Setting goals can be one of the best ways to drive your performance and rehab forward.
Here is a great little booklet we put together to help you out.
DOWNLOAD - HNR goal setting ebook.
It is also important that the hand is mobilised gently and regularly, either by yourself or by a support person or therapist. Your therapist will be able to provide you education on how to do this, and you can look at the resources here.
Positioning post stroke is extremely important as it allows for muscles and joints to remain in there correct positions which helps with returning function and reducing impairments of joint changes and pain.
The New Zealand Stroke foundation has some excellent resources for positioning post stroke
Find these here
For left hemiplegia
For right hemiplegia
We have recently been discussing the importance of good sleep but for the many that can be difficult, for many different reasons. It may be that you have a neurological condition that impacts on your sleep, it maybe that you have developed insomnia over your life, like me you may have an interrupted sleep pattern due to small children or animals, it maybe that you feel you just don’t need that much sleep.
Well prioritising getting a good nights sleep can be one of the best things you can do for your health, in this post we are going to discuss the ways you can set your self up for a good nights sleep.
Regularity – going to bed and waking up at the same time each day helps set your Circadian Rhythm (your body clock) to be working well and gives you the best chance to fall asleep well. Research shows adults need between 7-9 hours sleep so ideally getting into bed to give yourself an 8- 8.5 hour sleep opportunity is important.
Embrace darkness – Not only is it important to have a dark bedroom by using eye masks or black out curtains in the bedroom. It is also important to watch your light exposure before bedtime. Cut the artificial lights down at night time, this will help allow melatonin levels to rise. Limit screens as the blue light from phones have been shown to disrupt your dream (REM) sleep when used as little as an hour before bed and this disruption has been shown to last for days afterwards.
Body temperature – To fall asleep we need to have our core body temperature fall, keeping your bedroom around 18 degrees allows for this. Use appropriate bedding and sleepware can help too. Having a warm shower or bath before bed assists with this process and helps you fall asleep faster. However having cold hands and feel can stop your core body temperature dropping so using socks or something like a wheat bag can help warm them up to drop your core temperature.
Watch what your drink - Both caffeine and alcohol will affect your overall quality of sleep, and have been shown to affect sleep in small doses even if you not aware of it. Caffeine, found in coffee, tea and soft drinks has a half life of 6 hours and a quarter life of 12 hours. Recommendations for sleep is to drink caffeine no later than midday.
Even one glass of alcohol has been shown to disrupt dream sleep and the by products of the body processing alcohol are still present 8-9 hours after that drink. Alcohol affects the quality of sleep.
Drinking too much fluid close to bed time can also increase nocturia (night time toileting) and can cause you to wake from sleep. Fluid intake and hydration is also important as dehydration also irritates the bladder and causes more toileting.
Watch when you are eating – avoid eating three hours before bedtime as this can cause ongoing issues with reflux, and your body is undergoing digestion process so can not repair until this is finished.
Bedtime routine – Having a consistent bedtime routine signals to your body that you are ready for sleep.
Some ideas for a bed time routine are
Manage stress – The build up of stress chemicals such as the hormone cortisol can impact of getting and staying asleep. Understanding stress triggers and dealing with these can support good sleep. Meditation before bed has been shown to help people get a better nights sleep. An hour before bed taking some time to document any thoughts or stressors can also help. If you wake in the middle of the night, you can go and quietly write down any of the things that are keeping you awake. Can’t get out of bed, try deep breathing into your stomach in through your nose and out through your mouth or trick your brain to stop going through all those thoughts imagine your self taking a gentle walk in your favourite spot, or if you can try to walk yourself through a guided meditation, ideally avoiding the use of your phone.
Keep the bedroom for sleep - The brain can be extremely associative it is recommended that if you are having difficulty with sleep that you use bedroom for only Sleep and sex. This is some of the reason why you can fall asleep on the sofa then try to go to bed you won’t be able to go to sleep. It is also why if you find yourself awake in bed for longer than 20 minutes it is recommended if safe that you get out of bed and do something quite until you feel sleepy and return to bed. Some people finding reading before bed can help and as long as this does not disrupt your sleep then this can be a good way to switch the brain off.
A word about rest and naps
We will cover fatigue management more at a later stage but if you find that you are needing to nap during the day and this is regular and dose not interfere with your night sleep then it it good to continue. Naps can affect a hormone call adensosisne which is needed to build up to help us sleep, when we nap we release some of the adenosine and that can impact out night sleep. If you have had a bad nights sleep it is better to wake up at the same time and then try to go to bed when sleepy in the evening to help with maintaining a good sleep pattern. If you do nap try not to nap too late in the afternoon before 3 pm is ideal.
How to set up the Zoom app on iPad or iPhone
1. Click on the App store icon on your phone or tablet
2. In the search bar enter ZOOM, select the one below
3. Click GET and wait
4. Then Click INSTALL
5. You may need to enter your Apple ID and password so have this ready
6. Then click OPEN
How to reset your apple password
How to install zoom for android tablet and phones via google play store
2. In the search bar type ZOOM
3. Select the below Zoom app, and click INSTALL
4. Then click the GET button
5. You may need to use your google account ID so have this ready to use. (This is most commonly a gmail account eg: firstname.lastname@example.org)
With this rapidly changing environment you maybe wondering what they are talking about with telehealth.
