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I think you may notice again that I’ve missed the May issue of this blog…mainly I was pursuing different career opportunities and it took some of my attention away from the maintenance work of my practice such as blog writing.
And now that’s over, and yes, I was successful my new pursuit (hurray), my mind has come back on a reflective mode after excitement of my spring adventures. Which now brings me to think about a concept of maintenance work and its place in our lives - personal, health, business, relationships, careers, basically everything.
Think about how we take our cars for annual service and MOT, or cleaning the gutters/windows in our homes (or at least have someone else do it), or cutting the grass and weeding the garden - there’s a phenomenal amount of maintenance work that actually takes place in our day to day life! Sometimes they can be engaging, other times it’s mundane, and yet, there’s no escaping - these tasks have to be done if we want to live in some sort of harmony and good order. On the flip side, when maintenance work is neglected or delayed, small issues start to creep in and with further neglect, can turn to bigger problems to solve. If this has ever happened to you, as it has to me, chances are you’ll be wishing you prevented it when you can.
In physiotherapy world, there is also a known practice referred to as maintenance physiotherapy which is not too dissimilar to what I described above. There is no single definition for the practice although the best way I can describe it is this - maintenance physiotherapy begins when all rehabilitation treatments have been completed and there is still work to do for better outcomes and quality of life. What is this in actual practice? At times, it may involve hands on physio treatment such as stretching, passive movements, or assisted movement, or coaching through exercise sessions. It also involves patient self- training and awareness, such as carrying out home exercise programs or tasks, and patients being more responsible for their condition.
In the outset, maintenance physiotherapy sounds simple and repetitive in nature. And at times, the gains are marginal that without accurate or specific measures, may not be noticeable. So you could ask, it is worth doing?
Yes.
All the more so for managing neurological problems. Once recovery or full rehabilitation potential has been reached, the task is how to keep the gains and keep deterioration at bay. Oiling the engines to stop the rust, so to speak. Doing small but regular maintenance work goes a long way in managing long term neurological conditions. The harsh reality is that one will only know how much gains are made is by stopping altogether - something I wouldn’t recommend!
I’m a big believer of investment time, effort, and money towards maintenance, as I would rather take vitamins than painkillers - wouldn’t you?
If all of these resonates with you, and you’re stuck somewhere between wanting to start and not knowing where to start, getting someone to coach you always helps. A structured starter plan will give you good foundation and will also provide a roadmap for the future.
Let’s talk. Register here or call 07451 551279 for your free consultation.
Enjoy the sunshine
So, just to set the tone, there’s 2 parts to this blog but trust me they are related…
For some time now, I’ve been curious about how activity trackers influence human behavior and levels of activity – in simple terms, do they work?? Of course, there are several types of activity trackers, and for the sake of making things simple, I chose to look at step counters also known as pedometers.
I decided to perform a short self-experiment and got myself a Fitbit Inspire 2 – for no other reason that it’s the one that fits my tiny wrist! I soon found out that it track all other things such as heart rate, sleep quality, women’s health, exercise days, and so on, but quite frankly, to this day, I’m only really using the step counter and the count down timer (mainly when I’m cooking something in the oven!). And so my experiment begins…
As a default, the daily step target has been set to 10,000 steps. I found out later on that this benchmark was originally set as a marketing campaign by a Japanese company (Yamasa Corporation) when they released their step-tracker (sometime in 1964), rather than as a specific health objective! Interesting!
However, I won’t question this too much, as the overall intention is for the greater good as walking is exercise, and anything that helps encourage this is ok with me!
I digress…
To go back to my original aim, I wanted to see for myself if tracking will help me keep to the target. If you recall from my very first blog, I mentioned how people who track their steps end up doing 2,500 steps more per day compared to those who don’t. So here we go….
