- Email: [email protected]
Neurology
202
Courses Brachial Plexus Lesions MADAM - I work as a senior physiotherapist in rehabilitation at the Royal National Orthopaedic Hospital Trust and part of my work is with patients who have sustained brachial plexus lesions. Patients are referred to us from all over the country and because of this I get quite a few inquiries with regard to treatment of such conditions. I feel it would be helpful to hold a course to look at the assessment and treatment of BPLs, the surgical options, other team members’ involvement, the flail arm splint and so on. But before doing so I would like to find out from members whether there would be sufficient interest to warrant holding such a course. If people are interested please would they write to me and perhaps let me know topics they would like to be covered and whether they prefer weekdays or the weekend?
Nicola Lear MSc MCSP (Miss)
Physiotherapy Department The Royal National Orthopaedic Hospital Trust Brockley Hill, Stanmore Middlesex HA7 4LP
apists who took the time to complete the questionnaire. The conclusions suggest that clinicians and managers perceive a need for physiotherapy post-registration training in neurology that is accredited with both professional and academic recognition. As a result, discussions are now under way between the physiotherapy department at The National Hospital for Neurology and Neurosurgery and the Institute of Health and Rehabilitation Studies at the Polytechnic of East London, for the development of a postgraduate diploma in neurological physiotherapy. It is hoped that the first intake of students could be considered for a June 1993 entry. Anyone interested in the results of the survey or the development of the course is invited to contact me at the address below, from September 1992. Yvonne Lewis GradDipPhys MCSP (Mrs) The National Hospital for Neurology and Neurosurgery Queen Square London WClN 3BG
Cause and Treatment of Cervical Pain
MADAM - I would like to offer some constructive criticism of the article ‘Cervical MADAM - We are writing about the traction with active rotation’ by Gill Gilworth Rheumatic Care Association of Chartered (Physiotherapy, November 1991). It is stated that the patient had cervical Physiotherapists’ CSP accredited course ‘Management of rheumatological spondylosis, presumably diagnosed by X-ray. The photographs show 8 Ib (3.6 kg) conditions’, level 3, 45 points. The RCACP organised the first such traction was applied in a vertical line course in January 1990. The second directly above the patient’s head, in sitting. I suggest this would provide little or no course will take place from January 1992 to January 1993 and will include both traction force to the cervical spine, let alone occupational therapists and nurses, cause distraction of the zygo-apophyseal making it multidisciplinary (by popular joints (2-joints) or discs. Work by Judovich showed that with traction applied in sitting, demand). We have been approached by nurses, weights of 9.07 kg (19.95 Ib) were needed physiotherapists and occupational to straighten the cervical curve, and 11.3 kg therapists with a view to organising this (24.86 Ib) to cause measurable separation course annually as opposed to bi-annually. of the 2-joints between C2 and C7. It is assumed that the patient’s condition This has been given due consideration by the Course Panel, and we would was caused by the degenerative changes welcome comments as to the viability of of cervical spondylosis, detected by X-ray. There is a wealth of evidence that X-ray this venture. Those interested are asked to contact findings do not correlate to pathological the course leader for further information. causes for cervical pain and that the average person over 30 years of age Nora Price MCSP will show degeneration at a constant Course Leader rate irrespective of any pain-producing Anne Spaight MCSP pathology. Miss Gilworth also assumes that Elveen Harvey MCSP most of the cervical problems on which she Jill Lloyd MCSP uses this technique arise from the 2-joints. Course Tutors As far back as 1959 Cloward showed that this assumption may be unfounded. Please contact Mrs Price at: He points towards the disc as a possible Physiotherapy Department source of cervical pain. Cannock Community Hospital Twomey has recently shown that Brunswick Road whiplash type injuries can cause disc Cannock WSl1 2XY damage and lesions of the disc rim. Due to the innervation of the disc, these lesions Neurology could also be a source of cervical pain. MADAM - In July 1991 I conducted a It would be necessary to read around survey regarding post-registration the subject of mobilisation and manipulation education in neurology. of the cervical spine before attempting a The response rate was 66% and I would research project on this traction with active like to thank the members of the movement. Association of Chartered Physiotherapists I believe that the traction described kept in Neurology and the Association of District the patient in one position long enough for and Superintendent Chartered Physiother- him to carry out repeated active rotatory Rheumatology
Physiotherapy, March 1992, vol78, no 3
mobilisations of the cervical spine. The staff member who benefited from the method by turning in one direction while in traction may have been performing repetitive end-range rotation type exercises similar to those described by McKenzie. I would be happy to supply references to anyone interested in these views. David Poulter BSc MCSP DipRG&RT MAPA PO Box 128 Numurkah 3636 Victoria, Australia Mrs Gilworth replies: I appreciate Mr Poulter’s constructive comments on my case study ‘Cervical Traction with Active Rotation’ (Physiotherapy, November 1991). The discussion points that accompanied that case study were very much my initial ideas as to why this technique might work rather than a compreherlsive proven list of its effects. Further research into this technique will be aimed at establishing its effectiveness at reducing neck pain and stiffness without speculating on the exact cause of such symptoms. I have not made any assumptions that the patients that are helped by this technique have any one particular pathology in common; and have certainly not ruled out the possibility of it helping with neck pain of discal origin, eg in the case of whiplash. If any other readers have any other ideas or comments on the technique and its clinical application, I would be grateful if they could let me know.
