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Neurological Rehabilitation

The nervous system, essentially the body’s electrical wiring…

…is a complex collection of nerves and specialized cells known as neurons that transmit signals between different parts of the body.

The experts at Pain & Movement Solutions greatly understand the power of the neurological system and how it contributes to your pain and movement problems.  Below are commonly treated neurological impairments that we treat in the clinic every day.

Click each title below to read more about each topic.

Vestibular Rehabilitation

The vestibular system connects the inner ear to the brain and helps control balance and eye movement. Diseases or injuries that damage this system can result in vestibular disorders, however, they also can occur for unknown reasons. Our vestibular rehabilitation experts can evaluate and treat patients who suffer from symptoms that include:

  • Vertigo
  • Dizziness
  • Unsteadiness
  • Balance problems
  • Blurred vision or visual disturbances
  • Motion sensitivity
  • Benign Paroxysmal Positional Vertigo (BPPV) (link to scroll down)
  • Patients with long-term disorders that have undergone other treatments with little or no success

Causes of Vestibular Disorders:

  • Motor vehicle accidents
  • Concussion
  • Ear infections
  • Aging
  • Insidious onset, such as BPPV (Benign Paroxysmal Positional Vertigo)
  • Unilateral/Bilateral vestibular hypofunction (reduced inner-ear function on 1 or both sides)
    • Meniere’s disease
    • Labyrinthitis
    • Vestibular neuritis
  • Acute or abrupt loss of vestibular function following surgery for vestibular problems

Benefits of vestibular rehab:

  • Improved balance
  • Reduction in falls
  • Decreased sensation of dizziness and spinning
  • Increase safety
  • Improve overall quality of life

Some vestibular disorders may only require a couple treatments for complete relief, while other conditions are much more complex and require months of home exercises that can be provided and progressed by one of our vestibular rehab clinicians every 2 weeks.

Our vestibular rehab clinician will perform a thorough assessment to evaluated your:

  • Eye & Head Coordination
  • Balance & Gait
  • Motion Sensitivity
  • Testing for BPPV

Vestibular Rehab Therapy is an exercise-based program designed by a trained physical therapist to assist in problems related to balance, dizziness/vertigo or visual control due to inner ear problems. Treatment may include:

  • Repositioning techniques or exercises, such as the Eppley maneuver or Semont Technique
  • Habituation Exercises: repetitive movements that provoke symptoms to “re-train” the brain to interpret signals appropriately
  • Balance Exercises
  • Vestibular Ocular Exercises: Head and eye movement exercises to help you regain visual stabilization

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is one of the most common causes of vertigo, leading individuals to feel their environment in spinning. These symptoms are typically brief periods of mild to severe vertigo experienced with changes in position of your head, such as when lying down at night, rolling over in bed or getting out of bed. Vertigo can cause nausea and vomiting, as well.

This condition occurs as a result of calcium carbonate crystals migrating within the inner ear. The majority of cases occur insidiously, although can be associated with head trauma or inner ear infection.

Fortunately, this condition can be treated very quickly and effectively by one of our vestibular therapists. The treatment consists of moving the head in specific directions utilizing gravity to move the crystals back to the appropriate locations. Research has shown that 90% of cases of BPPV can be resolved within 1 to 3 vestibular therapy visits.

We give our patients with BPPV top priority to ensure the get feeling better as quickly as possible!

Concussion Management

The Center for Disease Control (CDC) estimate that in sports alone, more than 3.8 million concussions occur each year.

A concussion is a type of mild traumatic brain injury that is caused by a blow, bump or jolt to the head that causes the head and brain to move rapidly back and forth. This sudden movement creates chemical changes in the brain and sometimes stretching or damaging brain cells. These injuries are not usually life-threatening, but the effects of concussion can be serious if not treated appropriately.

Symptoms of a Concussion:

  • Headaches
  • Dizziness
  • Eye Strain or Blurred Vision
  • Balance Problems
  • Motion Sensitivity
  • Persisting Nausea
  • Difficulty concentrating
  • Neck Pain

Appropriate Medical Treatment is Necessary to Assist with a Full, Speedy Recovery.

Because the brain is so complex, every concussion is different in presentation of symptoms and recovery time. It is best to address these symptoms as soon as possible to help you return to work, school and play.