I started on 24th February and since then I have an average of 10,618 steps. I have since earned the Urban boot badge (15,000 steps in a day) 10 times, have walked the equivalent of the entire London Underground (although I’m not sure if that includes the Elizabeth Line). I know on some days I have done 22k (my poor legs – they did hurt on those days! Thank goodness for Theragun – that’s another blog post!), and there’s at least 3 days where I was under 10k. I don’t have much more data as it’s only April, but that’s the general summary of it.
Just to look at this not so scientific experiment, it seems that trackers do work in increasing general activity….or do they???? I’ll touch on this in Part 2, but here’s a more detailed study…
A feasibility study by Paterson, Burridge and Johnson (Synapse Spring 2023) has looked at the use of activity monitor to increase physical activity of patients in acute stroke unit. Now, this is a rather complex study to delve into with great detail, however, it did suggest that both staff and patients involved in the study thought that the monitors were useful in creating awareness of levels of activity. What it couldn’t directly suggest is whether the levels of activity of the patients increased during the study periods. The key messages points to the effects on behavior such as providing feedback for patients, and highlighting the importance of physical activity. I suppose we can assume that there was a likelihood increase in activity given that it was seen as a motivational tool for hitting targets set by therapists. The study acknowledged that while activity feedback (trackers) may be useful as an intervention, it requires better understanding of how to best deliver this.
So I guess my question whether activity trackers work is not as simple to answer as I thought, and I certainly do not want to mislead. But is it worth trying to see if your activity does improve? I think so. There’s something about having feedback as what we’ve done that make us sit up and pay attention to the numbers. However, what made me question the trackers is whether do we connect to the numbers of steps, or to the wider aim of getting to the set number of steps (goodness, this is going to be a very long blog!!!). I may have to tackle this topic in the future, and for now, I will leave you decide…
I’m going back to my personal experiment. Overall, I was pleased I was hitting the 10k steps a day goal, and you might be wondering, how did she do that?
Me too.
When I started this journey, I was actually dreading the extra work I might have to do just to keep up with the target. Onwards and upward, I put on the Fitbit on my wrist as soon as woke up…
On average, from the time I got out of bed, got ready, made breakfast for 3, packed lunch for 3, got my 4 year old ready for school, basically, the usual things I have to do before I get in the car to leave, I’ve clocked about 2000 steps. That’s before 8 am…
As you may have guessed, I have a fairly active day job, I don’t sit down for long periods except for lunch, and when I finish a full day shift that’s another 5000 steps at least (7000 in total so far).
Here comes school run, playtime at home or in a field/playground or running after a scooter/bike operated by a child (!) making dinner, bath time/bed time (for the little one) which actually averages 4000 steps (ka-ching 11,000 steps!)
That’s weekdays. School days. Weekends and school holidays – that’s when I clocked the over 20k.
So to answer the 2nd question – here’s how not to count your steps – track your activities instead! If you’re constantly running after a child/children, doing household chores, walking to your local shops/school/church/bus stop etc, they all add up! On average, I noted I do the 10k steps by walking 7 kilometers, so feel free to use that as a benchmark (although I am 5’2” with short legs so if you’re taller you’ll get to 10k steps sooner!)
The nice surprise for me was that I didn’t need to do anything extra to do the 10k steps – I was already doing it. Did I really need to tracker to tell me that? Actually, I did. I didn’t know how much I was doing. It goes back to the point of the feasibility study about raising awareness. Although I’m not sure if I am doing more since having a tracker, I just do what I need to do to get on with my life. It’s too soon to tell if I’m actually more fit, but I can keep up with my life’s demands and for now that’s good enough. And I’m sharing this, because, if you’d rather not have a tracker, you can use my personal experiment to measure your own levels.
Or you can just get your own tracker. That might be easier. It also helps avoid burnt food in the oven.
Think you need to talk about how to get moving? Register now for your free consultation.
I know, I know, this is coming on a bit later this month, it’s a good thing I don’t work for Vogue, they’re always a month ahead in their current issue!
