Neurophysiotherapy is a specialist branch of physiotherapy. Our team member, Patsy, is a chartered physiotherapist with a speciality in neurophysiotherapy who uses the concept of neuroplasticity to help patients with all kinds of painful conditions, injuries or disorders. In this article, we ask her about her work as a neurophysiotherapist, what neuroplasticity means, and what issues she can help with.
Q: Patsy, what is neurophysiotherapy, and how does it differ from other types of physiotherapy?
Within the field of Physiotherapy there are many different specialities – musculoskeletal (MSK) physiotherapy, cardiorespiratory physiotherapy, sports physiotherapy to name a few. Neurological physiotherapy is dedicated to individuals with neurological disorders such as stroke, spinal cord injuries, Parkinson’s disease or multiple sclerosis. This specialisation aims to improve movement, coordination and balance with the help of techniques that help retrain the nervous system to achieve better motor control and foster independence.
I trained as a Bobath therapist for adults with stroke and use a hands-on approach to facilitate my patients’ movements. My hands on their limbs, joints and muscles tell me if their limbs have high tone, felt as resistance to movement, spasticity which can make muscles or a limb go rigid, or the opposite can happen and the muscles may be really floppy. I feel this as I am working with my patient and adjust my handling according to that patient’s needs.
Unlike musculoskeletal physiotherapists who focus on treating joints or soft tissue damage in specific areas of the body, neurophysiotherapists communicate with the patient’s brain. We try to let the motor areas of the brain know, through facilitation and movement, that the corresponding body parts are still there, awaiting instruction from the brain. My work aims to coax new brain activity, rewiring or rerouting of synapses, making the vital connections in order to move affected areas of the body.
Neurophysios often see clients over longer periods of time when the patient is wanting to work on gaining movement and better coordination of movement, or work more on fine-tuning certain abilities such as walking. This means often there is a much closer relationship between patient and therapist which is a great perk of the job.
Of course, as a neurophysiotherapist I will also use equipment but the initial starting point is through handling and facilitation, the therapist taking on just as much work as is needed and reduce the hands-on as the patient is able to take over more of the movement.
I have heard it said, mistakenly, that six months after a stroke, patients are unlikely to improve. But as a clinician I know that the brain continues to relearn skills as long as it is given the opportunity to do so. Brains don’t stop learning, and we can take advantage of this. I believe that many people have further scope for recovery – in fact all of us continue to learn new skills throughout our lives. I find the expression “you can’t teach an old dog new tricks” one of the most untrue and unhelpful sayings, in fact it’s utter rubbish as far as the brain is concerned.
Q: How do you use neuroplasticity in your work as a physiotherapist?
Every movement we make is orchestrated by the brain. Most of this happens seemingly instantly and much is automatic. You don’t have to think in detail about most tasks such as lifting your arms or walking – it just happens when you want to. But when we suffer a brain trauma these pathways can be damaged. The neurophysiotherapist encourages the patients’ neurons to reawaken pathways or lay down new ones to restore movement.
Even without brain trauma, when someone has been very unwell or only able to sit in a supportive chair, getting up and moving independently can be really difficult or even impossible. Working to rehabilitate with these patients is a similar scenario. The less the body moves, the more ability is lost – just like with muscles and joints and soft tissues, if you don’t use it, you lose it. This happens to the motor areas in the brain as well. For the client the rehab work is to gain back what they have lost in muscle strength as well as relearning coordination, balance and re-exploring movement patterns and ranges of movement.
It can be a creative process – what works for one person may not for another. But using my expertise I try to find a way to enable people to move better and more easily. This really can make an enormous difference to their lives.
Q: Can you tell us how you treat patients with neurological problems?
The first step is to understand the patients’ goals. These vary from one person to the next. It could be wanting to be able to learn to sit up on the edge of the bed again. Or, as was the case for one of my patients who had had a stroke, wanting to be able to walk with more ease and be able to enjoy sport again. He had gone from being very active to having a lot of stiffness and pain in his left side which drastically reduced his quality of life. I worked on helping his brain regain feeling for and control of small movements of trunk and pelvis and building up to bigger movement on all planes. Increasing range of movements in his trunk, hips and knee helped to loosen the tightness in his muscles and joints.
