What is a Stroke?

What is a stroke 

A stroke is when the brain cannot get enough blood, either due to a blocked or burst artery. Blood carries oxygen and nutrients to the brain, and when the brain cannot get enough of these, brain cells can get damaged or die.

There are two types of stroke

• Ischaemic - when an artery in the brain gets blocked by a clot, causing part of the brain to lose blood supply. This can cause damage and injury to that part of the brain. This is the most common type of stroke.

• Haemorrhagic - when an artery breaks or bursts either directly in the brain, or on the surface of the brain. This can also cause damage and injury to the brain.

Symptoms and what to do 

The Stroke Foundation recommends learning these most common signs of stroke and getting medical attention FAST. 

F - Face: is one half of the person’s face drooping? Ask them to smile, does half of their mouth droop?

A - Arm: can the person lift both arms and hold them there? Is one arm weaker and more difficult to lift?

S - Speech: is their speech slurred? Are they more difficult to understand? Do they understand you?

T - Time: time is critical. If you see any of these signs, call 000 immediately.

Stroke is always a medical emergency - the longer you wait to get medical attention, the greater the risk of brain damage.

Risk factors 

The following can increase the risk of having a stroke:

• Type 2 diabetes 

• Hypertension (high blood pressure)

• High cholesterol

• Atrial fibrillation or other irregular heart beats

There are many more risk factors for having a stroke - if you’re concerned about your risk, speak to your GP and get their advice.

Preventative measures 

There are many things you can do to reduce your risk of having a stroke. These include:

Remaining physically active 

The Australian Physical Activity Guidelines suggest, for adults less than 64 years old, completing moderate to vigorous physical activity for 30 minutes on most days, preferably all days. 

This exercise can be anything, as long as it gets your heart rate up, a little out of breath and feeling warm. Some ideas can include:

• Brisk walking

• Swimming 

• Strength training 

• Dancing

Physical activity improves your heart health and reduces the risk of developing  the risk factors for stroke.

Eating healthy 

Your diet has in impact on many risk factors for stroke, for example:

• obesity/overweight increases the risk of heart disease and high blood pressure 

• Too much salt increases blood pressure

The Australian Dietary Guidelines recommend eating:

• Lots of fruits and vegetables (different colours and types) 

• Grains and cereals, like pasta, rice and bread.

• Lean meats, chicken, fish, eggs, tofu

• Diary products like milk, yoghurt and cheese

It is also recommended to limit intake of saturated fats, sugar, and salt.

Quit smoking 

Smoking doubles your risk of having a stroke, and the more you smoke, the greater the risk of having a stroke.

Smoking increases the risk of a clot developing in your blood and blocking an artery supplying blood to the brain. It does this by:

• Making your blood more sticky 

• Increasing your blood pressure

• Reducing the amount of oxygen carried in your blood 

Stopping smoking significantly reduces the risk of a stroke - within one month, your blood pressure returns to a normal range and the risk of stroke can reduce by up to 50% after one year of not smoking.

Avoid alcohol 

Alcohol increases your risk of high blood pressure, irregular heart beat, uncontrolled diabetes and increased weight (common risk factors for stroke).

Limiting alcohol intake reduced the risk of developing these conditions.

Rehabilitation and the journey after stroke 

After someone has a stroke, they can experience a wide range of effects. Some common effects include:

• Hemiplegia (one sided weakness) in the face, shoulder, arms, hand, trunk and leg. 

• Difficulty speaking, understanding language, reading or writing

• Personality changes

• Fatigue and brain fog 

• Incontinence 

• Difficulty swallowing, eating and drinking

• Vision loss or blindness

There is support available for anyone experiencing these changes, which can include help from a Physiotherapist, Speech Pathologist, and/or Occupational Therapist, to help you get back to daily life. 

How can a Neurological Physiotherapist help

A Neurological Physiotherapist is specially trained to understand neurological conditions, including a stroke, and support a person to do exercises that support the brain’s recovery, both in the short term and long term after a stroke. These exercises utilise your brain’s neuroplasticity - your brain’s ability to recover and rewire after injury. This is crucial to recovery and improving function after stroke.

A Neurological Physiotherapist will work with you to conduct a thorough assessment into impairments and function and develop treatment goals that are meaningful to you to create an individualised treatment plan.

Rehabilitation with a Neurological Physiotherapist may involve:

• Exercises to strengthen the shoulder, arms, trunk, and leg on the weakened side 

• Retraining balance to improve sitting, standing and walking safety and independence

• Exercises to improve sensory loss and perceptual deficits

• Prescription of orthoses and assistive technology, like a walking aid or wheelchair, to improve function and independence

A Bespoke Physiotherapy, our team of Physiotherapists are highly trained in a variety of different therapeutic approaches, including Bobath and Feldenkrais, to support motor recovery after stroke. 

If you’re interested in neurological rehabilitation after a stroke for yourself or a loved one, please call Bespoke Physiotherapy for a discussion on how we can support you.

