Reaping the benefits of hydrotherapy

Jo had a good physiotherapy session today, with the benefits of the previous day's hydrotherapy session manifesting themselves.

Jo's new goal is to stand unaided and she accomplished that with relative ease.

Back in the water and back on track

After an abortive week last week, which saw Jo’s hydrotherapy session cancelled in midstream because a second person did not appear to satisfy health and safety requirements and her physiotherapy session cancelled because her physiotherapist took some more annual leave, we finally got back on track with a hydrotherapy session today.

This went very well with Jo getting better and better at kicking her left leg from the knee whilst floating on her back and saw her increasing the use of her left leg to stand from a semi-sitting position in the water.

She seems to be moving from stage 4 to 5 of Brunnstrom’s 7 stages of neurological recovery, where spasticity begins to decrease and movement patterns are not dictated solely by limb synergies.

It was interesting to read, in a Wikipedia entry on spasticity, that “multi-tasking, such as walking while talking, or doing several physical activities simultaneously, can also trigger an increase in spasticity, especially if one or several of those activities makes the person nervous”.

This describes exactly what is happening during Jo’s walking exercises, with anxiety about turning corners leading to an increase in muscle spasticity and thus pain.

Progress brings another barrier to overcome

Jo had an assessment today, to determine the level of continuing support for her rehabilitation from the NHS neurological physiotherapy team.

They saw definite progress in her standing, walking and limb movement of the left leg. Her new goals are to stand from a sitting position unaided and to walk with only the support of a zimmer frame or four-legged walking stick. Jo has a conceptual aversion to both of these as 'old people's things', although I sense less so to the latter. Examination of her leg showed good muscle tone is returning and the ankle is getting looser, snmething Jo's Thai masseuse observed on the weekend. This means Jo will not require botox treatment there but they may look at a brace to support the looser, and hence weaker, ankle until muscle strength is further developed.

As part of the assessment they asked Jo to perform her nine yard walk to the front door. As on Friday, Jo got halfway before the pain overcame her. The physiotherapist echoed my observation that anxiety was causing the pain rather than vice versa. What the physiotherapist observed is that, as Jo's stepping of the left leg is improving, she is neglecting to 'prepare' the left leg for weight transfer by straightening it sufficiently. The consequence of this is that she attempts to put weight on a bowed leg, feels the leg giving at the knee, as it naturally would if any of us attempted the same. At this point panic begins to set in, prompted by a natural fear of falling, a fear exacerbated by the fall suffered at the hands of her carers back in March. This anxiety triggers the pain in the knee that eventually overwhelms Jo. We all perform this leg straightening 'preparation' without thinking about it as it is a response learnt in infancy, one that Jo must now relearn.

Pain and Progress

Jo's physiotherapy session went well despite her mental attitude, which has been negative all week. She performed the nine yard walk without any assistance placing her foot. Halfway through the walk she began to complain of pain in her knee and had a panic attack.

The physiotherapist thought this might be 'predictive pain' where anxiety about the returning muscle function causes one to experience pain.

Water works

Autumn is finally upon us and the colder weather made Jo and I feel more weary than usual today. Jo did not really feel like going to hydrotherapy but persevered anyway. Once in the water the beneficial effects manifested themselves yet again, with Jo progressing in her ability to place her left leg down on the bottom of the pool from a position floating on her back. On her first attempt she could hardly manage it but each successive attempt saw her gain in proficiency and confidence. Such was her increase in confidence that, on the last two stands accomplished thus, she took her right hand away from the side rail and stood completely unsupported.

Apparently this neuro hydratherapy used to be provided by the local hospital on the NHS but it is no longer supported. That is a great shame as Jo and I feel this is more beneficial to her than regular physiotherapy.

Signs of progress

Today Jo had a "fitting" for a new wheelchair to address the issues of lack of support for her left arm and the fact that it is too low. The fitting went well, with us identifying that it is the lower height of her current chair that is making transfers into the car more difficult.

During the course of the fitting Jo had to perform several transfers from one chair to the other. What really impressed me was the relative ease with which Jo performed these operations. It is only a matter of degree and progress remains agonisingly slow but we both could see that progress is being made.

A Step Onto The Scales

Jo's physiotherapy was very fulfiling today. Jo managed her walk to the hallway and her stepping was more purposeful than ever before, showing the beneficial effect of the hydrotherapy sessions. Jo did experience pain in the left leg, from her ankle to her knee. The physiotherapist identified this as muscle stretch, that is the pain of muscles being brought into use after a long period of dormancy.

Jo then attempted to stand on the new Salter scales purchased for this purpose as they had a wide footplate. Placing her left foot on the scales she stood, putting all her weight on that leg and stepped up onto them with her right leg. There was no pain in the left leg dvring this, despite all of her weight being transferred to this side during the procedure.

As a further bonus the scales revealed that Jo had lost 14 pounds over the last month as a result of following a low carbohydrate diet.

Hydrotherapy really suits Jo…

.. she is very comfortable and relaxed in the water and today’s session saw further improvement with none of the fear of falling that accompanies her physiotherapy sessions.

She was able to kick with both legs whilst floating on her back and perform the scissors movement better than she had done last time.

Jo performed several stands from a sitting position in the water, pulling herself upright with the bar at the side of the pool. The first time it was difficult for her to control the left leg, bending it down and placing it on the floor of the pool. Each successive attempt saw this accomplished more readily.

We have a review with the physiotherapist in two weeks time and we shall discuss whether to increase Jo’s land-based therapy or whether it is worth investing the time (and money, this is being paid out of our pocket as it is not available on the NHS or via medical insurance) in increasing the frequency of these beneficial sessions.

Reaping the benefits

Jo’s physiotherapy session today showed the benefits of her two hydrotherapy sessions as she was able to step with her left foot completely unaided.

There is still pain in the left foot and anxiety about falling. It seems to me that the later precedes the former and I remain convinced that Jo’s confidence is still suffering from the fall in March.