How to treat neurological conditions with physical therapy

From U.S. News & World Report

By Vanessa Caceres

Physical therapy helps people improve their movement. You may think of physical therapy as something you use after a sports injury or after certain types of surgery. However, physical therapy helps with a variety of health issues. For example, breast cancer patients who have had their lymph nodes removed often get physical therapy to help with lymphedema. Physical therapy can also help with neurological disorders.

Neurological disorders (also called neurological diseases or conditions) affect the brain, spinal cord or nervous system. There are more than 1,000 neurological diseases. Some examples include:

  • ALS (amyotrophic lateral sclerosis)
  • Alzheimer’s disease
  • Cerebral palsy
  • Concussions
  • Epilepsy
  • Migraines
  • Multiple sclerosis
  • Muscular dystrophy
  • Parkinson’s disease
  • Spinal cord injury
  • Stroke
  • Traumatic brain injury

Nearly 100 million Americans were affected by neurological disorders in 2011, according to a report in the Annals of Neurology. This number will likely increase as the population ages. Stroke and Alzheimer’s disease were the fourth- and fifth-highest killers in the U.S. in 2017, according to the Centers for Disease Control and Prevention.

Physical therapists are trained, licensed professionals who focus on evaluating and treating problems that affect any type of movement, says Anne Aldrich, a board-certified clinical specialist in pediatric physical therapy at CHOC Children’s, a pediatric health care system in Orange, California.

Physical therapists help to improve movement, so people can more easily do the things they want to do, says physical therapist Julie A. Blank, owner of On the Go Therapy Services in Sarasota, Florida.

Physical therapy is a good fit for many people with neurological disorders because they may have problems with their movement. These problems are often caused by the disorder. Depending on the type of neurological condition someone has, movement problems can get worse as the disease progresses. This is the case with conditions like Alzheimer’s disease, Parkinson’s disease and ALS.

How physical therapy can help

“These impairments can be small or large and can have a varying impact on an individual’s ability to move,” Aldrich says. Here are a few examples of how movement problems affect people with neurological disorders – and how physical therapy can help:

  • A man had a stroke eight years earlier. The stroke caused him to walk abnormally. Now his knee hurts due to the way he walks. He wants his knee pain to get better.
  • A child with a neurological disorder may need to learn to walk with a cane. Before doing this, she needs to practice sitting and standing. Then eventually, she can learn to walk with the cane.
  • A woman has a traumatic brain injury. Now her feet and hands aren’t moving together when she walks.
  • A man with ALS wants to learn some simple exercises to help avoid joint pain and stiffness.
  • Caregivers for a woman with Alzheimer’s disease want to help prevent her from falling. A physical therapist practices balance exercises with her to reduce her fall risk.
  • A physical therapist helps a woman with migraines by performing manual therapy, which is a manipulation of the muscles used by physical therapists and other health professionals. These movements help to decrease pain and expand mobility in the head and neck.
  • An older man with Parkinson’s disease has physical therapy to help with repetitive twisting of the foot, which can happen with Parkinson’s. The exercises done in physical therapy help to strengthen his foot.

Physical therapists tailor their care to each patient. They work with patients to create realistic goals. This means the therapy that one person receives will be very different from the therapy someone else gets. For instance, a person who needs a little training with the mobility equipment he or she uses will have very different needs than someone who has just had a stroke and needs to get back to work in a couple of months, says American Physical Therapy Association spokeswoman Alison M. Lichy. She is also the owner of Neurological Physical Therapy in Falls Church, Virginia.

What to expect

Goals for physical therapy also are tailored for each person, and so are the frequency of physical therapy sessions. A person in the hospital due to a recent stroke or other major neurological injury may receive physical therapy and other types of therapy at the hospital a couple of times a day to help speed up progress.

Other patients may see a physical therapist a couple of times a week at a physical therapist’s office, although some therapists will come to a person’s home.

Sessions also can be done:

  • In a gym.
  • At hospice.
  • In a classroom or on a playground, which would be options for children.

It’s important to start physical therapy for neurological conditions as early as possible. Physical therapy can’t stop these conditions or their effects on movement entirely, but it can help slow down their progression, Blank says. “We can help to maintain things like good posture, balance and strength,” Blank notes. It’s harder to get good results if physical therapy starts later on.

Physical therapists help their patients get better with regular, repetitive exercises. Depending on a person’s goals, this can include practice with:

  • Balance.
  • Strengthening.
  • Stretching.

Even if the movements done during those exercises aren’t perfect, they help retrain the muscles and the brain to work together – something they may not have done for a long time.

Physical therapy for children with neurological disorders is a little different because sessions can be set up as playtime. For example, a therapist may have a child reach for a toy to help get them to practice rolling over or balance on one foot while playing ring toss in a pool. “This can make pediatric physical therapy both fun and satisfying for children and their parents,” Aldrich says.

An important part of physical therapy is the practice done outside of therapy sessions. Lichy says, “(Patients) need to know how to do activities at home and do them safely to maximize what they do outside of physical therapy.”

Patients who are motivated to progress tend to do better than those who want to be left alone. Blank says, “Our main job isn’t to provide therapy. It’s to teach and equip you to help you succeed moving forward. We give you the tools to help you get better or maintain what you have.”

Getting the most out of physical therapy for neurological disorders

If you or someone you care for needs physical therapy to help with a neurological condition, there are a few tips to keep in mind to get the best care possible:

  1. Find out about the therapist’s experience with neurological disorders. There are physical therapists who have a designation called neurologic clinical specialist, or NCS. Although physical therapists all have some knowledge of neurological disorders, those with the NCS designation have passed a special test to expand their expertise in this area. The American Physical Therapy Association can help people find a physical therapist and allows users to specialize if they want someone with neurological expertise.
  2. Clearly communicate about your problem. If your movement problem isn’t something that can’t be recreated when you first see a physical therapist, then try to take pictures or videos at home, and bring them with you, Aldrich advises.
  3. Speak up if you need more care. Many patients in today’s health care system feel their care is limited by what their insurance is willing to pay, Blank says. This can leave them feeling frustrated, especially if they still feel they need more care. Let your physical therapist know if that’s your situation. Some will work with you to file additional paperwork for more sessions or to offer additional care, Blank says.
  4. Practice your assigned exercises at home. This can’t be stressed enough. Doing designated exercises outside of physical therapy sessions can make a big difference in rebuilding your strength or preventing a further loss of movement if you have a worsening condition.