Neurology

Neurological physiotherapy is the treatment of patients who have a neurological disorder. Neurological disorders are those affecting the brain, spinal cord and nerves; such as stroke, MS and Parkinson’s disease.

How does neurological physiotherapy differ from other physiotherapy?

When the nervous system is damaged muscles may feel weak and floppy or very tight with spasms or tremor and movement may be uncoordinated. Along with movement disorders there may be altered sensation and problems with speech and swallowing.

Your initial assessment will consist of a full physical assessment and a detailed account of your past medical history and previous mobility.

 Physiotherapy goals will then be set between you and your physiotherapist (and, if appropriate, your family or careers) before treatment is started

Treatment is specific to you, and involves methods to overcome your physical problems such as stretching, strengthening, balance and walking practice (if appropriate), respiratory assessment and education. Advice and recommendations will also be given on suitable walking aids and home adaptations / equipment. Treatment programs vary depending on your symptoms and condition, ATPC are able to provide intensive daily physiotherapy treatment or maintenance physiotherapy of one or two sessions per month..

The physiotherapists at ATPC can offer treatment and advice at any stage of a condition; sometimes early treatment can prevent the progression of a condition and prevent secondary complications. In some cases, although conditions may progress over time, there can still be gains by having physiotherapy to improve quality of life and promote independence

Adult Neurological Physiotherapy

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

At ATPC we treat a number of neurological conditions, including:

Stroke
spinal cord injury
Multiple Sclerosis
Parkinson’s disease
Cerebral Palsy
Motor Neuron Disease
head injury
peripheral nerve injury
Guillain Barre Syndrome
Vestibular rehabilitation

Our specialized physiotherapists will initially provide a thorough assessment before developing a structured treatment program unique to your needs. Treatment programs may include:

Improving standing and quality of walking
Strengthening
Balance exercises
Developing gross and fine motor skills
Re-educating normal movement patterns
Stretching
Offering guidance and advice to family and caregivers
Physiotherapy regularly utilizes hands-on treatment combined with exercise to aid improvement. 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 center. 
For adults with physical neurological problems physiotherapy should begin almost immediately. At ATPC there are no waiting lists and we are therefore able to offer early intervention. Our physiotherapists also work directly with occupational therapists who can offer further equipment and treatment should it be required.  Image

Multiple Sclerosis
Motor Neuron Disease
Guillain-Barré Syndrome
Head injury
Parkinson's Disease
Peripheral Nerve Injuries
Spinal Cord Injury
STROKE

Multiple Sclerosis

Introduction to Multiple Sclerosis Multiple Sclerosis (MS) is a disease affecting the brain and spinal cord. It causes weakness and spasms throughout the muscles in the body and feelings of tiredness. 
The majority of individuals with MS greatly benefit from the input of a specialist physiotherapist. 
Following a neurological assessment, physiotherapy can maximize your potential recovery by stretching and strengthening tight and weak muscle groups and retraining normal patterns of movement. 
Physiotherapy can also increase your energy levels following an exacerbation of MS. What is Multiple Sclerosis? Multiple sclerosis (MS) is a disease of the central nervous system (the brain and the spinal cord). 
In MS the conductive outer coating of many of the nerve fibers is damaged. The body can repair the damage to some extent but oftensmall scars are left and the nerves do not function quite as they did before. As MS affects different areas within the central nervous system it is described as multiple, and the small scars which arise can be described as areas of sclerosis. This is how the name multiple sclerosis arises. 

The cause of MS is unknown. It is thought that it may be due to a small defect in the body’s immune system. MS is a relatively common disease and affects about one in 750 of the British population. It most often affects young adults; over 70 per cent of affected people experience their first symptoms between the ages of 20 and 40. 

Once diagnosed, MS stays with you for life, but your symptoms can be well managed by specialists.

Effects of Multiple Sclerosis

Multiple sclerosis (MS) can cause a variety of symptoms. These include;

sensation changes
muscle weakness
muscle spasms
movement difficulties
reduced coordination and balance
speech or swallowing problems
visual disturbances
fatigue
acute or chronic pain syndromes
bladder and bowel difficulties
cognitive impairment
depression

Diagnosis of Multiple Sclerosis

Due to the variety and complexity of the symptoms, MS is not easy to diagnose. There are special criteria that medical professionals use to diagnose MS. You will normally be referred to a neurologist who will perform a number of tests to determine if you have MS. These tests include:

Neurological examination
Magnetic Resonance Imaging (MRI) of your brain and spinal cord.
Evoked potentials
Lumbar puncture
Blood tests

Types of Multiple Sclerosis

Relapsing-remitting

Relapse remitting MS is characterized by unpredictable attacks followed by periods of months or years with no new signs of disease activity. The effects of the attacks may be permanent or may resolve. When deficits always resolve between attacks, this is known as benign MS. 

