Adult neurological physiotherapy refers to the rehabilitation of people aged over 18 with neurological conditions. At Precision Neuro Physio we have experienced adult neurological physiotherapists who offer specialised physiotherapy treatments for people with many different neurological conditions.

At Precision Neuro Physio we manage a number of neurological conditions, including:

• Multiple Sclerosis
• Parkinson's disease and other movement disorders
• Cerebral Palsy
• Stroke/ paralysis
• Motor Neurone Disease
• spinal cord injury
• head injury
• peripheral nerve injury
• Guillian Barre Syndrome
• Post COVID neurological complications
• Dementia
• Cerebellar Ataxia
• Bells palsy
• Muscular dystrophy
• Vertigo and other vestibular disorders

These are to name a few of them

Our specialised physiotherapists will initially provide a thorough assessment before developing a structured treatment programme unique to your needs. Treatment programmes may include:

• Improving standing and quality of walking
• Strengthening
• Balance exercises
• Developing gross and fine motor skills
• Re-educating normal movement patterns
• Stretching
• LSVT BIG therapy
• Constraint Induced movement therapy
• Dynamic Neuromuscular stabilization
• Kinesiology taping
• Dry needling
• Functional Electrical stimulation
• Treadmill training
• Visceral manipulation
• Vestibular rehabilitation
• Aquatherapy
• Offering guidance and advice to family and carers
• Offering telerehabilitation/ online consultation whenever needed

Physiotherapy regularly utilises hands-on treatment combined with exercise  and technology to aid improvement. Precision Neuro Physio uses a mixture of various neurological physiotherapy principles, including the Carr and Shepherd Concept (motor relearning), Brunstrom Approach (synergistic movement), the Bobath Concept (normal movement), task oriented approach and functional rehabilitation. Your treatment approach will be determined by your individual requirements to ensure the best possible treatment is offered.

Depending on your needs, adult neurological physiotherapy treatment is offered in the comfort of your own home, or at our clinics.

For adults with physical neurological problems physiotherapy should begin almost immediately. At Precision Neuro Physio we are therefore able to offer early intervention.

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What are pelvic floor muscles?

The pelvic floor muscles give you the ability to control the release of urine (wee), faeces (poo) and flatus (wind) and to delay emptying until it is convenient.

When you contract the pelvic floor muscles, they lift the internal organs of the pelvis and tighten the openings of the vagina, anus and urethra. Relaxing the pelvic floor allows passage of urine and faeces.

This function is especially important if your urethral or anal sphincters (muscles) do not work normally, as may be the case after giving birth or after prostate surgery.

Pelvic floor muscles are also important for sexual function in both men and women. In men, it is important for erectile function and ejaculation. In women, voluntary contractions (squeezing) of the pelvic floor contribute to sexual sensation and arousal.

The pelvic floor muscles in women also provide support for the baby during pregnancy and need to be relaxed during the birthing process.

Common problems with Pelvic Floor Muscles

Like any other muscles in our body, the pelvic floor muscles can become too weak or too tight. They can also be overstretched or torn with injury or traumatism.

Weak pelvic floor muscles

Low-tone Pelvic floor muscles can lead to stress incontinence and pelvic organ prolapse.

USI or Urinary Stress Incontinence is when you leak when coughing, sneezing, running or laughing.

Organ prolapse happens when the too loose pelvic floor muscles and their surrounding fascia do not hold sufficiently the pelvic organs leading to a descent of the bladder, uterus or rectum.

The good news is that the training and strengthening of pelvic floor muscles have shown to be effective in many conditions. Your physiotherapist will prepare a specific exercise programme to train and strengthen pelvic floor muscles. Other approaches may be used such as manual therapy, biofeedback and electrotherapy technique. Tight does not mean strong muscles

When pelvic floor muscles are in spasm or unable to relax, strengthening exercises may just exacerbate the symptoms. Pilate core type exercises which focus on tightening the pelvic floor muscles would not be appropriate. We must first treat the tension and then only the weakness.   It is

difficult to initiate or activate hypertonic pelvic floor muscles if they are not able to relax towards the basic resting tone.

Physiotherapy treatment for hypertonic pelvic floor muscles usually includes "hands on" manual therapy, diaphragm breathing, awareness exercises, biofeedback and down-training approaches to relax and lengthen the pelvic floor.

Lack of awareness, coordination and control

Pelvic floor muscles are not easy to work out simply because women and men are often not aware of the pelvic area and simply due to the difficulty of seeing them!

