• Parkinsons Disease
This is a progressive neurological disorder mainly affecting the brain
centres responsible for movement.
What is it?
Normally nerve cells in the part of the brain called the basal ganglia
produce dopamine, a chemical messenger used to transmit nerve impulses
from the brain to various parts if the body.
In Parkinson's disease degeneration of these nerve cells means not
enough dopamine is made and messages transmitted from the brain to
the muscles become less efficient.
 Symptoms
Hand tremor is often the earliest sign. Other symptoms include slowness
of movement, muscle rigidity, poor coordination and clumsiness. As
the disease progresses movement and everyday tasks such as dressing
and writing become more difficult.
Speech may also be affected. A person with Parkinson's may develop
an expressionless or 'mask-like' face. Many people experience depression
and some develop dementia.
After several years sufferers may develop a shuffling walk without
arm movement. Initiating activity may be difficult but once started
they move too fast and end up almost running.
Treatment
Treatment involves medical management through the use of medications
and therapy. Physiotherapy intervention is based around postural education,
self management and prevention of complications.
• Stroke
A stroke is when an area of the brain is deprived of its blood supply
for 24 hours or more - usually because of a blockage or burst blood
vessel - causing vital brain tissue to die. It's essentially the same
as what happens in the arteries leading to the heart when someone
has a heart attack, which is why a stroke is sometimes described as
a 'brain attack'. There are two main types of stroke:
Ischaemic stroke
In this, the most common type of stroke, the artery is blocked by
a blood clot, which interrupts the brain's blood supply (ischaemia
means to restrain blood in Greek). This may be due to a cerebral thrombosis
(sometimes called a thrombotic stroke) where a blood clot forms in
the main artery leading to the brain, or to a cerebral embolism (sometimes
called an embolic stroke) in which a blood clot forms elsewhere in
the body and is swept into the arteries serving the brain.
Haemorrhagic stroke
In this type of stroke a blood vessel in or around the brain ruptures
causing bleeding, or a haemorrhage. The build up of blood presses
on the brain damaging its delicate tissue, while other brain cells
in the area are starved of blood and damaged.
In an intra-cerebral haemorrhage the bleeding occurs inside the brain
itself. In a subarachnoid haemorrage the burst blood vessel bleeds
into the subarachnoid space surrounding the brain.
• Transient ischaemic attack (TIA)
A transient ischaemic attack, often known as a mini-stroke, is when
the blood supply to the brain is interrupted for a shorter period
of time - anything from a few minutes to 24 hours - followed by complete
recovery. In around one in five people it can be a warning sign of
a subsequent stroke.
Treatment
The process of rehabilitation may include physiotherapy, speech and
language therapy, occupational therapy and psychological help Starting
rehabilitation as early as possible can substantially improve recovery
and reduce the effects of disability.
• Multiple Sclerosis
Multiple sclerosis (MS) is a progressive neurological condition that
results in disturbed transfer of messages from the central nervous
system to the rest of the body. As there is no cure, medical treatment
concentrates on symptom relief.
There are several different types with different patterns of disease.
Of these , one in five sufferers have a benign form with mild attacks
and no permanent disability, while another 15 per cent have a progressive
disease that steadily worsens.
MS has a wide range of symptoms, is unpredictable, and affects everyone
differently. Symptoms vary depending on the type of MS - but typically
wax and wane. The condition can affect any part of the body but usually
starts with a single episode of nerve dysfunction, classically inflammation
of the optic nerve in one eye. Other common symptoms include:
• double or blurred vision
• numbness or tingling in any part of the body
• tiredness
• temporary blindness
• fatigue and dizziness
• distortion or loss of sense of touch
• limb weakness, spasticity and pain
• incontinence
• constipation
• cognitive impairment
Treatment
This is based around symptom relief and includes medication and therapy.
Physiotherapy can assist in pain relief, decrease of spasm and improved
functional movement.
•Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis (or Encephalopathy)
(CFS/ME)
What is it?
CFS/ME is a relatively common illness. The physical symptoms can be
as disabling as multiple sclerosis, rheumatoid arthritis and other
chronic conditions.
CFS/ME involves a complex range of symptoms that includes fatigue,
malaise, headaches, sleep disturbance, difficulties with concentration
and muscle pain. The pattern and intensity of symptoms vary between
people, and during the course of each person’s illness. People often
have symptoms for many years before CFS/ME is diagnosed. The causes
and disease processes of CFS/ME are still not understood.
Treatment
There is good evidence that with the right treatment it is possible
for people to be helped to manage the condition, with the aim of maintaining
and extending their physical, emotional and cognitive capacity.
Graded Exercise Therapy (GET) and Cognitive Behavioural Therapy (CBT)
are the treatments for which there is the clearest research evidence
of benefit. GET should be delivered by a suitably trained GET therapist
with experience in CFS/ME. This is often, but not exclusively a Physiotherapist.
• Incontinence
Many women, young and old, suffer from leakage of urine or faeces.
The most common type of Urinary Incontinence is Stress Incontinence
when urine leaks during activities such as coughing, sneezing, laughing
and running. Urge Incontinence is where you leak when you have a sudden
urge to go to the toilet and can be associated with frequency or urgency.
Faecal Incontinence is when you leak from your back passage or have
difficulty controlling wind.
Treatment
After evaluating your symptoms with the on-line e-PAQ questionnaire
and a simple chart, your specially trained physiotherapist will perform
a vaginal examination to examine the pelvic floor. Physiotherapy Treatment
consists of looking at your bowel or bladder habits to see if any
simple lifestyle changes can help. If your pelvic floor muscles are
weak, this can cause incontinence, so physiotherapy will aim to strengthen
these muscles. Sometimes, it is necessary to stimulate the pelvic
floor muscles with an electrotherapy unit similar to a TENS machine
in order to help them become stronger. In some women, the pelvic floor
muscles are over-active and they need to be taught how to relax rather
than tighten.
If you wish to discuss any aspect of the assessment or treatment prior
to making an appointment, please contact the Practice and ask to speak
to Alison Bourne, our Specialist Women’s Health Physiotherapist. If
she is not available, your contact details will be taken and she will
call you back as soon as she is free.
• Back and Pelvic Pain in Pregnancy
Around half of all women who become pregnant will develop back or
pelvic pain at some point during their pregnancy. Pain can be felt
in the lower back or buttocks or over the pubic bone (called Pubic
Symphysis Dysfunction). The pain is often worse on one side and may
even swap sides from one day to the next.
Pain that comes from the back is often different to pain that comes
from the pelvis. Pelvic pain is often misdiagnosed as sciatica and
as the treatment for these two conditions is quite different, it is
important to have a full assessment from a qualified professional,
experienced in the treatment of pelvic pain in pregnancy, in order
to decide how to treat the pain.
Treatment
Pelvic Pain usually occurs when the pelvic joints are ‘unlocked’.
Treatment involves learning how to ‘lock out’ your joints during your
daily activities to control the pain. A support belt will help to
control some of the movement in your pelvis and you will be taught
exercises to stabilise your pelvis. Uneven stiffness in your back
or hips may also cause the pelvic joints to become over-stressed and
mobilisation of these joints will help to reduce symptoms. Acupuncture
can often help with pain relief and also with relaxation and sleep.
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