Secondary progressive

This is the most common type of MS. Secondary progressive MS refers to symptoms of initial relapsing-remitting MS, who have a gradual neurologic decline between attacks without any definite periods of resolution of symptoms. 

Primary progressive

Primary progressive MS is characterized when no resolution of symptoms is seen following an initial attack. A gradual decline occurs continuously without clear attacks. 

Progressive relapsing

Progressive relapsing MS is characterized by a steady neurologic decline but also suffer attacks.

Multiple Sclerosis Physiotherapy

Physiotherapy treatment for MS is mostly exercise based combined with ‘hands on’ physiotherapy. Our experienced physiotherapists understand that MS affects everyone differently and your goals will be unique to you. 
Physiotherapy should commence as soon as possible following an initial attack to allow you to reach your full potential and limit the progression of your symptoms.
During your initial assessment you and your physiotherapist will discuss realistic long and short term goals. These goals will be at the center of your rehabilitation. 
The physiotherapists at ATPC will usually teach you (and your family members / caregivers if appropriate) exercises to be continued between appointments. 

As well as improving your general health, physiotherapy can help:

improve balance and walking difficulties
reduce muscle spasms and stiffness
increase strength
retrain normal patterns of movement
increase energy levels
reduced bladder or bowel problems
increase mood
educate about MS and your symptoms
reduce risk of falls

ATPC can also give advice regarding walking aids and equipment to make your home or working life easier. 
Our specialist neurological physiotherapists can maximize your recovery and help you achieve your goals.

Why ATPC

Motivated, caring staff
Unique treatment programs tailored to suit each individual
No waiting lists
Be seen in our center, at your home or in your care home
Patients can be seen by more than one physiotherapist at once, if required
Dedicated, patient centered approach
Specialist falls prevention program available
Hydrotherapy treatment available
Case management
Proven track record

ATPC provide private MS physiotherapy services throughout Greater Amman. MS physiotherapy treatment can be provided at home, care homes and in our physiotherapy center. 
ATPC understands the difficulties experienced following MS and the impact it has on those close to you. Our dedicated, specialized staff can maximize your potential by working closely with you, your family and caregivers.
Following an initial assessment ATPC will liaise with your GP, consultant and other medical professionals
ATPC has helped many people following an MS and their families. See our testimonials to read about the experiences of our patients.  





Motor Neuron Disease

Introduction to Motor Neuron Disease

Motor neuron disease is a rare, progressive disease affecting the nerves in the brain and spinal cord that supply the muscles of the body. This leads to weakness of the muscles and reduced function. The management of motor neuron disease by ATPC includes; exercises and stretching, joint care, positioning, the provision of aids and equipment, and breathing exercises. Through physiotherapy we aim to maintain your quality of life for as long as possible.

What is Motor Neuron Disease?

Motor neuron disease (MND) is a term used to describe a group of related diseases that affect the motor neurons in the brain and spinal cord. Motor neurons are the nerve cells along which the brain transmits instructions to the muscles. Therefore, degeneration of the motor neurons leads to weakness and wasting of muscles. Motor neuron disease is most common among people aged 50 to 70, and affects men slightly more than women.

Diagnosis of Motor Neuron Disease

The diagnosis of motor neuron disease is established by a neurologist based on the history of the symptoms and a neurological examination. There is no diagnostic test for motor neuron disease. Other investigations may be performed to rule out other disorders that may present with similar symptoms to motor neuron disease.

Despite this, the diagnosis of motor neuron disease remains a clinical one. Once other diseases have been excluded, a rapid progression of symptoms is a strong diagnostic factor. Although the progression of motor neuron disease may sometimes "plateau", it will never resolve and will ultimately continue.

.Physiotherapy for Motor Neuron Disease

ATPC understand how a diagnosis of motor neuron disease can affect all aspects of the lives of you and your loved ones. Through physiotherapy we aim to keep your work, home and social life as active as possible.

Physiotherapy for motor neuron disease includes;

* exercises and stretches
* joint care
* breathing exercises and chest clearance techniques
* pain control
* anticipating and minimizing secondary complications of motor neuron disease
* provision of equipment, walking aids, orthoses and wheelchairs
* advice for you and those caring for you on handling techniques and equipment
* referral to appropriate health professionals (eg. occupational therapy, speech and language therapy)

The effects of physiotherapy can be:

* increased quality of life
* increased independence
* increased energy levels
* reduced pain and muscle spasms
* reduced risk of chest infections
* reduced stiffness




Guillain-Barré Syndrome

Introduction to Guillain-Barré Syndrome

Guillain-Barré syndrome (GBS) is a disease in which the peripheral nerves (those outside the brain and spinal cord) become inflamed and stop working. This causes weakness of the muscles in the arms, legs, face and those responsible for breathing. 