Therapy sessions are a sort of safe experimenting with movement – both range of movement and diverse movements – tapping into the brains’ ability to adapt (neuroplasticity), awakening the possibility for better movement. And this progress is then incorporated into daily activities. For example, for my patient recovering from a stroke, during this phase of his rehabilitation, he started to experiment with trying to ride a bike in the park. I am really excited to say that he was successful.
Q: How does neuroplasticity help patients with other types of condition?
I really enjoy working in rehabilitation with patients who may have found they have lost skills, either after an illness that may have resulted in being unable to leave their home, or after a long stay in hospital, finding themselves bedbound. This is where home visits are essential for people to regain skills in their own environment and gain the ability and confidence to do things again for themselves.
A patient who had been in hospital was discharged home but bedbound. She found it difficult to move because of severe osteoarthritis in her knees. Her lack of movement meant fluid built up in her lungs, and she ended up with a chest infection.
For this lady, the essential component was getting her upright and encouraging movement to shift the fluid.
The principles are similar; target a key activity and facilitate the conditions to learn, or relearn, it.
In the first visits, I spent time teaching her how to sit herself up on the side of the bed. It was a seemingly simple movement, but because she had been immobile for such a long time, the ability had been lost.
She had to relearn the technique of sitting herself up. It was more than just getting stronger, although that was important. We had to work on her coordination, her balance and her timing. Her central nervous system needed to relearn how to engage the muscles and joints in the right way.
This simple movement meant her health improved, and it unlocked the route to getting her back on her feet, little by little.
The aim with some of my patients has been to get back to an activity they enjoy, or with the increased confidence and mobility to then join an exercise class. It is incredibly rewarding being part of that rehab journey.
Q: You also have training in Liebscher & Bracht technique – what’s that about?
I was drawn to Liebscher & Bracht because the method has had impressive results in reducing pain and it seemed like a great technique to add to my toolkit. And having now become a practitioner I really see the benefits of it.
Liebscher and Bracht is a pain therapy originating in Germany using a technique called osteopressure (using pressure points on the bone). There are 72 points in all, and depending on the area that is causing pain, a therapy session will focus on those corresponding pressure points.
Put simply, the therapist will work to reduce the pain which has restricted movement in a joint. Once the pain is reduced, we can then work to stretch and strengthen the soft tissue around that joint. This then leads, with less pain, to a greater range of movement. The idea is that the pain does not return.
Q: How has it helped your work as a neurophysiotherapist?
The Liebscher and Bracht method is a wonderful addition to my practice.
I used it recently with a lady who was struggling with day-to-day activities because of osteoarthritic pain in both her knees. She was so worried about this that she was thinking of moving out of her first floor flat because she was struggling so badly with the stairs up to her flat.
In our first session, I used the Liebscher & Bracht technique on one of her knees and within a few hours she texted me to say that she realised she had no pain in the knee we treated. The following week we treated the other knee and worked on the exercises that she continued in-between sessions. Using the L&B osteopressure method brought her pain levels right down. That meant she could then do the particular exercises and stretches to increase her range of movement of her joints. It is great to be able to remove some of the pain so that people can do the exercises they need – it is so hard to exercise when in pain!
She came back to me, delighted, to report that for the first time in a long time, she was able to take her rubbish bags down the stairs to the bins! This may seem a small thing, but it really boosted her confidence, and since then she has been doing even better. And, I’m glad to say, is still in her home.
Q: What are your interests outside of work?
I like gardening and hiking – especially in good weather! I cycle too, as a means of getting around, but it’s so much rigmarole to get ready and make sure I’m visible on the London streets!
I try to practice what I preach as a physiotherapist and maintain a variety and quality of movement. I am working on a new goal, to be able to do handstands, as well as improving my headstands – both in duration and grace!
I have recently rekindled my love of climbing which I last did many years ago in the Austrian mountains.
Patsy Beck is a chartered physiotherapist with specialist training in neurophysiotherapy and neurodevelopmental physiotherapy. Over her decades of experience, she has improved the lives of people of all ages, with symptoms related to cerebral palsy, stroke, neurodegenerative disorders, pain conditions, and more. She has a reputation for success with patients that have previously struggled to make improvements. She is currently available to see patients in clinic on Sundays, and Home visits during the week. Get in touch to find out more.
