Physiotherapy Treatment at Home Services by Alyson Smith
Assessment and treatment – Physiotherapy treatment at home
During the first appointment Alyson will undertake a full assessment of your physical abilities and difficulties.
Her aim is to find out what your own needs are, any history of previous interventions and discuss together the most appropriate way of helping you. Treatment is a partnership, working together towards achieving your goals.
Alyson will explain the main issues we need to address, and how we can work on them. Together we can work out the best plan for you.
Education of clients of the recovery process plays a key role. It helps with their understanding of what has happened to them, and empowers them to take control in their recovery/or disease.
Often the session will include a number of key discussions of understanding, and so it can be helpful to have a family member, or friend, with you who can remind you of some of these things between sessions.
During the first session Alyson will share simple exercises and activities which you can do on your own or with the help of others (where appropriate) between treatments.
You will be given key points in writing, but some people choose to have someone videoing some of the exercises to aid memory.
How many sessions?
This varies. Some people have regular physiotherapy treatment at home (once or twice per week). This allows them to have regular support, to make changes.
Hands on treatment can improve range of movement, strength, balance, and help you to get into the routine of a regular exercise programme. The aim is to help you to change strength, mobility, balance in order to alter movement patterns and improve your abilities.
Others want assessment, advice, and to be shown an exercise/activity programme which is then reviewed a week or so after. Sometimes followed by a few “review” sessions. The goal here is to guide people into implementing their own activity programme, sometimes with the support of family/friends or carer. They self re-refer for reviews, if, or when, they feel necessary.
For some examples of what you could be doing at home, see my you tube videos for exercises and ideas https://www.youtube.com/watch?v=c80N_PieFcA This link will take you to my first video.
click on my account (the photo of me with my dog) to see all my other videos.
Enjoying movement again
Following a major event, or with gradual deterioration the enjoyment of moving can be lost. The thought of movement can be something which is dreaded and makes you feel fearful (of falling or pain).
During sessions we will work to rediscover how to explore your movement, in a safe and effective way. Helping you to be able to be curious about how you move. Guiding you to gently push at your boundaries, to rebuild confidence.
The ultimate goal is to make movement (as far as possible) feel like a positive and joyful thing again.
Here are some of the neurological conditions Alyson frequently treats.
- Multiple Sclerosis
- Parkinsons Disease
- Stroke
- Traumatic Brain Injury
- Huntington’s disease
- Spinal cord injury
- chronic fatigue
- Functional Neurological Disorder
The list is not exclusive, she has a wide range of experience, including some of the rarer conditions such as meningitis, Friedreich’s ataxia and motor neurone disease. She has worked with case managers and their teams in the rehabilitation of patients with complex needs
During her time working in rehabilitation Alyson worked with people with mobility problems. These may be people who’s mobility has gradually reduced, or those who have lost confidence following a fall.
Other more complex cases include loss of mobility caused by generalised weakness following prolonged periods in hospital, multiple joint arthritis, unexplained loss of balance, or severe anxiety. Or multiple pathologies common in the elderly.
She has found that improving the client’s confidence and reducing fear (of falling or pain) works well. There have been many instances of people being able to stand or even walk following prolonged periods of bed or chair rest.
Treatment looks at helping you to reduce your anxiety (of pain, injury or falls) through gentle, controlled reintroduction of movement and standing. The ultimate aim is to be able to work on your strength, balance, and general mobility through positive experiences of movement.
When helping others to become mobile again it is important to go at their pace, ensuring that they feel safe and supported at all times. From this more confident place they can learn to explore their movement and even begin to enjoy standing/walking again.
- Self-referrals/family
- Case managers
- Solicitors
- Physiotherapists
- Occupational therapists
- Speech and language therapists
- Psychologists
- Voluntary organisations
- GPs
- Consultants
- Nurses/care homes.
Please note that I am only registered with CIGNA health insurance company. Please check your insurance company before booking for treatment which you expect to claim for.