Concussion Recovery:

  • Brain Rest is critical for the first few days following injury.
  • Light Exercise initiated at the right time aides recovery.
  • Communication between your physician, PT,  and coaches/teachers/employers is critical for success. This team will coordinate your return to school/work, accommodations needed and ability to return to play/learn/work.

How PT Can Help

Pain & Movement Solutions utilizes the CLEARED CONCUSSION RECOVERY Program® to assist in your recovery. This same program is utilized by the Denver Broncos & Resilience Code Concussion Clinic.

  • Evaluation & Assessment: identify your unique treatment protocol
  • Vestibular Therapy: various eye examinations to strengthen vision, resolve dizziness and improve balance
  • Exertion Therapy: assist with brain function and recovery
  • Manual Therapy: reduce headaches and neck pain associated with concussion
  • Home Program Development: to address other possible ongoing symptoms, such as mood, irritability, brain fog and fatigue.

Call today to take advantage of our concussion management and Return to Play (RTP) programs.

Neurological Disease Rehabilitation

Various neurological disease create movement disorders that require a team approach to maximize a person’s quality of life. These diseases affects many areas of the brain and symptoms can vary greatly in individuals. At Pain & Movement Solutions, we seek to provide a comprehensive, patient-centered care that is evidence-based and collaborative with the individual, family, healthcare team and community to optimize patient-specific and family goals.

Neuro Rehab Services Provided:

  • Evidence-based outcome tools to track, progress and monitor changes throughout the lifespan for stage-specific goals
  • PWR!Moves – individualized intensive, whole-body, amplitude-based training
  • Fall prevention & balance training
  • High-intensity therapeutic exercise that includes strengthening, flexibility and aerobic conditioning
  • Coordination, agility and power training
  • Postural awareness training
  • Dual tasking & cued strategy training
  • Aquatic therapy
  • Manual therapy to joints & muscles for neuromuscular retraining
  • Functional Dry Needling
  • Instrumented soft-tissue mobilization
  • Community collaboration and exercise groups

Who will benefit?

Physical therapy can help people maximize their quality of life and minimize their risk for falls, at any stage of the disease. Working with a physical therapist that utilizes evidence-based treatment and measurement tools to track changes is essential to moving towards maximum functions.

Commonly Treated Disorders:

  • Parkinson’s Disease
  • Multiple Sclerosis
  • Stroke (CVA)
  • Huntington’s Disease 
  • Inclusion Body Myositis
  • and others

Let our doctors of physical therapy help you find your SOLUTION today.

Fall Prevention Solutions

  • Fall-related medical costs totaled around $30 billion in 2010.
  • 1/3 of adults 65 and older fall each year.
  • 1 out of 5 falls results in serious injury (e.g. head trauma, fracture).
  • About 1/3 of those who fall fear future falls, causing a limitation in activity, which in turn actually increases the risk of falling.
  • A senior citizen dies every 29 minutes from a fall.

Falls are NEVER normal at ANY age

Falls present a significant risk to patients and pose a significant financial burden.  Physical therapy can decrease those risks while providing cost-efficient treatment.

A meta-analysis and systematic review published in the British Medical Journal, reviewing results of 17 trials involving 4,305 patients aged 60 and older living in community dwellings revealed that physical therapy can:

  • Lessen the rate of falls
  • Reduce the severity of injury when falls do occur
  • Improve balance
  • Improve cognitive functioning
  • Increase speed and effectiveness of protective reflexes
  • Diminish force of impact on the body by increasing energy absorbing capacity of soft tissues (such as the muscles)

Balance — Don’t Use It, You LOSE It!

But it can return quickly with PT and PRACTICE.

Risk Factors for Falling that can be Modified with PT

  • Lower Body Weakness
  • Joint Mobility Impairments
  • Antalgic gait: slow gait speed, decreased step length, increased step width, and step variability.
  • Foot Abnormalities
  • Inadequate or improper footwear
  • Home Hazards
  • Fear of Falling
  • Proper use of assistive device
  • Balance Difficulties
  • Postural Dizziness
  • Vestibular Issues
  • Kinesthetic awareness problems.
  • PAIN
  • Muscle coordination & firing

Physical Therapy Treatment

Patients will undergo an initial evaluation utilizing several tests to assess impairments and risk factors for falling. Treatment will address any identified modifiable risk factors, including exercises to increase strength and improve balance. Exercise intervention has a positive preventative effect on falls that result in injury as well as falls that lead to more extensive medical care.

