people in England are living with a neurological condition, and Neuro Physiotherapy is one approach used to help improve their quality of life.
But how is it done? To help explain I’ll use the example of somebody who has had a stroke. About 150,000 people suffer a stroke in England every year, and brain damage caused by stroke means that they are the largest cause of adult disability in the UK. When someone has a stroke, the damage is caused by either a blockage in a vessel, stopping blood reaching some areas of the brain (known as an ischemic stroke, the most common type), or a bleed in the brain, which again means the blood can’t reach all areas of the brain it should do (known as a haemorrhagic stroke). In either scenario blood, and therefore oxygen, can’t move around the brain in the way it should, and without oxygen brain cells die.
Depending on where these cells were, they might have been responsible for moving the arm, coordinating the movements needed for speech or generating the thought processes needed to plan out how to make breakfast. Whichever it was, that function will now be impaired, and the person may struggle with the most basic of day to day tasks. The difficulties the person has will be entirely dependent on the extent and location of damage in the brain.
But research and anecdotal evidence shows us that those impairments and difficulties don’t necessarily last a lifetime. We now know that when nerves in the brain are killed, by an ischemic stroke for example, other brain cells may take over their job. Just like when a main road is blocked off, we can often still get to where we need to go by taking the side streets, other cells can sometimes do some extra work to compensate for lost functions.
Taking the ‘diversion’ might be slower and more effortful – and in the brain it might even take some time for that route to be available – but there is hope that you might reach the same end result. This process of reorganisation is called neuroplasticity, and it is the basis of Neuro Physiotherapy. We know that these new connections can be made - but it takes some work.
If our stroke survivor has a very weak leg and a target to walk again, the patient and the Neuro Physiotherapist must work together to jostle the brain into making the new connections required for walking. Strengthening the leg with weights or getting fitter using an exercise bike will help to an extent, but the one most important cog in the wheel of re- learning to walk again, is to practice walking. The patient may need hands on assistance, splints, a treadmill or all of these things, but the Neuro Physiotherapist helping the patient practice the correct movements of walking will encourage the brain to ‘re-learn’ the movement pattern.
And as with anything, learning takes time. Think of the process of learning to juggle. The extremely difficult coordination and control required gets easier and easier as we continue to practice and our brain learns the movement pattern. Neuroplasticity means new connections are made, just as they are in our stroke survivor re-learning to walk.
And so, Neuro Physiotherapy aims to take people through correct movements, guide limbs and facilitate people doing day to day tasks, to encourage the brain to ‘re-learn’ normal movement. If people with a neurological problem are given the opportunity to practice the things they want to improve at, with facilitation to move in the right way, over time new connections can be made in the brain. Neuroplasticity is thought to occur mainly in the weeks and months following a stroke or a new neurological problem. However, new connections have been known to occur years and years down the line.