On some occasions Health insurance companies have accepted receipts for part reimbursement. However it is your responsibility to check this and amount of payment/sessions they will allow for home visits.
Alyson does not sell or issue equipment but is happy to advise on the possible need for and choice of specialist equipment such as wheelchairs, walking aids, positioning and assistive aids.
She may provide (on request) information of a third party who will bring wheelchairs/armchairs for you to try. This can sometimes be more costly, however it is better to buy the correct equipment the first time, rather than replacement of something which turns out to be unsuitable. She has no financial or otherwise connection with the companies she suggests.
Advice for nursing/care homes regarding their residents who are repeat fallers. Together with general advice about how to make their environments more encouraging for residents to maintain their mobility and confidence.
I offer training for staff to help them to recognise fear of movement in their residents and to help them to build resident’s confidence. “Fear, its effect on the way we move and how to overcome this and build confidence”
In addition there are training sessions for activity coordinators who want to run “move with confidence” exercise classes for their residents. Visit my education for more information.
The process
Following telephone discussions to understand your requirements. I will come and meet with senior members of staff to discuss residents who are regular fallers or in danger of falling.
We then briefly meet each resident to assess an individual resident’s environment. Then advise, where possible, on environmental changes which could have a positive effect on safety/mobility.
Due to time constraints it is usually not possible to carry out a full physiotherapy assessment of the individuals. Often it is possible to ascertain whether future referral to physiotherapy/occupational therapy services would be of benefit.
I can often advise whether trial of alternative aids may be useful. Plus, offer suggestions by way of alternative handling or positive changes which may increase confidence in staff or the resident.
Conditions
The effects of stroke are wide and varied, and how a person responds to their stroke is just as varied.
During the assessment phase Alyson will find out your main goals and what is your best way of working towards them.
Together you will work on regaining sensory awareness, and the reintegration of your affected side into normal movement. She has found that some people can regain abilities over long periods of time, and can find improvement even if the stroke occurred many years ago.
The effects of a left stroke and right stroke are not the same. There can often be complex changes to attention and sensation in the affected side which require experienced and knowledgable interventions. Alyson’s extensive years of experience have helped her to achieve a good level of success with some people who have suffered very severe strokes.
Alyson will discuss with you the areas you are working on, and how changes can be made. Likely outcomes are discussed, although it is usually impossible to predict exact levels of recovery or how long they would take. In general we aim high in the hope of getting further. However, it is important to her to be of the highest integrity at all times and she will work together with you, discussing goals and aims at regular intervals.
Alyson has links with her local Headway and has given a well received talk to their members.
Alyson has extensive experience in working with many people with Traumatic Brain Injury (TBI). Some individual cases, supporting them over a period of many years.
She has a good understanding of how the care pathway works and has worked with case managers and other expert members of the team to support and maximise recovery for the person and their family.
She works to find out the individual’s own goals and main aims and forms a team with all involved to ensure they are effective in gaining full potential and maximising activity.
Her coaching training is integrated with her physiotherapy interventions to aid motivation and team work, for more successful working practices and outcomes.
Alyson has delivered a well received talk to the local Headway support group.
Alyson has experience in treating people with this Huntington’s disease, including treating two people with Huntingdon’s over a long period of time.
The main aims during treatment is to encourage regular, fun exercise which keeps the person as active as possible for the longest period of time. An important part of physiotherapy intervention is sometimes education and support for caregivers, working together in the support of maintaining or improving physical ability for the client.
Often we look at risk and weigh up the pros of keeping active over the cons of risk of injury from falls. Largely we find that keeping active far outweighs the risk of falls, but this is a personal decision for each individual and their caregivers.
Please see my blog written about the wonderful experience I had working with an incredible woman who had HD
https://www.neuro-physiotherapist.co.uk/physiotherapy-for-huntingtons-disease/
When working with people with Parkinson’s disease it is important to have a good knowledge of how the disease can progress. This helps with the correct implementation of timely exercises.
