Physiotherapy

Home visits / 1:1 sessions – We provide therapy sessions in your own home following the CSP guidelines for physiotherapy treatment.
We also provide online assessments and sessions.

You will receive a thorough condition-specific and holistic physiotherapy assessment, and we will devise a plan together, based on your goals.

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Neurological Physiotherapy

Neurological Physiotherapy is a specialist type of physiotherapy, whereby Therapists have undertaken further training and gained experience working with people who have had injuries or damage to their nervous system.

⦁ The most common conditions are Stroke, Multiple Sclerosis, Parkinson’s Disease and Spinal Cord Injury. Neuro Physiotherapists will have treated people with a variety of other conditions such as Motor Neurone Disease, Peripheral Nerve damage, Vestibular problems and congenital conditions.

⦁ Damage to the nervous system can lead to symptoms such as muscle weakness or stiffness. Other problems can include increased pain, altered sensation, tremor, spasticity or balance impairments.

⦁ These symptoms impact on functional tasks such as moving around the house, access to work and on everyday life and leisure pursuits.

⦁ A Neuro Physiotherapist will support and teach you methods and strategies to improve how you move and make these functional tasks easier and more efficient. This may include facilitation techniques, strengthening programmes or knowledge of specialist equipment or aides.

⦁ Advice to the client, families and carers is a very important part of the rehabilitation process.

⦁ Setting up self-management programmes for people with long term conditions will maximise their independence and function.

“Caroline Bullock has been coming to us from the time when my husband left the hospital after a stroke. She helped us with the shock of his sudden immobility and then set clear and realistic goals to strengthen his muscles and encourage him to stand. Her skill and optimism have encouraged him to progress”
Maureen, wife of Tim

Home Based Physiotherapy

Home Based Physiotherapy provides therapy in the comfort of your own home.

Post operation – after hip or knee replacement for example. A physiotherapist can review and progress the exercises set in the hospital. We follow post operative protocols and liaise closely with the Orthopaedic team. We aim to work towards gaining your independence so that you can return to the activities you enjoyed before the operation. Often you become more active than you were before.
Long Term conditions that impact on your mobility – If you feel your mobility is being affected then you can give us a call and we can discuss whether we can assist with your rehabilitation or connect you to one of our physiotherapy colleagues.

Peter had several weeks of physiotherapy with Caroline after a hip replacement following a fracture of the neck of his femur.

“Caroline carefully supervised his exercise programme, gently encouraging him to persevere and managed to restore his confidence. Now, after 6 months, his mobility is impressive. He enjoys long walks and just joined a new exercise class using weights. He is 86 years old.”
Thank you, Caroline. From Marietta, Peter’s wife

Common Neuro Conditions Treated Include:

Stroke (Cerebral Vascular Accident)

A stroke occurs when the blood supply to part of the brain is cut off. Lack of oxygen to the brain results in damage to the brain tissue. This can be due to a blood clot (emboli) or a bleed (haemorrhage).

A stroke can affect people in different ways. Usually the problems people have after a stroke are related to the area of the brain that has been damaged. As a rule, a stroke on the right side of the brain will affect the left side of the person’s body and vice versa. This is referred to as hemiplegia. The person might also have problems with their speech, swallowing, cognition and behaviour depending on the site of the damage.

After a stroke the brain can regenerate/ recover. This means that new pathways in the brain can be formed allowing an individual to carry out tasks that were initially lost when the stroke occurred. Also, individuals can learn new or adapted ways in which to perform tasks, allowing them to maintain independence in the home environment. People need assistance from specialist teams to maximise this regeneration/ recovery.

Most people who have had a stroke will have spent some time in hospital and will have received rehabilitation. Rehabilitation usually involves being seen by a team of therapists and doctors to maximise a person’s independence prior to going back home. A Neurological Physiotherapist is a member of this team. Once home the person might receive ongoing rehabilitation for a period. Often NHS provision is limited by the number of treatments available or waiting list pressures. Therefore, more and more people are looking to the private sector to bridge the gap in provision. This is where ‘mobile neuro physio’ comes in.

A Neurological Physiotherapist has the skills to assist people improve their functional ability. A holistic assessment is carried out by the physiotherapist and a rehabilitation plan is set out tailored to the individual’s needs. This might be a short course of treatment to bridge the gap between hospital discharge and community services, regular rehabilitation or the setting up of a maintenance programme.