References 

• https://strokefoundation.org.au/about-stroke/learn/what-is-a-stroke

• https://www.stroke.org/en/about-stroke/stroke-symptoms 

• https://www.health.gov.au/topics/physical-activity/24-hour-movement-guidelines-for-all-australians/recommendations-for-adults-18-to-64-years?language=en 

• https://www.health.gov.au/sites/default/files/australian-dietary-guidelines.pdf

• Shahid J, Kashif A, Shahid MK. A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals. Brain Sci. 2023 Apr 25;13(5):717. doi: 10.3390/brainsci13050717. PMID: 37239189; PMCID: PMC10216461.

Why Do Falls Matter?

A fall is defined as an event causing a person to unintentionally come to be on the ground, floor or lower level. In Australia, 30% of falls result in injuries requiring medical treatment and 10% are serious injuries (such as fractures). Falls are the leading cause of injury-related death. Almost two-thirds of falls are caused by slips, trips and balance problems. 

Falls risk factors - are you at risk?

There are a large number of well-researched falls risk factors, which means that these factors can increase your risk of falling. We can think about these factors in a number of different categories:

• Demographic risk factors

• Advanced age

• Falls risk increases significantly from the age of 80

• History of falls

• Difficulty or limitation undertaking usual daily activities

• Fear of falling

• Women are also at a higher risk of falls than men

A note on fear of falling

• Fear of falling reduces confidence and can limit participation in daily activities, resulting in a vicious cycle of reduced physical activity and worsening physical ability

• Fear of falling affects people who have fallen AND people who have not yet fallen

• It is more common in women > men, and increases with advancing age

• Medical risk factors

• Impaired cognition/depression

• Stroke

• Parkinson’s Disease

• Incontinence

• Acute illness

• Vestibular disorders

• Arthritis

• Foot problems

• Diabetes

• Abnormal neurological signs

• Orthostatic hypotension (blood pressure that drops quickly when you move from lying, or sitting, to standing)

• Medication risk factors

• Certain medications including benzodiazepines, antidepressants and antipsychotics are known to increase the risk of falls in older persons

• One of the other key medication risk factors includes the use of more than 4 medications. 

• Sensory & neuromuscular risk factors

• Vision changes

• Poor visual contrast sensitivity

• Reduced depth perception

• Greater reliance on vestibular and somatosensory systems when vision is reduced

• Multiple age-related changes contributing to increased risk of falls in dim lighting and difficulty judging steps/curbs/obstacles

• Reduced peripheral sensation

• Peripheral neuropathies can result in loss of sensation in the feet

• Reduced vestibular function

• Vestibular function declines with ageing, contributing to impaired balance and mobility

• Vestibular impairment can result in dizziness, vertigo and balance problems

• Dizziness in older adults is common and affects 10-30% of older people 

• Chronic vestibular symptoms are associated with an increased risk of falls

• Vestibular disorders account for around 48% of dizziness

• Muscle weakness

• Age related muscular changes

• We all experience a progressive loss of muscle mass from our mid-20s

• Muscle mass diminishes by 35-40% by 80 years of age

• Muscle strength decreases by 50% by 80 years of age

• Reduced hip, knee and ankle strength increases falls risk

• Strength gains improve balance and stability

• Balance & mobility risk factors

• Impaired stability when leaning and reaching

• Slow voluntary stepping

• Impaired gait and mobility

• Impaired ability in standing up

• Impaired ability with transfers

• Impaired stability when standing

• Poor reactive stepping 

A note on balance and reaction time

Balance is the ability to maintain your centre of mass over your base of support (usually your feet), within your limits of stability. It relies on a combination of sensory information from:

• The visual system

• What you see

• The vestibular system

• An inner-ear balance organ in each ear senses head movement in different directions and linear acceleration

• The somatosensory/proprioceptive system

• What you feel - tactile information from the hands and feet, with input from muscles and joints 

Your brain needs to process and integrate information from each of these systems and generate an effective motor (movement) response.

Reaction time slows as we get older, which reflects slower processing speed

• Ageing slows information processing and reduces attentional capacity

• Adding a second task further slows reaction time (divided attention)

• Challenges with divided attention include walking while talking, navigating uneven surfaces, carrying items

• Slower reaction time delays protective stepping, affects balance and increases falls risk

So…what can you do about it?

In addition to considering the falls risk factors outlined above, you can screen your own falls risk by asking yourself 2 questions:

• Have you fallen in the past 12 months? 

• Are you worried about falling?

If you answer yes to either or both of these questions, you are likely to benefit from a thorough falls risk assessment. Physiotherapists play a key role in falls risk assessment and ongoing falls prevention and management. 

Falls Prevention - The Current Evidence 

The Australian Commission on Safety and Quality in Healthcare published updated Best Practice Guidelines for preventing falls and harm from falls in Older People in 2025. 