I do want to share an interesting learning I’ve completed recently - a masterclass in neuro technology.
By definition, Neuro technology refers to devices and technological applications used to influence the nervous system in order to make plastic changes and enhance function (Hobbs Rehabilitation, 2023). Without getting bogged down with too much detail, it simply means technology used for therapeutic purposes. However, these are not just any old games console, these are specialist devices designed specifically for rehabilitation and recovery, something that “games” won’t necessarily target directly as they are designed for entertainment purposes.
It’s not to say that Neuro technology isn’t entertaining - in fact, by design, they are immersive, which often meant that user becomes unaware and less conscious of their surroundings while becoming more focused on the task at hand. Which I think is quite cool - external distractions can be a nuisance during therapy!
Neuro technology has been around for quite some time, however, it isn’t always accessible in mainstream physiotherapy, due mainly to cost of acquiring one. That aside, there are numerous benefits to users and therapists, my favourites of which are the precision of movement being trained and the number of repetitions which can be done in a short span of time. As much as I like traditional hands on therapy, I think neuro technology has this advantage which therapists ought to explore and take advantage.
It is also fair to say the neuro technology isn’t aimed at replacing human therapists - it is, after all, a mechanical (but very smart!) device which still needs the correct input from a therapist who knows what needs to be done. But as with other aspects of life, technology now needs to be considered to enhance physiotherapy provision, no matter the complexity of the condition.
In recent months, I’ve been using a hand held device called Gripable for hand therapy. It’s one of the many types of neuro technology available in the market, and it’s one of the most accessible given it’s size, complexity of use, and cost. I don’t have a full audited data of outcomes as yet, however, it shows great potential. I will, of course, share the outcomes here once I’ve completed my own study.
And yes I am biased, I like technology and whichever side of the fence you are, technology is here to stay. As a slogan said “I can wash my clothes by hand, but why would I?” I will let you decide.
If you’re curious how Gripable could work for you, do get in touch.
I wonder if Vogue would be interested in a neuro tech contributor???
Acknowledgements:
The Mint AcademyYou might be wondering what happened to December issue? Did I go and hibernate after all? I wish. I’ll tell you later.
New year…new me…new goals…blah blah blah. I wish I could write about starting fresh and new for 2023, but to be honest, surviving 2022 was an ordeal in itself I can’t even think about what 2023 holds for me, for all of us. However, I’m not about to nose dive into black hole depression, there’s enough left over alcohol from Christmas to stop me doing that. I’m just recognizing that there is a small percentage of people (including me!) that don’t feel all that motivated to starting something new when the New year hits. Okay, I don’t have actual statistics for this, but I do know that about 43% of people who set New Year’s resolution/goal give up after just one month. Which shows that even the positive outlookers/thinkers will hit the wall at some point and lose the will to carry on.
So I shall be that dark horse and say, never mind New Year’s resolution. Heck, if you can remember to write or say 2023 when you’re asked for the date, that’s a good start! Who needs new goals when we’re still working on the ones we’ve set last year? Who says you can’t carry on as you are? And who says carrying on as you are isn’t enough? My point here is…just carry on, don’t stop. Keep doing the things that bring good things in your life…whatever that may be. Remember what I said last month, about doing 1% more in the right direction? Just keep doing that. And if you do decide you want to start something new, well, good. Do it. But do it because you want to, not because it’s the New Year.
I know you’re thinking this blog sounds counteractive to what I actually do as a profession, motivating people to take charge of their bodies, their conditions, and their lives. Hear me out. What I’m recognizing here is that we are humans and not machines, we cannot be ‘consistently the same’ all the time. Everyday, we wake up a different version of ourselves, sometimes better, sometimes worse. We even do the same things differently every time. It’s ok not to be positive all the time. That’s what makes life interesting.