ATPC provides rehabilitation for patients with Guillain-Barré syndrome following their discharge from hospital. The aim from physiotherapy is maximizethe patient potential to make a full recovery. Recovery times are variable ranging from two weeks to two years. Some individuals may never return to their full previous level of function. 

Our neurological physiotherapists realize that Guillain-Barré syndrome affects everyone differently and every patient has different rehabilitation goals. Our physiotherapists can provide home based exercise programs, specialist gym based rehabilitation programmers and, hydrotherapy treatments to achieve their goals. 

What is Guillain-Barré Syndrome? Guillain-Barré syndrome (GBS) is an acute disease of the peripheral nervous system causing the nerves in the arms and legs to become inflamed and stop working. This causes sudden weakness, limb paralysis, loss of sensation, speech and swallowing difficulties, and sometimes pain. Patients often require treatment on an intensive care unit as the muscles required for breathing also become weak. 

GBS affects approximately 1500 people each year in the UK. It canaffect anyone and is not hereditary or contagious. The exact cause of GBS is unknown but many patients suffer from infections, influenza or stress prior to the onset of the symptoms of GBS. 

A total recovery is made by approximately 80% of patients. Patients often spend up to three months in hospital and then recover over the following year. Approximately 15% of patients do not recover completely and have residual weakness, reduced sensation and pain. A few patients are unable to resume their normal occupation. Modern medicine makes death from GBS rare but it occurs in approximately 5% of cases, usually in the elderly. 

Effects of Guillain-Barré Syndrome

The initial symptoms of Guillain-Barré syndrome (GBS) are usually numbness and tingling in the fingers and toes with increasing weakness in the arms and legs over the following days.  In the mild cases of GBS, the progression of weakness ceases at this point causing moderate difficulty in walking, requiring the use of a walking aid. In other cases the weakness continues to progress and causes a complete paralysis of the legs and the arms can also be affected. 

In approximately 25% of cases the weakness progresses to the chest and the patient is unable to breathe independently and requires ventilation in an intensive care unit. The nerves supplying the throat and face muscles may also be affected making swallowing impossible. 

Physiotherapy Treatment of Guillain-Barré Syndrome Physiotherapy treatment for Guillain-Barré syndrome (GBS) should start in hospital and continue until you have reached your maximum potential. ATPC are able to provide physiotherapy assessments and treatment as soon and as often as you require. 

Physiotherapy for Guillain-Barré syndrome can:

increase muscle strength
increase mobility
increase balance
retrain normal patterns of movement
increase energy levels
assist in return to previous activity levels
educate about GBS and symptoms

Physiotherapy treatment can consist of:

‘hands on’ physiotherapy
home based exercise programmers
specialist gym based rehab programmers hydrotherapy
ATPC can also give advice regarding walking aids and equipment to speed up your recovery and make you home or work life easier. 
Our physiotherapists can maximize your recovery and help you achieve your goals. 



  Head injury


Introduction to Traumatic Brain Injuries

At ATPC we understand about the potential devastating effects a head injury / traumatic brain injury (TBI) can have on an individual and their family. Our specialized team can help you get back as much independence as possible. The rehabilitation process will be specific to you, depending on your future goals and the symptoms you are experiencing. 

Common effects of traumatic brain injuries are arm and leg weakness, facial weakness and speech problems. These lead to decreased mobility, balance problems and difficulty performing everyday tasks. 

Physiotherapy treatment is very important following a traumatic brain injury. It should commence as soon as possible and continue until an individual has reached their maximum potential. Physiotherapy can improve an individual’s quality of life by increasing their independence, mobility and ability to perform everyday tasks. 

ATPC understand that a traumatic brain injury can cause a huge change in lifestyle for an individual and their family. We also understand that everyone wants the maximum recovery for their loved ones. 

ATPC realize that traumatic brain injuries affect people in a variety of ways and that everyone is different. As a result, we offer both home and clinic appointments. This allows us to provideneurological physiotherapy to patients with a huge variety of physical abilities and future goals. 

ATPC are experienced at working alongside solicitors, case managers and insurers to provide a hassle free service to our clients. 

What is a Traumatic Brain Injury? A traumatic brain injury (TBI) is caused initially by a blow to the head. TBI also includes potential complications seen after the initial injury caused by lack of oxygen to the brain tissues or increased pressure within the skull. 

A TBI can, therefore, be analysed as three ‘injuries’: 

First injury:

This is the initial injury occurring in the seconds after the accident. Damage is described as closed, open or crush injuries.

Second Injury:

This occurs when the oxygen supply to the brain is reduced in the minutes and hours after the accident, worsening the damage already caused by the first injury.

This can be caused by an obstruction to an airway or serious blood loss. Third Injury:

This occurs as a result of blood leaking from damaged blood vessels, over a period of days or weeks, into the area causing the brain to swell. The skull is a fixed space and the brain can suffer damage if it squeezes against it.

If the brain swells it can squeeze the blood vessels, limiting the brain's blood circulation.