Exercise

There is good quality, high level evidence (based on research) to recommend that people at risk of falls should engage in exercise as a key part of falls prevention intervention. The evidence tells us that exercise for falls prevention should involve:

• A tailored (individualised), supervised exercise program

• Targeted strength, balance and mobility exercises

• This needs to be in addition to any incidental physical activity or walking

• 2-3 hours of this type of exercise per week, on an ongoing basis

For people at lower risk of falls (1 per year), it may be appropriate to participate in community-based exercise programs or a Physiotherapy-prescribed home exercise program. 

People at high risk of falls (2 or more falls per year) should have a comprehensive assessment from a Physiotherapist to assess their falls risk factors and provide them with a tailored exercise program for falls prevention. Physiotherapists make sure that you can complete your exercises safely and effectively, and will work with you to explore how you can achieve the recommended level of strength, balance and mobility training for falls prevention. 

There is evidence that people with mild-moderate Dementia (cognitive impairment) should also be supported to participate in exercise to prevent falls. 

Other considerations 

In addition to exercise, the best practice guidelines include strong evidence to support a number of multi-factorial falls prevention strategies including:

• Home safety assessments and tailored home safety intervention delivered by an Occupational Therapist (OT)

• Medication reviews 

• Vision reviews

• Assessment of feet & footwear

• Nutrition advice

• Continence assessments

• Strategies to address concerns about falling, anxiety, depression and cognitive impairment

At Bespoke Physiotherapy, we can help! 

Our Physiotherapists can:

• Complete thorough individual physical assessments that considers the function of each sensory system that contributes to balance and your motor (movement) control including strength, coordination and flexibility

• Complete full vestibular assessments as indicated 

• Screen for other multifactorial falls risk factors and refer on as needed for further assessment and intervention

• We can communicate with your GP and help to facilitate referrals to other healthcare professionals including Occupational Therapists, Podiatrists, Dietitians and Continence Clinics

• Provide ongoing individual (1:1) sessions or small group exercise classes to undertake tailored, supervised falls prevention exercise

• Prescribe a home exercise program that is safe for you to complete independently

• Discuss whether telehealth sessions are a safe and effective option for you if you have difficulty attending our clinic in person

Move Easier. Feel Calmer. Why Physio-Led Yoga might be for you.

Gentle movement to improve balance, strength, and wellbeing

Living with a chronic or neurological condition such as multiple sclerosis (MS), Parkinson’s disease, stroke, or neuropathy can make everyday movement more challenging. Issues with balance, stiffness, coordination, and fatigue can affect confidence and independence.

At Bespoke Physiotherapy, our experienced neurological physiotherapists in Melbourne understand the importance of finding exercise options that are safe, enjoyable, and effective. One approach we often recommend—when carefully tailored—is yoga-based exercise for neurological conditions.

What Is Yoga?

Yoga is much more than stretching. It’s a mind-body practice that combines:

• Gentle physical postures (asanas)

• Breathing exercises (pranayama)

• Relaxation or mindfulness

Rooted in ancient Indian tradition, Yoga has evolved into a modern, evidence-supported way to build strength, mobility, and reduce stress. 

When guided by a physiotherapist or trained yoga therapist, yoga can be adapted for any ability level, including seated or supported postures.

What Yoga Isn’t

Many people imagine yoga as young, flexible people doing back bends and complicated twists.

 In reality, yoga is for everyone. It’s not about flexibility or performance — it’s about mindful movement, breathing, and working safely with your body’s current abilities. However it’s important to find a class & teacher that’s suitable for you. 

Key Benefits of Yoga for Neurological Conditions

1. Improves Balance and Coordination

Many people with neurological conditions experience balance difficulties. Yoga helps retrain balance systems and core stability through slow, controlled movement—reducing falls risk and improving confidence.

2. Increases Flexibility and Strength

Yoga poses and movements help ease muscle tightness, improve joint mobility, and build strength in the trunk, legs, and shoulders—key areas for functional mobility. 

3. Manages Fatigue and Breathing Efficiency

Breathing techniques and exercises support better respiratory control and energy management, making it particularly helpful for people with MS or Parkinson’s disease who experience fatigue.

4. Reduces Stress and Enhances Mood

Yoga activates the parasympathetic nervous system, helping reduce stress and anxiety. Regular practice can improve emotional wellbeing and sleep quality. 

5. Builds Body Awareness and Confidence

Slow, mindful movement helps reconnect the brain and body, improving posture and alignment, and confidence in movement—essential goals of neurological rehabilitation.

Safety and Adaptations in Neuro Yoga

People with neurological conditions should only participate in yoga that’s modified for their abilities. At Bespoke Physiotherapy, our physiotherapists design adapted yoga sessions that prioritise safety and success. We can also tailor your session to meet your needs and complement your goals. 

Adaptations may include:

• Chair or rail support for balance

• Seated or lying-down posture options

• Shorter, flexible sessions to manage fatigue

• Avoiding overheating (especially for people with MS)

• Focus on breath and mindfulness over intensity

Real-Life Results

Many of our clients have found yoga to be a powerful complement to physiotherapy.

• A client with early Parkinson’s disease reported feeling taller and better balanced after regular yoga-based balance training.