Caroline has worked with people who have had a stroke throughout her career. She enjoys keeping up-to- date with the latest evidence based practice and strategies to assist people who have had a stroke maximise their independence. Please get in contact for a chat!

Multiple Sclerosis (MS)

Multiple Sclerosis is a condition that can affect the nerves of the brain and/or spinal cord. The insulating sheath (myelin )around the nerve becomes damaged. The signals along the nerves become delayed or do not reach the muscles and therefore muscles become weaker. This nerve damage can occur in all parts of the body, therefore affecting arms, legs, trunk muscles, and speech muscles. There are different types of MS. Neurological physiotherapy can assist with all types. A Neurological physiotherapist can teach exercise, standing and stretching programmes. They can re-educate function and give postural advice.

Caroline worked as a specialist MS physiotherapist with Richmond NHS Trust and has a wealth of experience with assisting people with MS in their daily lives and exercise. Please get in contact for a chat!

Parkinson’s Disease (PD)

Parkinson’s Disease is caused by a lack of neuro-transmitter (dopamine) in the brain. Often the first thing people notice is a tremor in their hand. Or difficulty starting or stopping movements. They report problems walking, getting up in the mornings and getting dressed. A person with Parkinson’s often feels their balance is affected and they have frequent falls.

A physiotherapist can help with reducing the stiffness in the muscles and joints, and provide an exercise programme to improve posture and strengthen muscles. A therapist has the skills to teach movement strategies for functional tasks. They can also help with balance and gait re-training.

Caroline has worked at the Movement disorder clinic at King’s College Hospital, with individual clients and in specialist PD groups so has gained a lot of experience working with this client group. Please get in contact for a chat!

Spinal Cord Injury (SCI)

Spinal cord injuries, can occur for many different reasons. The most common is due to a traumatic event such as a motorbike accident. But a SCI can be caused due to illness, such as a tumour. The spinal cord can be completely severed (complete SCI) or partially damaged (incomplete injury). This results in loss of movement and feeling below the level of the injury.

Most people who have had a SCI will spend time in a specialist unit and will receive rehabilitation. A Neurological Physiotherapist will be part of that team. After the initial rehabilitation period the person is sent home. Follow up in the community varies depending on the resources available in that area. Therefore, people look to the private sector for ongoing rehabilitation and support.

A Neurological Physiotherapist can assist with ongoing therapy at home. This would involve continuing with maintaining and strengthening muscles which are still active. Practice of wheelchair skill and transfers in the community setting. Implementing a standing programme where appropriate. Giving advice on posture and positioning. In addition, teaching family/ carers on moving and handling techniques and stretches.

Caroline has worked with clients with SCI throughout her career both in the hospital and in the community setting. She keeps up-to-date with the latest technology available to help improve people’s fitness and participation. She has links with Specialist Therapists at Spinal Injury Centres. Please get in contact for a chat!

Traumatic Brain Injury (TBI)

A traumatic brain injury can occur because of direct trauma to the head e.g a sporting accident. But can also be due to a tumour or bleed to the brain. The symptoms of TBI vary, but can involve movement problems, speech and language problems, cognitive and behavioural problems.

Most people with TBI will have had a period of rehabilitation in hospital. A comprehensive care package will be set up and usually a community team will be assigned to the client to provide ongoing care and management in the community setting.

A private Neurological Physiotherapist is often employed to continue rehabilitation at home.

A Neurological Physiotherapist has the skills to assist people improve their functional ability. A holistic assessment is carried out by the physiotherapist and a rehabilitation plan is set out tailored to the individual’s needs. Rehabilitation can vary depending on the client’s needs. This would include setting up exercise programmes at home or at a local facility. Setting up a stretching and position programme at home. Or working on walking or transfer skills. Communication with other team members is essential.

Caroline has worked with people who have had a TBI throughout her career and keeps abreast of the latest evidence based practice and strategies to assist people who have had a TBI maximise their independence. Please get in contact for a chat!

Other Conditions

There are many other Neurological conditions. These include Motor Neurone Disease; Peripheral Nerve Injuries; Polyneuropathies and Muscle disorders.
Caroline worked at King’s College Hospital which is a regional Neurological Centre for the South East of England. While working here she treated and advised many people with different neurological conditions. She worked as the Physiotherapist in the Motor Neurone Disease Clinic and co-wrote a chapter on the Physiotherapy management of Motor Neurone Disease in the book “physical management in Neurological Rehabilitation, second edition “, edited by Maria Stokes.

Please get in contact for a chat!

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