Types of Traumatic Brain Injury

ATPC treat all types of traumatic brain injury. These include:

subdural hematoma
epidural hematoma
subarachnoid hemorrhage
intraparenchymalhemorrhage
intraventricular hemorrhage

Effects of Traumatic Brain Injury

Individuals can present with a huge variety of symptoms following a traumatic brain injury (TBI). These symptoms depend on the type of TBI suffered, its severity, the area of the brain affected and the extent of damage to the brain tissue. Common effects seen are:

Physical Changes
reduced mobility
altered muscle tone – high /low
altered movement patterns
altered co-ordination
altered balance
Chronic pain
Changes to normal body functions
Cognitive deficits
Speech and language problems
Changes in sensation
Perceptual difficulties
Visual disturbances
Increased or reduced hearing
Loss of smell
Loss of taste
Seizures
Social / emotional changes

Traumatic Brain Injury Physiotherapy Treatment Many traumatic brain injury (TBI) survivors are left with significant disability. The brain is, however, very adaptable and, with the correct physiotherapy input, recovery can take place over a period of years. People often witness a rapid period of recovery in the first few weeks following a TBI, followed by a slower recovery over the following years. To gain the maximum recovery, physiotherapy treatment should be continued immediately once you leave hospital until your full potential has been reached. 

You will be discharged from hospital when you are medically stable. Being discharged from hospital does not mean that you will not improve further. Your rehabilitation should continue as soon as you leave hospital. With the correct physiotherapy input and advice you still have lots of potential to improve over the coming years. 

With the correct level of physiotherapy input long term improvements can be made. ATPC commonly see individuals make significant improvements. 

During your initial assessment you will discuss your short and long term rehabilitation goals. These goals will then be at the center of your rehabilitation. 

Physiotherapy will assist you in regaining as much movement and function as possible. Treatment often focuses on sitting balance, standing balance, walking, using your affected arm / hand and managing any changes in muscle tone, pain or stiffness. 

Neurological TBI physiotherapy can help: improve balance and walking increase ability to roll / move in bed / sit / stand
reduce muscle spasms, pain and stiffness
increase strength
retrain normal patterns of movement
increase affected arm and leg function
increase energy levels
increase independence and quality of life
decrease risk of falls

After a TBI many people experience difficulties performing tasks that were previously simple. This can make everyday life a struggle for both you and those close to you. ATPC will advise you on the use of walking aids, splints, supports and home equipment to make your life easier. 

During treatment sessions our neurological physiotherapists will lead you through a progressive programmer of functional exercises to increase your mobility and muscle control.

The physiotherapists at ATPC will usually teach you (and if appropriate your family members / cares) exercises to be continued between treatment sessions. 

ATPC is able to provide manual handling training sessions for cares and families. This training involves teaching safe therapeutic handling and positioning techniques that will promote normal movement and postural alignment to those caring for you. The therapeutic use of specific hoists and slings can also be taught. Where required postural, bed, seating and wheelchair assessments can be carried out by our specialist physiotherapists.

Having a TBI is a life changing event. TBIs can lead to changes in personality, feelings of frustration and reduced confidence. At ATPC we aim to make our treatment sessions effective and enjoyable. Many patients develop close relationships with our physiotherapists. This, combined with increased function and independence, allows our patients to lead as fulfilling lives as their potential allows.




Parkinson's Disease

Introduction to Parkinson's disease

Parkinson’s disease is a condition in which the numbers of chemical messengers in the brain are reduced. It often causes reduced mobility, memory problems, muscle tremors, and difficulties performing everyday tasks. Physiotherapy for people with Parkinson’s disease concentrates on increasing and maintaining mobility whilst reducing the risk of falls. 

ATPC provide neurological physiotherapy treatment specific to the needs of the individual. Our specialist physiotherapists understand how Parkinson’s affect an individual and those close to them.

What is Parkinson's Disease?

Parkinson's disease affects approximately 1 in 500 of the general population. It is a progressive neurological condition affecting activities such as walking, talking, and writing. It is named after Dr. James Parkinson, the London doctor who first identified Parkinson's as a specific condition. 

Parkinson's disease occurs as result of a reduction of nerve cells in the part of the brain known as the substantia nigra. These cells are responsible for producing a chemical known as dopamine, which assists in the transmission of messages sent to the parts of the brain that co-ordinate movement. With the significant reduction in the number of dopamine-producing cells, these parts of the brain are unable to function normally. 

The Effects of Parkinson's Disease

Common motor symptoms seen in Parkinson's disease are:

Tremor - usually begins in one hand (the first symptom for 70% of people with Parkinson's disease). Slowness of movement - people with Parkinson's disease often find that they have difficulty initiating movements or that performing movements takes longer.

Stiffness or rigidity of muscles – people with Parkinson’s disease often find that they have problems with activities such as standing up from a chair or rolling over in bed. Postural instability - leads to impaired balance and falls.