• A person living with multiple sclerosis found that mindful breathing and stretching helped reduce stiffness and fatigue and improve body awareness. Another person with MS reported a significant improvement in their ability to manage stress across their day. 

• A person living with chronic-stroke reporting improved breath control and increased ease getting on and off the floor with regular yoga-based classes. 

Yoga can provide both physical and emotional benefits—supporting movement confidence and quality of life.

Getting Started with Yoga and Physiotherapy

If you’re living with a neurological condition, speak to your physiotherapist before starting yoga.

At Bespoke Physiotherapy, we can help you:

1. Understand whether yoga is appropriate for your condition.

2. Trial you with our Yoga Trained Physio to introduce you to the class structure and some asanas (poses and movements) before a group session. This also allows the physio to learn about your specific goals, challenges and needs. You will learn to start slowly, listen to your body, and focus on gentle, mindful movement.

3. Start  you with a suitable 1:3 or 1:4 yoga-based physio group session. You will practice various postures and movements, breathing techniques and mindfulness with other similar people with neurological conditions

What to Expect at our classes:

- Gentle seated yoga with a focus on safe stretching and mobility
- Supported standing balance exercises to improve confidence and stability
- Mindfulness practices to reduce stress, enhance relaxation and improve sleep

- Breathing exercises for improved lung function and stress management
- Learn about self care and movement strategies
- A welcoming space for social connection and peer support

1. If suitable for you, we can help you transition to regular community based yoga sessions so you have an understanding of how to manage the class to make it most suitable for you and your condition. 

Yoga has been shown to have very significant benefits in all people with chronic conditions through considerable research. For people with MS, yoga has been found to have many benefits, such as easing pain, fatigue, anxiety, and depression, and improving balance, mobility, and leg/arm strength. It is also effective at reducing stress

Why not try it out and see how it can benefit you? 

. (Thakur P, Mohammad A, Rastogi YR, Saini RV, Sainib AK. Yoga as an intervention to manage multiple sclerosis symptoms. J Ayurveda Integr Med. 2020;11(2):114–117. )

Hydrotherapy

What Is Hydrotherapy?

Hydrotherapy, also known as aquatic therapy, involves performing targeted exercises, stretches, or hands-on treatment in warm water to help improve specific symptoms or physical limitations.

At Bespoke Physiotherapy, our neurological physiotherapists are highly experienced in delivering hydrotherapy for both neurological and musculoskeletal conditions, using water-based therapy to support safe and effective rehabilitation.

Principles of Hydrotherapy

Hydrotherapy is guided by several key principles that make it a powerful and adaptable treatment approach:

• Warm Water (typically 33–36°C):
  Warm water helps relax muscles, increase blood flow and reduce pain and stiffness.

• Buoyancy:
  Water supports body weight, decreasing stress on joints and making movement easier. This allows people to perform exercises that may be difficult or painful on land.

• Hydrostatic Pressure:
  The natural pressure of the water acts like a gentle compression bandage, helping to reduce swelling (oedema) and joint inflammation.

• Resistance:
  Water provides gentle, consistent resistance that helps build strength without the need for weights. Resistance can be increased using water currents for more challenging exercise.

• Balance Support:
  Water movement and currents help safely challenge balance in a controlled environment.

Benefits of Hydrotherapy

Hydrotherapy can lead to a wide range of physical benefits, including:

• Improve cardiovascular fitness and walking endurance

• Reduced pain

• Decreased muscle spasm and muscle tone

• Increased muscle strength and power

• Improved walking quality

• Better balance and reduced risk of falls

• Enhanced overall functional capacity

• Spasticity management 

Conditions Supported by Evidence

Hydrotherapy has strong evidence supporting its use for a range of conditions, including:

• Multiple sclerosis

• Parkinson’s disease

• Stroke

• Spinal cord injury (both incomplete and complete)

• Rheumatoid arthritis

• Lower back pain

• Osteoarthritis and other forms of arthritis

• Post-operative recovery following surgery

Local Pool Options

At Bespoke Physiotherapy, we can attend a range of pools across Melbourne. However, we recommend the Northcote Aquatic and Recreation Centre due to its close proximity to our clinic (helping minimise travel costs) and its excellent facilities designed to support people with varying physical abilities.

Getting Started

If you are interested in trying hydrotherapy, please contact our admin team or speak directly with your physiotherapist at Bespoke Physiotherapy.

Before commencing hydrotherapy, we will complete a consent form and ensure there are no medical conditions that would make participation unsafe.

References 

Amedoro A, Berardi A, Conte A, Pelosin E, Valente D, Maggi G, Tofani M, Galeoto G. The effect of aquatic physical therapy on patients with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord. 2020 Jun;41:102022. doi: 10.1016/j.msard.2020.102022. Epub 2020 Feb 22. PMID: 32114368. 

Al-Qubaeissy KY, Fatoye FA, Goodwin PC, Yohannes AM. The effectiveness of hydrotherapy in the management of rheumatoid arthritis: a systematic review. Musculoskeletal Care. 2013 Mar;11(1):3-18. doi: 10.1002/msc.1028. Epub 2012 Jul 16. PMID: 22806987.

