What is a Neurological Physiotherapist?

When most people hear "physiotherapist," they picture a sports clinic with strapping tape, massage and athletes recovering from injury. While sports physiotherapy is a big part of the profession, physiotherapists are movement specialists in many varied areas. They work across an enormous range of settings and specialties, from intensive care units to aged care facilities, from paediatrics and women’s health to oncology.

Neurological physiotherapy is one

of those specialties. They work closely with people living with conditions like Parkinson's disease, post-stroke, multiple sclerosis, acquired brain injury, and many others.  

What does a neurological physiotherapist target?

The brain and nervous system have a remarkable capacity to adapt. The brain’s ability to strengthen connections in response to specific input is known as “plasticity”. Physiotherapy and exercise are some of the most powerful tools we have to encourage this process. When certain movements or activities are targeted and trained, the brain can strengthen the circuits needed to restore or improve function.

A neurological physiotherapist’s role is to understand how a condition is affecting a person’s movement and functioning, then work to improve it. This might involve a tailored exercise program, assistive devices, or strategies for everyday function - targeting things like walking pattern, strength, balance and falls prevention, or moving safely at home and in the community.

Education is just as important. Physiotherapists help people and their loved ones understand how their condition affects motor function, mood, independence and everyday life, and what activities will help them most as individuals.

How does physiotherapy help Parkinson’s Disease?

Exercise is a non-negotiable part of managing motor symptoms in Parkinson’s disease. Physiotherapy helps identify which areas of function are most affected and which exercises will target them effectively. For example, if freezing or shuffling of gait is an issue, a physiotherapist may provide alternate movement patterns and specific cues to help manage this.

There are several theories on how exercise positively impacts the brain in people with Parkinson’s:

·      Exercise increases neural activity. This is how quickly, and accurately different parts of the brain communicate with each other.

·      Complex skill acquisition, such as dancing or dual-task activities, challenges the brain with new movements and coordination demands. These demands result in new skills that the brain transfers into everyday function.

·      Exercise stimulates activity in brain areas affected by Parkinson’s, helping improve symptoms from motor performance to mood.

·      External cues, like music or walking poles, help restore a normal rhythm of movement by “bypassing” the brain circuits that disrupt smooth movement.

·      Repeated, targeted training like balance exercises, strengthens proprioceptive circuits and the body’s feedback to the brain.

·      Exercise boosts protective brain chemicals and stimulates blood flow.

Johansson, M. E., Cameron, I. G. M., Van der Kolk, N. M., de Vries, N. M., Klimars, E., Toni, I., Bloem, B. R., & Helmich, R. C. (2022). Aerobic Exercise Alters Brain Function and Structure in Parkinson's Disease: A Randomized Controlled Trial. Annals of neurology, 91(2), 203–216. https://doi.org/10.1002/ana.26291

Zhang, M., Li, F., Wang, D., Ba, X., & Liu, Z. (2023). Exercise sustains motor function in Parkinson's disease: Evidence from 109 randomized controlled trials on over 4,600 patients. Frontiers in aging neuroscience, 15, 1071803. https://doi.org/10.3389/fnagi.2023.1071803