Neurological Physiotherapy in Private Practice

 

NEUROLOGICAL PHYSIOTHERAPY

Neurological Physiotherapy is a specialist area of physiotherapy focused on the treatment of individuals with neurological conditions. Neurological disorders affect the functioning of the brain, spinal cord, and nerves. Stroke, multiple sclerosis, spinal cord injury and Parkinson’s disease are common neurological conditions . It also includes conditions of the peripheral nervous system such as Guillain Barre Syndrome. Neurological conditions can have a devastating impact on the lives of the sufferers, along with family and friends. Disturbances in the travelling of messages between the brain and the body can result in the loss of movement, sensation, co-ordination, and balance. Other aspects of bodily function, such as perception, speech, memory, cognition, and behaviour may also be effected. Therefore, it is important that neurological physiotherapists work in close partnership with other members of the multidisciplinary team including speech and language therapists, occupational therapist, dieticians, nurses, and doctors. Effective communication between patient, family members, and the multidisciplinary team is critical to positive healthcare outcomes following a neurological disorder .

AIM OF NEUROLOGICAL PHYSIOTHERAPY
Neurological Physiotherapy aims to provide interventions which assist an individual to regain or maintain the maximum movement and functional independence by aiding in the development of new pathways through repetition and exercise.

TREATMENT INTERVENTIONS
A number of treatment approaches are used, often incorporating a selection of the following as appropriate

Stretching
Strengthening
Balance re-education
Gait re-education
Joint mobilization
Electrical stimulation
Postural exercise
Spasticity management
Advice/Education on lifestyle, fatigue management, and exercise

PREVALENCE OF NEUROLOGICAL CONDITIONS.

The Neurological Alliance  reported the total number of neurological cases in England to be 12.5 million or 59,000 cases per CCG in 2013-14, with a further 1 million cases in Scotland reported in the NHS QIS Clinical Standards on Neurological Health Services . 

Figure 1:

Figure 1 represents the most common neurological conditions in England.

Image 1 illustrates the number of neurological conditions and the distribution of cases between progressive, intermittent, stable with changing needs, and sudden onset.

Image 1: 

Within NHS Lothian, it is estimated that 53,480 people are living with a neurological condition. The number of people disabled by the condition is 5,348 and an estimated 1,872 people will need assistance carrying out activities of daily living. Each year, a further 8,489 people in Lothian will be diagnosed with a neurological condition 

PUBLIC PERCEPTIONS OF NEUROLOGICAL CONDITIONS.

A study conducted by Sue Ryder revealed that 45% of the UK population feared being impacted by a neurological condition the most which is compared to 36% who feared getting cancer. The study highlighted the beliefs of the public with regards to neurological conditions, showing that 26% of the public felt that “nothing much can be done” for people with neurological conditions . It is understandable why the general public fear being effected by a neurological condition when one takes into consideration patients poor experience with neurological healthcare. The Neurological Alliance conducted a neurological patient experience survey in 2014 .  

Figure 1 illustrates the population responding to this survey

Figure 2 indicates the neurological conditions represented in the survey.

The survey stated that 58.1% (n=3402) of NHS England respondents (n=6916) have experienced difficulty accessing the service/treatment they require, 39.8% (n= 2357) of respondents had a 12-month waiting period from the time of observation of the first symptom to seeing a neurologist specialist, 31.5% of respondents (n=2140) had 5 or more GP visits related to the health problems experienced due to their condition prior to being referred to a neurological specialist, and 71.5% (n=4603) of respondents were not provided with a care plan to help manage their condition .

WAITING TIMES FOR NHS NEUROLOGICAL SERVICES

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The 2005 National Service Framework for Long-term Conditions (Link in document) identified the need for prioritising an accurate and rapid diagnosis of neurological conditions, highlighting the importance of early diagnosis within this clinical population to reduce neurological damage, delay disease progression, elevate survival numbers, and enhance patient’s quality of life. However, it appears in 2014 that this call to action had not been achieved with 3,402 respondents to the neurological patient experience survey voicing concerns regarding challenges experienced trying to access the treatment and services they needed.
“Waiting times for some assessments or appointments can be stupidly long, often due to funding issues. For example, I often have to wait around six months between appointments with my specialist” Respondents opinions emphasized the concern of long waiting times especially transitioning from general practice to specialist care settings.
The Invisible Patients: Revealing the state of neurology services.
In December 2011, a survey of NHS Physiotherapy waiting times in the UK was published, showing that in neurology departments, the longest wait reported was 2-4 weeks and 83% of neurological patients were seen in 8 weeks or less. The shortest wait was less than a week and the longest wait was 18-20 weeks.

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