Gu X, Zeng M, Cui Y, Fu J, Li Y, Yao Y, Shen F, Sun Y, Wang Z, Deng D. Aquatic strength training improves postural stability and walking function in stroke patients. Physiother Theory Pract. 2023 Aug 3;39(8):1626-1635. doi: 10.1080/09593985.2022.2049939. Epub 2022 Mar 14. PMID: 35285397. 

Liu Z, Huang M, Liao Y, Xie X, Zhu P, Liu Y, Tan C. Long-term efficacy of hydrotherapy on balance function in patients with Parkinson's disease: a systematic review and meta-analysis. Front Aging Neurosci. 2023 Dec 13;15:1320240. doi: 10.3389/fnagi.2023.1320240. PMID: 38152605; PMCID: PMC10751311.

Mirmoezzi M, Irandoust K, H'mida C, Taheri M, Trabelsi K, Ammar A, Paryab N, Nikolaidis PT, Knechtle B, Chtourou H. Efficacy of hydrotherapy treatment for the management of chronic low back pain. Ir J Med Sci. 2021 Nov;190(4):1413-1421. doi: 10.1007/s11845-020-02447-5. Epub 2021 Jan 6. PMID: 33409843.

Palladino L, Ruotolo I, Berardi A, Carlizza A, Galeoto G. Efficacy of aquatic therapy in people with spinal cord injury: a systematic review and meta-analysis. Spinal Cord. 2023 Jun;61(6):317-322. doi: 10.1038/s41393-023-00892-4. Epub 2023 Mar 25. PMID: 36966260.

Radder DLM, Lígia Silva de Lima A, Domingos J, Keus SHJ, van Nimwegen M, Bloem BR, de Vries NM. Physiotherapy in Parkinson's Disease: A Meta-Analysis of Present Treatment Modalities. Neurorehabil Neural Repair. 2020 Oct;34(10):871-880. doi: 10.1177/1545968320952799. Epub 2020 Sep 11. PMID: 32917125; PMCID: PMC7564288. 

Sleep Hygiene in Neurological Conditions

Sleep is essential for brain health. 

A good night’s rest supports our attention, memory, problem-solving, emotional well being and physical recovery. When sleep is disrupted, people often experience fatigue, low mood and reduced ability to cope with daily tasks. For individuals living with neurological conditions, sleep is not just restorative – it is a critical component of rehabilitation and long-term brain health.

Why Sleep Matters in Neurological Rehabilitation

During sleep, the brain consolidates learning, strengthens neural connections and clears metabolic waste products. These processes are fundamental to neuroplasticity - the brain’s ability to adapt and reorganise - which underpins recovery in neurological rehabilitation.

Poor sleep can negatively affect concentration, balance, reaction time, pain perception and emotional regulation. This can limit engagement in therapy and reduce physical performance. 

Supporting healthy sleep habits is therefore an important part of maintaining physical function and emotional well being. 

Common Causes of Sleep Problems in Neurological Conditions

Sleep difficulties are very common in people with neurological conditions and are often multi factorial. Common contributors include:

• Disruption of brain areas involved in sleep-wake regulation

• Fatigue and altered circadian rhythms

• Pain, spasticity or stiffness at night

• Medication side effects

• Reduced mobility or difficulty changing position in bed

• Anxiety, low mood or stress

• Bladder and bowel dysfunction leading to night-time waking

Identifying the underlying causes is key to effective management.

Why Sleep Is Especially Important in Specific Neurological Conditions

Parkinson’s Disease

Sleep disturbances affect the majority of people with Parkinson’s disease. Common issues include insomnia, REM sleep behaviour disorder, restless legs syndrome, vivid dreams and excessive daytime sleepiness. Poor sleep can exacerbate motor symptoms such as rigidity, bradykinesia and balance impairment, as well as cognitive and mood changes. Improving sleep quality can help optimize daytime function and participation in exercise and rehabilitation.

Multiple Sclerosis (MS)

Fatigue is one of the most common and disabling symptoms of MS, and sleep disturbance frequently contributes to it. Pain, spasticity, nocturia and temperature sensitivity can all disrupt sleep. Inadequate sleep can worsen fatigue, cognitive difficulties and mobility limitations. Supporting good sleep hygiene can play a meaningful role in managing fatigue and improving quality of life.

Stroke

After a stroke, changes to brain structure and function can disrupt normal sleep patterns. People may experience insomnia, excessive sleepiness or sleep-disordered breathing. Poor sleep can negatively affect attention, memory, mood and motor recovery. Research has shown that balanced sleep patterns can positively impact cognitive function and functional recovery after stroke. 

Practical Tips for Improving Sleep Hygiene

Regular Routine - Try to go to bed and wake up at the same time each day, even on weekends. This helps to regulate release of sleep hormones, leading to more efficient sleep onset and waking at desired time. 

Develop a calming pre-bed routine to prepare the body for sleep; this may involve relaxation techniques such as gentle stretching, reading, listening to music, a warm bath, practising mindfulness.