Gait and posture disturbances:
Shuffling gait.
Decreased arm swing
Stooped, forward-flexed posture
Gait freezing - occurs in tight, cluttered spaces, doorways or when initiating gait

Other motor symptoms:
Fatigue
Mask-face, expressionless face with infrequent blinking
Micrographia (small, cramped handwriting)

Various non-motor symptoms may also be experienced, for example:

Sleep disturbance
Constipation
Urinary urgency
Depression
How is Parkinson's Disease Diagnosed?

The onset of the physical symptoms of Parkinson’s disease tends to be gradual; therefore, it is often a number of months, or even years, before the symptoms become obvious enough for a person to consult their doctor. 

Parkinson's disease is difficult to diagnose, as there are no special teststo prove whether or not someone has the condition. Diagnosis is therefore based on medical history and a clinical examination of the person. The common symptoms of Parkinson's disease can have other causes and so tests and scans are often performed to rule these out. 

Guidelines state that people with suspected Parkinson's disease should be referred quickly (within 6 weeks) to a specialist with expertise in the differential diagnosis of this condition. Guidelines also recommend that the diagnosis of Parkinson's should be reviewed regularly (every 6-12 months). 

Medical Treatment for Parkinson’s Disease As there is no cure for Parkinson's disease at present, drugs are used to try to control the symptoms. In the majority of newly diagnosed people considerable improvements can be achieved by careful introduction of anti-Parkinson drugs. When only mild symptoms are present, individuals may decide, together with their GP/consultant, to delay drug treatment until their symptoms increase and instead rely on a healthy lifestyle, focusing on exercise, relaxation and diet. As Parkinson's disease is a very individual condition medication is prescribed and adapted to individual needs. Response to medication varies from person to person and not every medication will be considered suitable for everyone. 

Types of medication commonly used are:

Levodopa
Dopamine agonists
COMT inhibitors
MAO-B inhibitors
Glutamate antagonists
Anticholinergics
Surgery

Surgery is available for some people with Parkinson’s disease, dependent on symptoms. This includes:

Deep brain stimulation
Lesioning
Parkinson’s Disease Physiotherapy Treatment

Physiotherapy is very important in the management of Parkinson’s disease. People with Parkinson’s disease usually have mobility problems and are often at high risk of falls. .ATPC aims to increase mobility and advises on changes to the home environment to increase independence and safety. As a result, patients with Parkinson’s disease will be able to cope better from day-to-day and maintain their independence. 

Independence is increased with balance, stretching and strengthening exercises and provision of walking aids and equipment. Our physiotherapists will assess how an individual performs activities such as; walking, going up and down stairs, getting out of a chair and getting in and out of bed. Our physiotherapists can teach patients, their family and cares, special strategies on how to deal with common symptoms of Parkinson’s.

ATPC recommend a home assessment is performed so advice can be given regarding any changes that may be required. This will increase the safety and independence of the patient with Parkinson’s disease. From the home assessment our physiotherapists will provide advice and suitable recommendations on aids and adaptations to maximize the independence and safety of the patient. A specific falls prevention programmer can be created to be completed between treatment sessions.

Why ATPC

Unique treatment program tailored to suit each individual
No waiting lists
Specialist falls prevention program
Home environment assessments
Be seen at home or care home
Hydrotherapy treatment available
Patients can be seen by more than one physiotherapist at once, if required
Specialist neurological physiotherapists
Motivated, caring staff
Case management
Proven track record

ATPC provide private physiotherapyservices throughout Greater Amman. The majority of patients with Parkinson’s disease are seen in their home environment. This allows for a thorough home assessment and reduces the anxiety of patients. 

ATPC understand the difficulties associated with Parkinson’s disease and the impact it has on patients and those close to them. Our dedicated, specializedstaff can maximize the individual’sindependence and safety by working closely with their partner, family and carers. 

Peripheral Nerve Injuries

Introduction to Peripheral Nerve Injuries Peripheral nerve injury is a general term used to describe damage of the nerves outside the brain or spinal cord. Peripheral nerve injuries are often caused by trauma. 

Common symptoms of a peripheral nerve injury are weakness, altered sensation, pain and loss of function below the level of the injury. 

Surgical repair of the damaged nerve is sometimes required. Whether surgery is required or not, physiotherapy has a very important role in your rehabilitation enabling you to reach your maximum possible recovery. 

The physiotherapists at ATPC understand the impact that a peripheral nerve injury can have on your everyday life. We provide home and clinic based appointments. 




What is a Peripheral Nerve Injury?

A peripheral nerve injury occurs when any nerves in the body that are not in the brain or spinal cord are damaged. If a peripheral nerve is damaged then muscles supplied by that nerve do not receive information from the brain and, therefore, they become weakened or paralysed. The nerve damage also means that the brain does not receive information from the body. This can present as altered sensation such as numbness or pins and needles. Unlike the spinal cord, peripheral nerves have the ability to heal. 