Telehealth is an online service which allows you to have an instant face to face consultation with your physiotherapist or other health care provider, allowing for assessment, treatment progression, exercise prescription and education.
At Hibiscus Neuro Rehab we will be using a platform called “ZOOM” to deliver our Video telehealth services. Zoom uses video/ audio conferencing via a computer or mobile device to allow for a meeting to take place.
Some people also use the telephone which is also classed as telehealth.
All sessions can be recorded for your convenience, allowing you as the client to have access to the information shared in the session. You will be able to review any instructions and demonstrations of your exercises. All information recorded will be protected and kept confidential.
Telehealth as way of delivering rehabilitation services has been growing over the last couple of years and is well established within the healthcare community. Telehealth is a reliable way of providing effective therapy, with positive health outcomes and high patient satisfaction.
Please feel free to contact us if you have any further questions. Sarah on 09 424 3254 or email@example.com.
Getting a good nights sleep is so important to our overall health and prioritising it is vital.
Here is a summary of what can be affected when we are sleep deprived.
- Memory consolidation is impaired, - you wont store all the new memories you have made in a day.
- Increase your risk for dementia and Alzheimer's - Deep sleep helps clear out a toxin protein in the brain called Beta Amaloid, which has an impact on developing Alzheimer's disease.
- Reproductive system in men is affected - Levels of testosterone drop when we are sleep deprived.
- Your immune system is compromised - Not only will this affect your risk of getting sick, from everyday colds and flu, being sleep deprived means you are at a potential risk of developing cancer.
- Risk of stroke and heart attack increase - Sleep helps lower our blood pressure, and when we are sleep deprived our blood pressure can increase, which increases our risk of cardiovascular disease.
- Increased risk of depression and anxiety - deep sleep helps quieten down the sympathetic nervous system which our fight, flight or freeze system. When we are sleep deprived our Amygdala our emotional centre is 60% more reactive than when we have had the recommended 7-9 hours good quality sleep per night.
Increased risk of obesity - Sleep affects our hunger hormones when we are sleep deprived our body increases the hormone Ghrelin (our hunger hormone) and decreases the hormone Leptin ( our satiety hormone) meaning we eat more. Obesity can lead to further complications with diabetes and cardiovascular disease.
For more information and an info-graphic view:
Check out this great video on how sleep impacts your brain and body here
Here is the article that we had posted in the Rodney and North Shore times it looks at how we manage vertigo and dizziness at Hibiscus Neuro Rehab
Pre-habiliation is about stopping falls before they begin, and it’s always the best option. There is enough research and evidence to know that we should be exercising whether we have Parkinson's or not. But what can we do once we start to fall, what is freezing and how can we protect ourselves from injury?
Falls are caused from a multitude of reasons, and those with certain neurological conditions may be more at risk. However, today we are going to specifically look at Parkinson's disease, and focus on the risk of falls, impaired balance and why this may be happening. By addressing the reasons falls occur, you can reduce the number of falls you are having and prevent further falls.
Some of these reasons include, freezing, reduced muscle strength, postural hypotension, cognitive decline, fear of falling, reduced postural responses, and environmental hazards.
If you are experiencing falls the best place to start is with using a ‘Falls Diary’. This is a useful tool to identify when falls are occurring and in what situation. For example, is it often when getting up to the toilet at night, or are you tripping over the front step, or could it be that you are falling in the kitchen when you turn around too fast? By noting these in your Falls Diary, this can help you to identify where you need to focus your falls prevention. To help support falls prevention, click here to access your own copy to complete.
For those with Parkinson’s, you may have experienced a period of Freezing. This is when there is a delay or complete inability to initiate a movement, most notably seen with walking. This could be when a person cannot take a step on first moving or when turning. It can also happen when rolling in bed or getting out of a chair.
The reason freezing occurs is not well understood, however we have a number of strategies which can be very useful to manage this. This includes gait retraining, use of cueing, which is external or internal cues that help you overcome freezing episodes, and counting or having lines on the floor. Specific practice and exercises help with freezing as well.
Muscle weakness in Parkinson's is related to the impaired activation of the muscle itself, however as the disease progresses and we become more sedentary we can get secondary muscle weakness. Keeping strong muscles in your bottom, thighs and ankles is important, as are targeted exercises to maintain good balance and good postural control.
Fear of falling, can potentially lead to more falls. I often talk about the ‘cycle of falls ‘ and how a fall can subsequently lead to a fear of falling. This can then result in reduced activity levels, lack of confidence and reduced mobility, exacerbating the issue. A great way to overcome the fear, and regain control, is to break the cycle and improve confidence around mobility. Learning how to get up of the ground, improving muscle strength and challenging your balance are key ways to feel stronger physically and confident in different situations.
Other medical conditions, such as Postural hypotension, which can be related to your Parkinson's can have an impact on your balance, as can medications. It pays to have regular reviews with your GP to make sure all your medications are needed and that your Parkinson's medication is at its optimum.