Creating a supportive sleep environment - quiet, dark and comfortably cool to help the body prepare for sleep. 

Optimise daytime habits - increase exposure to natural daylight. Even 15-20 minutes of sunlight daily assists with circadian rhythm and appropriate sleep/ wake phases. Additionally, limit day time naps (or keep them short and earlier in the day).  

Limit screen use before bed - blue-light can interfere with melatonin production. Keep any screens out of the bedroom - reserve bed primarily for sleep!

Diet - reduce caffeine and alcohol intake later in the day, avoid heavy meals close to bed time. 

Research shows that caffeine after about 3pm significantly prohibits a restful sleep cycle; it can prolong the time it takes to fall asleep, limit depth of your sleep cycles and increase frequency of disturbances and wake time throughout the night. 

Alcohol also alters sleep routine and quality. Alcohol suppresses REM and leads to increased wake time and disturbance. 

leading a healthy diet, avoiding high-sugar food and increasing your fiber and vitamin B intake regulates your body’s release of melatonin, helping you to fall asleep fast, stay asleep throughout the night and effectively spend more time in restful phases of sleep leaving you feeling rested and energized for the following day. 

Role of Exercise - regular exercise, guided by your physiotherapist, can promote natural tiredness and improve sleep quality for a more restful and restorative sleep.

The 10, 3, 2, 1, 0 Rule 

The 10, 3, 2, 1, 0 rule is a helpful and memorable way to organise and use good sleep hygiene practices. 

To allow you to enhance and stick to a steady routine, use it as follows: 

• Eliminate caffeine 10 hours before sleep

• Cut alcohol 3 hours before bed

• Stop working 2 hours before bed

• Stop screen time 1 hour before bed 

• Hit “snooze” 0 times in the morning!

All of these techniques can help to reduce some of the variables that could prolong or delay the start of sleep or increase the disturbance throughout the night by limiting the intake with enough time for your body to eliminate them. 

When to seek support? 

Sleep hygiene is not a one size fits all technique, particularly for people with neurological conditions due to other variables such as medication, fatigue, pain and altered circadian rhythms. 

It often takes a period of trial and error and various strategies to achieve the best results. It is important to try each technique for several days and may be helpful to keep a diary of your attempts to find strategies that work best for you. 

If sleep difficulties persist or significantly affect daily function, it is important to seek professional support. It is important to discuss night-time symptoms, medication timing or bladder strategies with your healthcare team to help identify contributing factors and develop an individualized management plan.

.References

1. Medic, G., Wille, M., & Hemels, M. E. H. (2017). Short- and long-term health consequences of sleep disruption. Nature and Science of Sleep, 9, 151–161.

2. Videnovic, A., & Golombek, D. (2013). Circadian and sleep disorders in Parkinson’s disease. Experimental Neurology, 243, 45–56.

3. Veauthier, C. (2015). Sleep disorders in multiple sclerosis. Current Neurology and Neuroscience Reports, 15(5), 21

Do I need a scan if I have BPPV?

What is BPPV?

BPPV (Benign Paroxysmal Positional Vertigo) is a common condition, affecting 2.4% ofindividuals at some time in their life. BPPV is a condition of the inner ear where crystals that belong in one area migrate to another area, called the canals, which causes an over stimulation of the nervous system resulting in vertigo (spinning) amongst other symptoms. It’s name means:

• Benign - not life-threatening

• Paroxysmal - occurring as brief, sudden spells

• Positional - triggered by certain head positions or movements

• Vertigo - A false sense of rotational movement.

Do I need a scan if I have BPPV?

Not usually. Luckily, BPPV is usually straightforward to diagnose and can be done by undertaking special positional changes that cause a very specific response by the nervous system. The response is directly related to the particular ear and canal within the inner ear that has the problem. It does not generally require investigations such as blood tests or scans. Occasionally, more specialized testing may be warranted where a clinician may wish to rule out less common causes of vertigo.

Luckily, BPPV is usually straightforward to diagnose without requiring investigations such as blood tests or scans.

There are some situations, however, where a clinician will need to rule out other causes of vertigo; further investigation may be required in these cases.

What does BPPV feel like?

The “garden variety” of BPPV will feel like this:

• Vertigo (often with nausea and sometimes with vomiting) is triggered by movement of the head. There may be a brief delay after moving the head, then the vertigo will last less than 2 minutes.

• In most cases patients will see or feel the room spinning, though for some it may be a more vague dizziness or sense of being off-balance.

• Symptoms come on suddenly. They are often first noticed turning in bed or when getting out of bed in the morning, though they can come on at any time.

• Once an episode of vertigo has passed, it will stay settled until the head is moved.

• There may also be vague symptoms such as tiredness, fogginess in the head, and blurry vision which may linger after the vertigo episode has passed.

• There will not be any change to hearing, nor any other neurological symptoms.

What will my GP do if I have an episode?