Patients will be instructed in exercises that are safe for them to complete independently. Balance exercises can be performed at all levels and be progressed from sitting, to kneeling, to standing once performed safely. Recognizing risks for falling will enable patients to improve their home safety.  We will also ensure that the patient is able to get up from the floor if a fall happens to occur.

We will assist the patient in fear management to reduce the fear of falling.  Once an individual experiences a fall, his/her standing activity levels decrease secondary to fear of falling again. Fear of falling creates a downward spiral of less and less activity.  Identifying reasons for decreased activity levels will enable us to initiate goals for increasing physical activity for overall health improvement and confidence.

The patient will responsible for a home exercise program. With diligent practice, the patient can expect neurological improvements in 2 weeks. To achieve lasting results, the patient will need to stay compliant with a home exercise program for 10 weeks.  At Pain & Movement Solutions we work with the patient, other health care professionals, and community services to create individualized programs for people to be successful with their rehab. For example, many individuals are progressed to a personalized program to complete at the community recreation center or their favorite gym, where we have close working relationships with many of the personal trainers.

Call today to improve your balance lower your risk of falls!

Chronic Pain

Pain & Movement Solutions can help you gain more control over your pain and enjoy the activities you love through cutting-edge physical therapy treatment, including dry needling, soft tissue manual therapy, aquatic therapy and more.

Learn more here.  


Physical Therapy Guide to Fibromyalgia:

A chronic condition that is often difficult to diagnose, fibromyalgia affects almost 5 million people in the United States; 80% to 90% are women. Fibromyalgia usually is diagnosed in adults between the ages of 30 and 50, but the symptoms—such as widespread chronic pain and fatigue—can show up earlier.

Although there is no definitive cure at this time, there are treatments that can help. Your physical therapist can help you:

  • Understand and manage your pain.
  • Reduce your fatigue.
  • Improve your function and quality of life.

What is Fibromyalgia?

The cause of fibromyalgia is unknown, but it’s thought to be due to changes in how the nervous system processes pain. It might be triggered by trauma, surgery, infection, arthritis, or major emotional stress, or it may develop gradually over time. People with conditions such as rheumatoid arthritis, systemic lupus erythematosis, or ankylosing spondylitis are more likely to develop fibromyalgia.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management.  Learn more at our #ChoosePT page.

Signs and Symptoms

Fibromyalgia isn’t just 1 condition; it’s a complex syndrome involving many different signs and symptoms. With fibromyalgia, you may experience:

  • Widespread pain, often a dull achiness, on both sides of the body above and below the waist  
  • Spots on your head, neck, chest, shoulders, elbows, hips, or knees that are tender to a firm touch; these “tender points” may move around or come and go
  • Muscle stiffness, especially in the morning
  • Headache
  • Thinking and memory problems
  • Fatigue
  • Depression
  • Anxiety
  • Pain or cramps in the abdomen or pelvis
  • Irritable bowel syndrome
  • Irritable bladder syndrome
  • Difficulty sleeping; waking unrefreshed
  • Temporomandibular (jaw joint) pain
  • Numbness or tingling

Often, stress can make your symptoms worse.

How Is It Diagnosed?

Because there are no blood tests, x-rays, or muscle biopsies that can be used to diagnose fibromyalgia, you’ll need to work closely with your health care providers to obtain an accurate diagnosis. Many conditions can cause pain and fatigue, so it’s important to have a thorough medical examination to rule out conditions other than fibromyalgia, such as rheumatologic or infectious disease, Lyme disease, hypothyroidism, metabolic disease, or side effects due to medication.

Once other conditions have been ruled out, a diagnosis is made based on key symptoms—extreme fatigue, pain in multiple “tender points” (points that are tender to touch and that move around), trouble sleeping, anxiety, and memory problems. Your physical therapist can identify fibromyalgia while performing a routine examination and taking your health history. Your therapist will pay close attention to the pattern of your symptoms. For instance, there are 18 possible tender points, and the more tender points you have, the more likely you have fibromyalgia. The therapist may refer you to a rheumatologist, a physician who specializes in arthritis, for medical care that includes medications.

How Can a Physical Therapist Help?