And as for December issue, no, I didn’t hibernate. I can’t. I have a 4 year old – it’s not an option. And thank goodness for that. Sometimes, it takes another human to push you to become superhuman. And to realize that the important things in life isn’t always about reaching your goal i.e. writing a blog per month – which was what I set out to do when I started! Instead, I chose to do what was more important at that time…I don’t think I need to spell it out here. The fact is, I’m here now, writing again, reaching out to you all, and carrying on what I set out to do from last year!
So if you’re in the mood not to set New Year’s resolution, let’s talk. I can help you carry on as you are. Get in touch. I’d love to hear from you.
And yes, I do still wish you all a Happy New Year.
Welcome to my first online blog here @AbilityNeuroPhysio!
I’m Molly, and if we’ve not met before, I am your friendly neighborhood neuro physiotherapist. I started my private practice in 2014 here in the UK, and I have specific interest in stroke and Parkinson’s disease. So, no surprises here if my blog will be mostly about this topic, although, really, I just want to write about stuff that will help you live well!
This time of the year, it goes without saying…Winter is coming! Yes, I am also a Game of Thrones fan, although for this blog I’d be lot less dark and scary than the Long Night episode of the final season (if you have seen that episode, you’ll know how pitch black it was, so dark I thought the TV turned off at one point!!).
However, what comes with winter is the natural slow down of life – nature going into rest and hibernate mode. And nature includes us humans. Don’t get me wrong, I like resting and relaxing, but hibernation...that’s another story.
I’ve had a lot of clients who called to see me in the New Year of every year wishing they had seen me sooner, because they have gone into semi-hibernation and are now dragging themselves out of it. Sometimes, literally – the Parkinson-type shuffling has gone worse, to the point their feet gets glued to the ground, or the post-stroke spasm that has made their arms or legs stiff with high tone. The problem with brain-related conditions like stroke or Parkinson’s is that they are dependent on movement, meaning, the less the person moves, the worse the conditions gets. As the condition worsens, it becomes harder to move, so it’s really a simple yet vicious cycle.
Ok, I promised to keep it light and I will. A Chinese proverb once said that the best time to plant a tree was 20 years ago, the second best time is now. And so it doesn’t matter when (in the spectrum of your condition) you start, so long as you start. But how, you ask?
First, look at what you do now on daily basis. What is your routine from waking up to going to bed? I suggest writing it down, because once you do this, I need you to look at how much MOVEMENT you do during the day. And by movement, I don’t just mean exercise (great if you do this already), I mean, how did you get from A to B? Are you lying/sitting/standing when you do task? Did you do task on your own or did you have help?
This is literally tracking your movements to help you understand where you are now. I can’t really tell you what is the ‘average’ amount of movement humans should be doing, it’s very person specific, however, YOU would know if you are entering (or already in) ‘hibernation’ mode because there’s something about this process of tracking that will make you very aware if we are doing more, less or the same as what we use to. Interesting, don’t you think?
And here’s a fun fact – according the American Council on Exercise (healthonline.com), people who track their steps end up doing 2,500 steps more per day compared to those who don’t. So just by starting to track your own movement and activities, the awareness will kick start you into doing more. Even if you move 1% more than you did yesterday, you’re still 1% away from hibernation mode. Keep doing the 1% more every day and that’s 10% more movement in 10 days! If you have a stroke or Parkinson’s, this is a game-changer as it can move you out of the vicious cycle of deterioration.
Is it really that simple? Well, yes, it is. Just try it out and let me know how you get on. And as ever, you have any questions, or are unsure about anything you’ve read here or how it applies to you, get in touch. I’ll be happy to hear from you. Whatever you decide to do, just do something. Now.
By the way, on the subject of hibernation, humans are do not have the ability to literally do this, so I won’t recommend doing at home. Just a thought, in case you decide to sleep through winter. Not. Going. To. Work.
Think you need to talk about how to get started? Register now for your free consultation.
To book an appointment or for more information please call 07415 551 279 or email info@abilityneurophysio.co.uk.