When visiting your doctor, they may do a number of assessments. Among these, they may look in your ears, test your eyes and perhaps test your balance. They may perform several special tests to exclude any significant illness. On occasion, they may do positional testing, though this is not common. Often GP’s will make a diagnosis by your history and symptoms, though this is not the gold standard.

Should I be assessed with positional testing?

Yes, this is the gold standard! The current guidelines on assessing suspected BPPV were published in 2016 (ref 1). They recommend:

• In-clinic diagnosis using the Hallpike-Dix and Supine Roll tests. These tests involve moving your head and, or body into particular positions and watching for specific eye movements (nystagmus) to occur. This will reproduce your symptoms if you have active BPPV and will often cause vertigo and may make you feel nauseated, but, it is important for accurate diagnosis and to guide treatment.

• Clinicians should differentiate BPPV from other types of dizziness and vertigo.

At Bespoke Physiotherapy, we use special Frenzel goggles that record your eye movements during testing. This allows us to very accurately diagnose BPPV, as sometimes the eyes’ movements may be subtle and brief.

Generally, clinicians should not refer for radiographic imaging or vestibular function testing in these patients, unless there are additional signs/symptoms of other conditions which would require these investigations.

By being assessed and diagnosed quickly and accurately, patients can avoid unnecessary scans and reduce the burden on the healthcare system and enables patients to have prompt and effective treatment much sooner.

Vestibular physiotherapist can treat you very effectively for BPPV. With a skilled practitioner, 90% of BPPV cases will resolve after 1-3 treatment sessions (2). Vestibular physiotherapists are highly trained at assessing the vestibular system, neck, balance, and other related parts of the body and brain. They will test you to help rule out other conditions and can provide valuable input should you need to see a neurologist, otolaryngologist (ENT) or other specialist.

So, if you have been diagnosed with BPPV by your GP or specialist or if you have symptoms that sound like those of BPPV, seek out an excellent vestibular physiotherapist, like ours here at Bespoke Physiotherapy, and start feeling better, sooner.

Once a diagnosis of BPPV is confirmed, a vestibular clinician can then commence treatment right away. In a skilled practitioner, 90% of BPPV cases will resolve after 3 or fewer sessions(2)!

References:

(1) Battacharyya N, et al. (2017). Clinical Practice Guidelines: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology-Head and Neck Surgery. 156(3_suppl): S1-S47. https://journals.sagepub.com/doi/10.1177/0194599816689667

(2) Parnes LS, et al. (2003). Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 169(7):681-693

Seated Stretches for Wheelchair Users

We all know that our bodies are designed to move. The way in which we go about our daily life will look different for everyone and depends on each person’s individual functional abilities. For those who spend the majority of their day in a wheelchair, regularly changing positions can be more challenging.

Wheelchairs allow individuals to have a greater capacity to get around independently, however spending a large amount of time in one position is not healthy for anybody.

Joints and muscles can become stiff and sore which may lead to less compliance within muscles and discomfort.

The many benefits of stretching for wheelchair users include:

• Increased flexibility and joint range of motion

• Improved circulation

• Improved posture

• Stress relief

• Reduced muscle tension and spasticity

• Increased energy levels

• Improved sleep

We have collated our favourite stretches that can be easily performed in a wheelchair, so give them a go!

• Triceps Stretch

Reach one arm up towards the ceiling and place your hand behind your head by bending the elbow. Hold onto the elbow with the other hand and gently pull elbow sideways until a gentle stretch is felt in the shoulder or back of your upper arm. Hold for 30 seconds then repeat on the other arm.

• Shoulder Shrugs

Lift your shoulders up towards your ears and hold this for 5-8 seconds. Relax completely and allow your shoulders to drop down naturally. Repeat this several times. This exercise is good for relieving stiffness and tension in the shoulders and neck.

• Forward Flexion

Bend forward starting from the head to stretch from the neck through the lower back. Find a comfortable position and hold it for about 1-2 minutes. To sit up, put your hands on your thighs and push your upper body to an upright position.

• Seated Rotation

Turn your upper body to the right and then to the left while you continue breathing normally. This exercise will create a stretch in your back and sides. Repeat this a few times in each direction.

• Neck Stretch

Tilt your head to the left side while you allow your right shoulder to move downward. This exercise will create a stretch along the side of the neck. Hold for 30 seconds, then repeat on the other side.

• Side Stretch

Hold your left elbow with your right hand and gently pull your elbow behind your head until an easy stretch is felt. Gently lean sideways from your hips to stretch along the side of your body. Hold for 30 seconds then repeat on the other side.  

• Scapula Activation

Interlace your fingers behind your head, keeping your elbows straight out to the side. If this position is uncomfortable, just rest your hands on your thighs. Gently bring the shoulder blades towards each other. Hold this position for 10-15 seconds; you should be able to feel the muscles in the upper back working. Repeat 10 times.

• Hip Stretch

Lift your knee toward your chest until a gentle stretch is felt. Hold the position until the stretch lessens, then stretch a little further until a mild, comfortable stretch is felt again. Repeat this on the other leg.