Peripheral nerve injuries can be caused by:
an extreme stretch of a nerve (eg. during a joint dislocation)

reduced blood supply to a nerve (eg. when someone falls asleep in a position that puts pressure on a nerve – such as with their arm over the back of a chair)

an electrical burn
a cut of a nerve (eg. from a knife or a traumatic fracture)

Peripheral nerve injuries can be classified as:

Complete injuries

All the nerve fibres in the injured section of nerve are damaged, causing total loss of muscle power and sensation below the level of the injury. Incomplete lesions

Some of the nerve fibres in the injured nerve are damaged and others are unaffected. Some muscle power and sensation will be present below the level of the injury. An incomplete nerve injury means that some of the nerve remains intact and, therefore, the chances of a full recoverybeing made are improved. 

Effects of a Peripheral Nerve Injury

The effects of peripheral nerve injuries vary, depending on the cause and severity of the injury. 

Common effects of a nerve injury are:

Pain (ranging from a tingling pain to intense, burning pain)
Numbness or altered sensations
Muscle weakness in the affected body part
Loss of function (eg. a hand or leg being difficult to use whilst performing tasks)

Loss of active movement (eg. wrist drop and foot drop)
Physiotherapy Treatment for a Peripheral Nerve Injury

The management of a peripheral nerve injury varies depending on the cause, type and degree of the nerve injury. If a nerve is not healing properly surgery may be required to repair the damaged section. Physiotherapy is very important to promote the recovery of peripheral nerve injuries regardless of whether surgery is required. ATPC  provide specialised treatment programmes, functional electrical stimulation and bracing / splinting to;

maintain range muscle length / joint range of movement
maintain nerve integrity
increase muscle strength
increase sensation
manage neuropathic pain






Spinal Cord Injury

Introduction to Spinal Cord Injuries

A spinal cord injury (SCI) is usually a result of trauma to the spine. This trauma causes a complete or incomplete tear of the spinal cord leading to loss of sensation and muscle power below the level of the injury. Spinal cord damage can also be due to other causes such as tumors and Spina bifida. The aims of physiotherapy treatment will differ in relation to the level of your spinal cord injury. Physiotherapy can help you reach and maintain your maximum physical potential and help in the management of other aspects of your condition. The physiotherapists at ATPC understand that a spinal cord injury is a life changing event and affects both you and those around you. We are able to provide home, center and specialist gymnasium-based physiotherapy appointments. Hydrotherapy treatment is also available.

What is a Spinal Cord Injury?

A spinal cord injury is a disturbance of the spinal cord that results in loss of sensation and/or mobility. This disturbance, or area of damage, is commonly referred to as a lesion. There are two common causes of spinal cord lesion:

* Trauma (road traffic accidents, falls etc.)
* Disease (spina bifida, tumors etc.)

Types of Spinal Cord Injury

Spinal cord injuries can be organized into two categories:

* Complete lesion - no function, voluntary movement or physical sensation below the level of the lesion. Both sides of the body are always equally affected.

* Incomplete lesion – the effects are variable dependent on the severity of the lesion. An individual may have more functioning or movement on one side of the body than the other, or may be able to feel parts of the body that cannot be moved.

In addition to a loss of sensation and motor function below the point of injury, individuals with spinal cord injuries will often experience other changes.

The Effects of Spinal Cord Injury

The effects of a spinal cord injury are dependent on the type and level of the lesion. Effects are seen below the level of a lesion and can present as a reduction or complete:

* loss of sensation
* loss of voluntary movement
* loss of proprioception (awareness of joint position in space)
* loss of bladder and bowel function
* loss of sexual function

Individuals also commonly experience:

* reduced ability to breathe deeply and cough
* pain
* muscular spasms

Physiotherapy for SCI

ATPC can assist you to achieve your maximum physical potential by treating the problems that arise following a spinal cord injury. During your initial assessment you and your physiotherapist will discuss realistic short and long term goals. These goals will then be at the center of your rehabilitation. The physiotherapy treatment you receive will be dependent on your symptoms, your goals, and the location and severity of your spinal cord injury. Physiotherapy for patients with spinal cord injuries can include;

* exercises and stretches
* joint care
* pain control
* anticipating and minimizing secondary complications
* provision of equipment, orthoses, and wheelchairs
* advice for you and those caring for you on handling techniques
* teaching you how to use specialized exercise equipment
* teach transfers (getting in and out of a wheelchair, bed, car, shower/bath and onto and off a toilet).
* teaching wheelchair skills
* hydrotherapy treatment
* breathing exercises and chest clearance techniques
* referral to appropriate health professionals

The effects of physiotherapy can be:

* increased quality of life
* increased independence
* increased muscle strength
* increased energy levels
* reduced pain and muscle spasms
* reduced stiffness
* reduced risk of chest infections

Having a spinal cord injury is a life changing event for both you and your loved ones. At ATPC we aim to make our treatment sessions effective and enjoyable. Many patients develop close relationships with our physiotherapists. This, combined with increased function and independence, allows our patients to lead as fulfilling lives as possible.