Cognitive decline can have an impact of falls, as you may not be aware of your environment or how you are moving within your environment. We know exercise is one of the most beneficial tools to help with cognitive abilities, as is learning new activities and brain training can also be implemented. Continued practice from diagnosis of key movement strategies such as sit to stand and stand and turn can help maintain function with cognitive decline. Therefore practical neuro active exercises can help to prevent further issues, and maintain current levels of activity.
As Physiotherapists, another important aspect in falls prevention is Balance Retraining. This is completing specific exercises and activities to improve balance, and to retrain balance, which means we need to stress and challenge the internal balance systems. Just think how a baby learns to walk – it is through repeated stepping and falling down that they learn to move, as our brain and body use a feedback loop to make adjustments to keep us upright against gravity. So when we retrain our balance we target specific individualised exercises that challenge a persons’ balance at the correct level to lead to better improvements.
Falls prevention is important as this contributes to your health, wellness and independence. There is help available, so if you need help or would like to chat for advice, call Sarah on: (09) 424 3254 or e-mail: firstname.lastname@example.org
In this blog we outline the difference, between general cardiovascular exercise which we class as Neuro passive exercise and Neuro Active exercise which we recommend for you to manage your Parkinson’s disease.
It’s now widely documented that when living with Parkinson’s you need to keep active and exercise. As a blanket statement for wellbeing that is fantastic. But what does it actually mean to be active? And what type of exercise do you need to do?
Often, we hear “I exercise every day and I am very active”. That’s is a great start! You should congratulate yourself on having a healthy lifestyle that supports your metabolic system and wards off heart and lung disease. But often this active lifestyle isn’t enough to slow down the progression of Parkinson’s.
What we have come to realise is that exercise needs to be Neuro Active. Simply put; Neuro active exercise is exercise that promotes not only brain health but also creates neuroplasticity. The brains ability to rewire and make new connections, opening dormant pathways.
SO what is the magic formula?
Thomas gardens every day, potters around in his shed, mows the lawns and keeps his property tidy. He doesn’t sit down much but might have a short nap in the afternoon. Overall, he remains mobile and “active”. The problem is that his movements will still be done on a smaller scale than normal, unless he is conscious and planned with how he moves every time he moves.
And what about Brendan, he goes to the gym four days a week, he is on the bike doing a gentle cycle for 10 minutes and then does weights for 30 minutes. This is helpful to build strength in his muscles. However, we know that with Parkinson’s there is not a primary problem of weakness, yes you get secondary issues with weakness because you are not moving properly and more sedentary. So what if we treated the primary reason, the fact that the brain is not activating the muscles through the correct range or with enough force?
Bronwyn walks every day on her local beach for about 30 – 45 minutes at a reasonable pace. However, she has noticed that she is walking shorter distances than she has in the past. Bronwyn has a great exercise behavior pattern, but this is still not helping her maintain her desired level of function. With Parkinson’s as the condition develops the brain recalibrates itself, movements become smaller and slower and it takes more time to walk along the beach.
If you see yourself in these made up cases, then please don’t stop what you are doing! Just make it work better for you. It is important that you maintain an active lifestyle but to change your brain your activities need to be neuro active.
As Physiotherapists we aim to teach patients the principles to be neuro active and how to put these into everyday life. We help you make the changes needed to slow down the progression of Parkinson’s. We show you how your activity choices need to be very deliberate and this can take a lot of hard work and effort.
This ‘hard work’ is more than just exercising. Its about committing to a new way of life that you need to control and keep working at it 24 hours a day. Unfortunately, Parkinson’s doesn’t take a day off, so to be neuro active in all parts of your life you need to be working at it constantly. This may seem like a lot of hard work, but it is achievable when you are willing to go to any length to slow down the progression of your disease and live your best life!
When we prescribe exercise programs, we incorporate seven core principles;
Power – Moving big and forcefully
High Effort – each movement needs to be at an 80% effort level to obtain the correct output and make brain changes
Challenging – Exercises need to challenge you both physically and cognitively to stimulate brain changes
Specific – The exercise you do needs to be specific to your impairments, working on what is hard for you will make the most changes that are going to improve your life. It also needs to be adapted to your body and specific injuries or health concerns.
Salience – The exercises must bring meaning to your life and your reason for exercising
Fun – You can put the principles into your favorite routine once you know what you are doing, if you enjoy it you will stick with it.
Frequency – Exercise must be done daily, unfortunately with a progressive condition it doesn’t stop so you can’t.
Our role is to incorporate these principles into specific exercises, and work with you to help you recognize and self-reflect on how to put these principles into your daily life it is these little, deliberate and constant movement changes that create the change you too can have.
In addition to becoming more neuro active, it is also recommended that you also participate in cardiovascular exercise that gets you out of breath. This type of whole-body exercise is thought to be Neuroprotective or Brain protective, potentially rther slowing down the progression of Parkinson’s.
Our first recommendation is that you see a Physiotherapist skilled in managing patients newly diagnosed with Parkinson’s disease so you can partner with them and learn the skills you need to effectively manage your condition.