Neurological physiotherapy in brain injury rehab

Guy Stewart, Neurological Physiotherapist at Richardson Care has been working in this specialist branch of physiotherapy for over 13 years. 

Richardson Care provides specialist rehabilitation and residential care for adults who have acquired brain injury, learning disabilities and associated physical disabilities and complex needs.

Service users present with a wide range of physical needs and abilities. For example, they may or may not be able to bear their own weight, they may need support with sitting balance, standing, walking or any aspect of functional living. 

The goal of neurological physiotherapy is to improve someone’s physical function. This may involve improving mobility, strength, flexibility, balance and/or posture.

Because a neurological condition affects each individual in a different way, Guy completes a full assessment before working out a therapy plan. This is then reviewed and reassessed on a regular basis, with goals set that are personal to each individual.

Multi-disciplinary teamwork 

Many of the service users have complex needs, so working with a multi-disciplinary team (MDT) is essential.

Guy works closely with other members of the MDT, which helps to find the best ways to support service users and help them engage in physiotherapy. Often he has to think outside the box to find the right solution as everyone is different. 

When someone is admitted to Richardson Care, it’s a new environment for them and there are lots of different people to get to know. It’s therefore very important for each therapist to build a rapport with them. Someone may be reluctant to engage in physiotherapy initially, for many different reasons, so it’s a step-by-step approach, slowly building a relationship and trust. This is where teamwork comes in.

Sometimes input from the neurological speech and language therapist is needed to understand someone’s communication needs, or it may be psychological support that is required. In addition, the team at Richardson Care may be in close contact with the individual’s family.

Individual person-centred care

As with all aspects of neurological support and rehabilitation, there is no one-size-fits-all approach.

Guy says: “You have to treat everyone as an individual, which sounds very obvious but that isn’t always the case that happens.”

Guy cites an example of a service user who didn’t want to engage in physiotherapy when he arrived at Richardson Care. However, after a discussion with his family, Guy discovered that the man supported a particular football team and liked a particular band. Therefore, at the start of each session they now have a chat about football and Guy also plays the man’s favourite music.

These connections help to build a rapport and bring the man on board to start the physiotherapy.

Guy adds: “You have to change your approach sometimes, so we just talk for the first 10 minutes.”

Supporting Tom to achieve his goals

This video shows Guy working with Tom, a young man who has a diagnosis of learning and physical disabilities. Guy has a great rapport with Tom and there are lots of jokes during their session.

Tom uses a wheelchair and often adopts a posture when he’s in his chair of holding his arms tightly into his body. The neurological physiotherapy involves transferring Tom to a tilt table and helping him to increase the range of movement and strength in his arms and upper body. In addition, by being on the tilt table, Tom gets to put his weight through his feet, which he doesn’t do very often.

The next stage that they are working towards is for Tom to use a standing frame. Once he can weight-bear, the next goal is to use the re-turn for transfers, rather than being hoisted. This will be an important achievement for Tom, helping him feel more independent, and he’s really engaged in that goal.

Helping someone to be as good as they can be

Guy adds: “[If someone has sustained a brain injury] quite often, you won’t get someone to where they were pre-injury, but you can make them as good as they can be, and then it’s really important to maintain that level.”

He concludes: “To work in the area of neurological physiotherapy, you have to be passionate about what you’re doing because you don’t necessarily get those quick fixes…you often have to look at the long-term gain. You build up relationships with people so it’s a very rewarding area to work in.”

Richardson Care provides specialist residential and rehabilitation services for adults with acquired brain injury or learning disabilities and complex needs in Northampton.

For more information go to www.richardsoncares.co.uk or call 01604 791266.