Why ATPC

* Motivated, caring staff
* Unique treatment programs tailored to suit each individual
* No waiting lists
* Be seen in our center, at your home or in your care home
* Patients can be seen by more than one physiotherapist at once, if required
* Dedicated, patient centered approach * Specialist falls prevention program available * Hydrotherapy treatment available
* Case management
* Proven track record

ATPC provide private SCI physiotherapy services throughout Greater Amman. SCI physiotherapy treatment can be provided at home, care homes and in our physiotherapy center. ATPC understand the difficulties experienced following a SCI and the impact it has on those close to you. Our dedicated, specialized staff can maximize your potential by working closely with you, your family and care givers. Following an initial assessment ATPC will liaise with your GP, consultant and other medical professionals

ATPC has helped many people following a SCI and their families. See our testimonials to read about the experiences of our patients.


STROKE

Neurological Rehabilitation Program

Introduction:

‘A stroke occurs when the blood flow to part of the brain is cut off it is a ‘brain attack’ (in the same way that a heart attack happens when the blood supply to the heart muscle is cut off). Without a blood supply, brain cells can be damaged or destroyed because they may not receive enough oxygen.’ (NICE clinical guideline, 3). A stroke patient will go through a long journey of treatment starting from the ICU and ending after months and maybe years in the clinic or his house.

The treatment and care of someone who has had a stroke or TIA should take into account their personal needs and preferences where possible. They, and their family and careers, have the right to be fully informed, and decisions should be made in partnership with the healthcare team (NICE clinical guideline, 1).

Forty percent of stroke patients are left with moderate functional impairments and 15% to 30% with severe disability. Effective rehabilitation interventions initiated early after stroke can enhance the recovery process and minimize functional disability. Therefore our aim is to maximize the recovery of the stroke patients in Jordan and the Middle East by introducing the first Neurological rehabilitation center in the country.

Our Message:

To develop a complete and professional rehabilitation program initially after stroke to enhance the recovery process and minimize functional disability.

Our Target:

The program will target stroke patients in the Jordanian hospitals who are still in the early stages or the ICU units.
The program will also include out patients who are still in the acute or sub-acute stages.
The program welcomes stroke patient from Jordan and other countries.

Evidences:

Every year a significant number of stroke survivors are left with residual disabilities varying from mild to severe form which can be reduced by proper rehabilitation. A number of controlled and uncontrolled randomized studies have suggested that rehabilitation program lead to an improvement in functional status that cannot be attributed merely to spontaneous recovery (Nessa et al. 2009).

In a retrospective study of 30 patients in an acute care hospital, there was a statistically significant difference in length of stay and ambulatory status for the group receiving rehabilitation treatment within the first 72 hours after admission. There was no significant difference between the two groups with regard to age, sex, site of lesion, or previous cardiovascular disease. The present study indicates that early intervention shortens hospital stay and improves outcome (Hayes and Caroll 1986).

The Agency for Healthcare Policy and Research Guideline for Post-Stroke Rehabilitation (AHCPR, 1995) has concluded that better clinical outcomes are achieved when patients with acute stroke are treated in a setting that provides coordinated, multidisciplinary stroke-related evaluation and services. Skilled staff, better organization of services, and earlier implementation of rehabilitation interventions appear to be important components.

Our Plan:

Based on the aim of the program and the unit, the program will start immediately the second day post admission where a physiotherapist will be sent to the ICU unit to assess the patient.

When the patient is stable, the rehabilitation will start in the ICU unit to reach a specific goals such as improve/ maintain a normal oxygenation, prevent any complications, maintain level of functional status.

The second stage of the program (if the patient is not able to reach the center) will be the home visits; a physiotherapist will be sent to the patient at least once/day depending on the patient’s need.

The third stage of the program will be in the center where an intensive rehabilitation sessions start from 3-6 hours / day (6 days/week) will be giving to the patient including; physiotherapy, occupational therapy and Speech therapy if needed.

Limitations:

1. Difficulties in patient’s transfer to the center.
2. Difficulties in reaching the patient and starting with him as soon as possible (the second day post admission).
3. To accommodate with each patient’s ability and tolerance.

Plans to overcome the limitations:

1. A full equipped van will be used in the future to transfer the patient from his place of accommodation to the center.
2. Arrangements with the best neurological physicians will be made.
3. Each patient will be given a program which will be planned and studied by a multi-disciplinary team to insure its suitability to the patient.

Conclusion:

Early initiation of rehabilitation procedures can enable greater return of neurological function and improves long term outcome and quality of life.