The global effect of Parkinson’s is to reduce extension, flow, size and freedom of movement. Treatment is aimed at working with individuals to find THEIR best way of accessing the biggest and most free flowing movement possible.
The use of fun, automatic movement such as activities with a balloon or ball, or swaying/moving to music can be very effective.
Most important is to work at the correct speed and right level for the individual to boost confidence and the ability to relax and enjoy movement again.
Treatment is very much done in discussion with the individual and how they can implement positive movement practices into their daily activities without increasing fatigue or stress. We cover “good practise” and tricks such as the use of well placed post-it notes to remind people at key points to “look up” and to look through doorways which may be causing “freezing”.
There are positive changes to range of movement, strength and finding “tricks” to create automatic movement which can really make an improvement to your physical and mental abilities.
Main areas which I have found to be essential to attend to when first diagnosed are:
- Finding a way of relaxing which suits you. The reduction of stress can be a very powerful tool in helping yourself to be more in control both of general energy and physical/cognitive ability.
- Maintenance of relaxed feet (often with reduced balanced one foot will become tight, creating further problems with balance in the future).
- Acceptance of how you are “on that day” and allowing yourself to respond to the day to day changes which are often a feature of PD. Sometimes by not pushing too hard, and with relaxation you can make it a “better day”. Helping others to understand that you may vary from day to day reduces the pressure (and stress) to over achieve.
- Learning to relax your eyes so that they do not become too fixed on the floor. Looking up (or forwards) has a very positive effect on maintaining extension (or fighting the flexed posture which often occurs with PD)
- Getting into the habit of “just standing” so that you can experience a positive, balanced upright posture which feeds back into your system that standing and moving is good
- Find a ball/shuttlecock activity which you can enjoy, so that you regularly experience fun movement which is automatic. Badminton or balloon tennis (played standing or seated) are good examples of this.
Alyson has delivered well received talks to her local Parkinson’s disease society.
Having worked with clients with Multiple Sclerosis (MS) for many years, Alyson has seen how the disease may progress and how timely interventions can make great differences to how the disease effects people’s lives.
She will discuss with you what are your priorities and how we can work to improve your abilities, implementing into your daily routine so that they become a regular habit.
Often treatment will focus on improving sensory awareness of limbs, working to begin strength and control, and reducing any swelling or spasms.
When looking at day to day activities we will take into account your levels of energy or fatigue, and how you can vary your activities to positively influence this depending on the day (or weather/heat!).
Wherever possible we will look at maintaining good posture, standing balance, active standing, walking, sports or, when necessary, appropriate use of standing aids.
She has extensive knowledge of use of mobility aids, positioning aids, wheelchairs, armchairs, and orthosis and is happy to advise on their use.
When people suffer from regular falls or “near misses” this often sets up a chain of events which creates a loss of confidence.
This often leads to:
- avoidance of standing unless to carry out essential activities (such as trips to the toilet)
- over-use of arms for support. Seen by “furniture walking”, leaning on, or reaching for, anything which may make them feel more secure.
- over use of eyes, by looking at the floor instead of ahead
Whilst this can create initial feelings of safety they lead to a reduction in ability as their legs become weaker, and balancing no longer happens through their feet, but through their arms (as they begin to dominate standing more and more).
Looking at the floor reduces use of other sensory reactions, creates too much flexion and makes standing up straight a rarity.
Alyson has extensive experience of working with individuals to teach them about the negative effects which often happen following falls. Helping people to implement simple, regular exercises and changes to how they move to increase confidence and improve balance. Often changes felt are fast and effective.
Having a caregiver or family member/friend with you for the initial assessment helps you to implement the activities on a daily basis to help with carry over of improvements.
Alyson has run courses for care-homes to help the caregivers to understand and notice when negative changes are happening and how to help their residents to improve their balance and confidence.