Living with fibromyalgia can be challenging. Your pain and other symptoms might take different forms from day-to-day. If you avoid activity because of pain, your overall physical fitness might be decreased.

Extensive research supports the use of education, aerobic exercise, and strengthening exercise to help improve fibromyalgia. But fear of pain often keeps people from beginning an exercise program. Your physical therapist will teach you how to interpret pain signals—and how to manage and decrease your symptoms—through a customized exercise program.

Help You Take Control Through Information

Research shows that people who are knowledgeable about their health condition have more confidence, can cope better with their condition, and are more likely to get “back in the swing.” Your physical therapist can explain how fibromyalgia affects the way your body perceives and responds to pain and how you can start to take control of the pain, rather than the pain controlling you. We also have evidence to support that knowledge is power, as it pertains to managing pain. There are several books, such as Why Do I Hurt, that have helped people in pain.

Your therapist also can provide information on local support groups, exercise programs, and self-help programs. 

Improve Your Range of Motion

Your therapist may use manual therapy techniques to move your joints while you are relaxed to help improve your joint motion. These techniques are combined with exercise, stretching, and movements that you control.

Use Special Techniques

Research indicates that the best results are likely to come from combining a variety of treatments. Appropriate medications, exercise, and “mind-body techniques” can work together to help you manage your symptoms.

Some techniques, such as meditation and cognitive behavioral therapy, can change your responses to pain and promote relaxation. Physical therapists also are educated and experienced in how to recognize behaviors that may interfere with recovery of function, and often refer patients to other health care professionals who can help them overcome these barriers.

Your physical therapist might use biofeedback to help you control muscle tension and decrease pain, using a device that provides you with information about the amount of tension in your muscles. The therapist places electrodes on your skin with a soft gel, and these electrodes record muscle tension while your therapist explains how you can relieve that tension.

Your therapist also can show you how to set a routine time for sleeping and waking to allow for good restorative sleep. The therapist will discourage you from sleeping in the daytime, as that can throw off your sleep cycle.

Reduce Your Pain

To reduce your pain, your physical therapist may select from a number of treatments:

  • Your therapist may use pressure on specific areas of the muscle, followed by stretching or contracting your muscles, to relieve pain and make the muscles more flexible. Your therapist also might use manual therapy techniques to help relieve pain in your muscles and other connective tissues (the material between the cells of the body that support the organs and other tissues).
  • In states where it is allowed by the physical therapist practice act, your therapist might use an approach called “dry needling” to relieve your pain by inserting very fine wire-like needles into the painful areas of the muscle.
  • Massage therapy can be used to increase blood flow to the tissues and promote muscle relaxation to decrease muscle pain and stiffness, and break up scar tissue.
  • Depending on the severity of your pain, your therapist might decide to use electrical stimulation to help relieve pain. Some people find that portable electrical stimulation devices help them manage severe pain independently. Your physical therapist will work with you to help determine if this type of treatment makes sense for you.

Can This Injury or Condition Be Prevented?

Unfortunately, the actual mechanisms behind fibromyalgia are not completely understood. Because of this, there is no way to predict or to prevent its onset. However, early detection of signs and symptoms related to fibromyalgia will help you and your medical providers begin early management, which may enhance your long-term outcomes. 

Real Life Experiences

Claire J. is a 32-year-old woman who has been struggling to get up each morning to get her 2 young children off to school. She has extreme fatigue, trouble remembering things (“I frequently misplace my eye glasses and purse”), and muscle pain and stiffness that seem to move around her body. The symptoms began suddenly and have persisted for 5 months. Her primary care physician is concerned that she might be depressed. He prescribes an antidepressant and refers her for physical therapy.

Claire’s physical therapist conducts a full physical examination and musculoskeletal testing and notes that she has 11 out of a possible 18 tender points, general fatigue, and muscle stiffness. The therapist recommends that Claire see a rheumatologist for medical management and starts her on a program of gentle stretching exercises, paced walking, and meditation using yoga. In addition, Claire and the therapist discuss a sleep hygiene routine and a sleep log, in which Claire will record her sleep patterns over the coming months.

The rheumatologist prescribes medication for Claire, and she continues her gentle stretching and exercise program. She begins sleeping 6 or 7 hours per night. The physical therapist then develops a gentle aerobic exercise program, which Claire says improves her fatigue once she gets herself motivated to do the exercise.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

Reference: www.choosept.com