According to the guideline for stroke rehabilitation, rehabilitation procedures should be started as soon as the diagnosis is established and life threatening problems are managed and this is the aim of this program.

Introduction to Stroke

A stroke is caused by a disruption of blood flow to the brain as a result of a blockage or leakage in a blood vessel. The effects of a stroke vary depending on the severity of the blockage or leakage. Common symptoms of a stroke are arm and leg weakness, facial weakness and speech problems. Symptoms can cause decreased mobility, balance problems and difficulty performing everyday tasks. Physiotherapy treatment is very important following a stroke. It should commence as soon as possible and continue until an individual has reached their maximum potential. Physiotherapy can improve an individual’s quality of life by increasing their independence, mobility and ability to perform everyday tasks. ATPC understand that a stroke can cause a huge change in lifestyle for an individual and their family. We also understand that everyone wants the maximum recovery for their loved ones. Our physiotherapists can work with an individual and their family / carers to achieve their potential. What is a Stroke?

A stroke occurs if an area of brain tissue is deprived of its blood supply causing brain cells to lose their supply of oxygen. This is usually caused by a blockage or burst blood vessel. Without oxygen, brain cells can become irreversibly damaged within minutes. Unlike other cells in the body, if brain cells are irreversibly damaged then they are unable to heal themselves. The brain, however, is very adaptable and areas of the brain are capable of learning new tasks to compensate for the areas that have been damaged. Physiotherapy encourages this learning and to help the body re-learn normal movement patterns.

There are two types of stroke:

* Ischemic (90%)
* Hemorrhagic (10%)

Ischemic strokes These are caused by a blockage within an artery. This blockage restricts the blood flow to an area of the brain, and therefore, brain cells in this area are damaged due to a lack of oxygen. Hemorrhagic strokes (also known as brain hemorrhages) These are caused when a blood vessel in the brain ruptures causing bleeding into an area of the brain. This causes a buildup of pressure and damages the delicate brain tissue. Blood flow to neighboring brain cells is restricted and these cells can also become damaged due to a lack of oxygen.

Effects of a Stroke

There are many common effects of strokes. These effects depend on the type of stroke suffered, its severity, the area of the brain affected and the extent of damage to the brain tissue. The effects of stroke can be described as:

* Physical effects
* Non-physical effects

Common physical effects

* Reduced mobility
* Weakness or paralysis (usually on one side of the body)
* Reduced sensation
* Neglect to one side of the body
* Swallowing difficulties
* Speech and/or language difficulties
* Incontinence
* Fatigue
* Post stroke pain
* Foot drop

Common non-physical effects

* Mood changes
* Cognitive difficulties
* Behavioral changes

Stroke Physiotherapy Treatment

Around half of stroke survivors are left with significant disability. The brain is, however, very adaptable and, with physiotherapy, recovery can take place over a period of years. Patients often have a rapid period of recovery in the first few months after a stroke followed by a slower recovery over the following years. To gain the maximum recovery, physiotherapy treatment should be continued once you leave hospital.

.. You will be discharged from hospital when you are medically stable. Being discharged from hospital does not mean that you will not improve further. Your rehabilitation should continue as soon as you leave hospital. With the correct physiotherapy input and advice you still have lots of potential to improve over the coming years.

During your initial assessment you will discuss your short and long term rehabilitation goals. These goals will then be at the center of your rehabilitation. Physiotherapy will assist you in regaining as much movement and function as possible. Treatment often focuses on sitting balance, standing balance, walking, using your affected arm / hand and managing any changes in muscle tone, pain or stiffness.

physiotherapy can help:

* improve balance and walking
* increase ability to roll / move in bed / sit / stand
* reduce muscle spasms, pain and stiffness
* increase strength
* retrain normal patterns of movement
* increase affected arm and leg function
* increase energy levels
* increase independence and quality of life
* reduce the risk of falls

After a stroke may people experience difficulties performing tasks that were previously simple. This can make everyday life a struggle for both you and those close to you. ATPC will advise you on the use of walking aids, splints, supports and home equipment to make your life easier. During treatment sessions our physiotherapists will lead you through a graduated programme of functional exercises to increase your mobility and muscle control. The

physiotherapists at ATPC will usually teach you (and your family members / carers if appropriate) exercises to be continued between appointments.

Having a stroke is a life changing event. Many individuals feel low in mood and have reduced confidence following a stroke. At ATPC we aim to make our treatment sessions effective and enjoyable. Many patients develop close relationships with our physiotherapists. This, combined with increased function and independence, allows our patients to lead as fulfilling lives as possible.

Why ATPC

* Motivated, caring staff
* Unique treatment programmes tailored to suit each individual
* No waiting lists
* Be seen in our center, at your home or in your care home
* Patients can be seen by more than one physiotherapist at once, if required
* Dedicated, patient centred approach
* Specialist falls prevention programme available * Hydrotherapy treatment available
* Case management
* Proven track record