Scar tissues and adherences

Scar tissues, adherences and nerve damage can cause pelvic floor tension and pain. Childbirth, perinea! tears, surgery, endometriosis or radiation can affect abdominal and pelvic function.

Lack or excessive local sensitivity.

Sensitivity issues may lead to difficulty in feeling and controlling the muscles, lack of sexual sensation or pelvic and sexual pain. Tight or overactive pelvic floor muscles

Muscles are not only about strength. Their ability to relax and lengthen is as important. A stiff neck can bring neck pain or headaches. Short, tight or hypertonic pelvic floor muscles can bring many problems which are often misdiagnosed such as:

Urinary frequency and urges or the inability to empty completely your bladder or bowels.

Sexual pain during or after intercourse. When muscles are too tight, intercourse can be very difficult.

Pelvic pain such as pain in the genitals area (vulva, vestibule or penis) or around the rectum and the coccyx. Tight pelvic floor muscles can lead to unexplained chronic back or hip pain.

Constipation and pain with straining when emptying bowels.

Pelvic Floor Rehabilitation

The goals of Pelvic Floor Re-education are to help you regain a functional pelvic floor.

After a full, detailed evaluation and a physical assessment which might include manual vaginal or rectal examination, a programme of treatment is agreed, based on the findings, individual needs, goals and desired progress.

Pelvic Floor Rehabilitation may include pelvic floor retraining, manual therapy, bladder or bowel training, biofeedback, electrotherapy, education and advice.

Pelvic floor muscle retraining

The most important part of pelvic floor reeducation. We will first provide you with awareness techniques to make sure you are doing the right pelvic floor exercise. We will then tailor a personalized exercise programme towards a healthy pelvic floor.

We will teach:

How to identify and activate the right muscles

How to relax tight and overactive muscles

How to control and do the right exercise at the right time

How to coordinate the pelvic floor muscles with the diaphragm, the deep abdominals and the other core muscles

How to adapt Pilates exercise to your problem

How to control abdominal pressure and avoid damaging the pelvic area with high impact activities, wrong abdominals exercises or coughing

How to Integrate functional exercises according to your daily activities and sports

The pelvic floor muscles are skeletal muscles which means that you can voluntary control them and that they can be trained, retrained, strengthened just like you may do for your quadriceps by repeating the same exercise overtime.

• Manual "hands on· therapies

Manual therapy in pelvic floor problems aim to relax, lengthen, mobilise and alleviate pain. This may include internal vaginal or rectal techniques and/or external techniques to treat your muscles, ligaments, fascias, tendons, nerves and joints.

We use many manual techniques according to your needs such as soft tissue mobilisation, myofascial release, deep tissue massage, urogenital mobilisations, joint mobilisations, muscle energy techniques, nerve mobilisation, trigger point pressure, connective tissue manipulation and visceral mobilisation.

• Bladder and Bowel retraining

How the bladder or bowel function

Techniques to control your bladder or bowels

Advice on diet and fluid intakes as well as general advice

How to use a bladder or bowel diary

• Biofeedback

Biofeedback is very useful tool to help you connect with your pelvic floor muscles and for retraining weak or over-active muscles. It makes it easier to control the muscle activation during functional and sports' activities. It also assists in creating strategies to confront or reduce pain.

Biofeedback provides information on a screen about when and how strong you contract or relax a group of muscles. External electrodes or a vaginal or rectal probe connected to the biofeedback machine measure the strength of the muscles and the resting tone. The readings are useful for outcome measures and to show your progression.

• Electrotherapy

Muscle electrostimulation can be used to enhance awareness and to remind very weak pelvic floor muscles how to work and to assist in strengthening the muscles.

Other electrotherapy modalities are used for overactive bladder and for pain relief as TNS (Trancutaneous electrical stimulation) and Ultrasound.

• Home Exercise Programme

You will be taught a progressive exercises programme, self-manual techniques and advice. For best outcomes and to achieve your goals, we encourage to play an active role in your rehabilitation and to put in  practice the advice we give and Home Exercise Programme.

• Patient education

We will teach you about your condition and give you tips and advice on specific lifestyle changes, advice on irritants and dietary/fluid modification advice and other behavioural modifications techniques.

• Acupuncture & Dry Needling

Acupuncture and dry needling can be used to help with pelvic pain conditions

Postural re-education Breathing, Relaxation Vaginal dilators Treatment of back pain