We always suggest that prior to starting an exercise program you make an appointment with one of our skilled Physiotherapist 9329 5551 so that they can guide you with a tailored exercises program to best suit you.

Resources:

https://enabled.in/wp/wheelchair-users-exercises-resources-and-guides/

Pilates vs Neuromuscular Exercise: What is best for me?

In the last few years, ‘pilates’ has gained huge popularity. You might have seen pilates classes listed on your gym class timetable as well as at your local physiotherapy clinic or pilates studio. There are important differences between a standard pilates class and the Neuromuscular exercise sessions we offer here at Bespoke Physiotherapy.

Pilates was developed by a man named Joseph Pilates in the 1920’s with the aim of improving physical and mental conditioning (1). Pilates is an exercise method which increases strength and endurance of core muscles, and improves flexibility, dynamic postural control and balance (2,3,4). It can also help to reduce stress and anxiety, and improve overall quality of life (5,6).

At Bespoke Physiotherapy, Neuromuscular exercise describes our approach to providing individualized guidance and treatment direction to help you improve your postural awareness, balance, strength and motor control. This may be achieved in different ways including the use of manual therapies and facilitated movements, clinical Pilates principles, targeted exercises, as well as education and advice on pain, fatigue, and symptom management.

This is not to say that pilates is not a highly effective form of exercise which can improve many aspects of your well-being. However, ensuring that your physiotherapist has a sound understanding and knowledge regarding neurological conditions, chronic pain, vestibular issues and recovery following surgery will enable you to receive the most appropriate and tailored rehabilitation.

Through using a thorough assessment process, we aim to identify areas within the body that need some extra attention, whether this means more movement, greater strength or more selective control, we are ready to work with you to help you achieve your goals!

References:

1. Wells, C., Kolt, G. S., Bialocerkowski, A. (2012). Defining Pilates exercise: A systematic review. Complementary Therapeutic Medicine, 20, 253–262.

2. Byrnes, K., Ping-Jung, W., Whillier, S. (2018). Is pilates an effective rehabilitation tool? A systematic review. Journal of Bodywork & Movement Therapies, 22, 192-202.

3. Landmark, T., Romundstad, P., Borchgrevink, P. C., Kaasa, S., & Dale, O. (2011). Associations between recreational exercise and chronic pain in the general population: evidence from the HUNT 3 study. Pain, 152(10), 2241-2247.  

4. Wells, C., Kolt, G. S., Marshall, P., Hill, B., & Bialocerkowski, A. (2014). The effectiveness of Pilates exercise in people with chronic low back pain: a systematic review. PloS One, 9(7), e100402.

5. Bulguroglu, I., Guclu-Gunduz, A., Yazici, G., Ozkul, C., Irkec, C., Nazliel, B., & Batur-Caglayan, H. Z. (2017). The effects of Mat Pilates and Reformer Pilates in patients with Multiple Sclerosis: A randomized controlled study. NeuroRehabilitation, 41(2), 413–422. https://doi.org/10.3233/NRE-162121

6. Marques, K., Trindade, C., Almeida, M., & Bento-Torres, N. (2020). Pilates for rehabilitation in patients with multiple sclerosis: A systematic review of effects on cognition, health-related physical fitness, general symptoms and quality of life. Journal of Bodywork and Movement Therapies, 24(2), 26–36. https://doi.org/10.1016/j.jbmt.2020.01.008

How to master working from home

Working from home has probably become the new normal for a lot of us over the last few months. However, it is likely that you don’t have the same ergonomic set-up that you do at work. Spending many hours at a work station that is not well set-up can result in back and neck discomfort, eye strain, and headaches, as well as reducing your productivity and efficiency. 

Here are a few tips and tricks to make your home office set-up as comfortable and efficient as possible:

• Chair height: Hips should be slightly higher than knees and feet placed flat on the floor to reduce strain on the low back. A kitchen chair can work well in the absence of a traditional office chair. Add a small lumbar pillow or roll up a towel to place in the small of the back if needed. If you have armrests, make sure they are set low enough that your shoulders aren’t scrunching up.

• Screen: The top of the screen should be at or just below eye level and about an arm’s length away from your eyes to reduce neck and eye strain. If you only have a laptop, we recommend placing some books underneath it or getting a laptop stand to lift the height of the screen. 

• Desk or table height: Forearms should rest comfortably on the table, or arm rests of chair about parallel to the floor.

• Movement: Set at timer for activity and stretching breaks every 30-60 minutes. Get up and walk or stretch. One of my favorite stretches that helps reverse the effects of prolonged desk work is an arm opening. Lie on your side with your arms straight in front of your shoulders, as seen in the photo on the left below. Breathe out as you lift your uppermost arm towards the ceiling and then allow the upper body to rotate so that the chest is turning towards the ceiling. Allow the head to follow the movement of the arm. Hold this position for a few breaths in and out, then bring the arm back to the start position.

If you are experiencing discomfort that does not resolve with these adjustments to your posture and set-up, do not hesitate to contact us. We may need to include some more specific and personalized recommendations or exercises to best help you.