Re-discover PNF MADAM - I was concerned to read in the December Journal that the next PNF course at Westminster Hospital has had to be cancelled due to lack of applicants. While appreciating that there are still some physiotherapists who would like to learn the skills but are prevented by lack of availability of funding and study leave, I do believe that there is a declining interest in PNF, as a therapeutic skill, within the profession in this country. In this ever-changing Health Service I would commend the approach to all physiotherapy managers. Accurately applied, PNF can speed up an effective outcome for a variety of conditions, sometimes used alone, often used as an adjunct to other modalities. It can reduce treatment time and the number of attendances. It is satisfying for the patient who sees results, is cost-effective for the Service, and should give job satisfaction to the physiotherapist. However, it does require a committed approach from physiotherapists and also hard physical work. I wonder if this has any bearing on the situation? When working under pressure with heavy workloads, I have always been pleased to have a skill which would allow me to be effective in a relatively short space of time. I urge the profession to re-discover PNF. Marilyn A Harrison FCSP Leicester
Courses Brachial Plexus Lesions MADAM - I work as a senior physiotherapist in rehabilitation at the Royal National Orthopaedic Hospital Trust and part of my work is with patients who have sustained brachial plexus lesions. Patients are referred to us from all over the country and because of this I get quite a few inquiries with regard to treatment of such conditions. I feel it would be helpful to hold a course to look at the assessment and treatment of BPLs, the surgical options, other team members’ involvement, the flail arm splint and so on. But before doing so I would like to find out from members whether there would be sufficient interest to warrant holding such a course. If people are interested please would they write to me and perhaps let me know topics they would like to be covered and whether they prefer weekdays or the weekend?
Nicola Lear MSc MCSP (Miss)
Physiotherapy Department The Royal National Orthopaedic Hospital Trust Brockley Hill, Stanmore Middlesex HA7 4LP
apists who took the time to complete the questionnaire. The conclusions suggest that clinicians and managers perceive a need for physiotherapy post-registration training in neurology that is accredited with both professional and academic recognition. As a result, discussions are now under way between the physiotherapy department at The National Hospital for Neurology and Neurosurgery and the Institute of Health and Rehabilitation Studies at the Polytechnic of East London, for the development of a postgraduate diploma in neurological physiotherapy. It is hoped that the first intake of students could be considered for a June 1993 entry. Anyone interested in the results of the survey or the development of the course is invited to contact me at the address below, from September 1992. Yvonne Lewis GradDipPhys MCSP (Mrs) The National Hospital for Neurology and Neurosurgery Queen Square London WClN 3BG
Cause and Treatment of Cervical Pain
MADAM - I would like to offer some constructive criticism of the article ‘Cervical MADAM - We are writing about the traction with active rotation’ by Gill Gilworth Rheumatic Care Association of Chartered (Physiotherapy, November 1991). It is stated that the patient had cervical Physiotherapists’ CSP accredited course ‘Management of rheumatological spondylosis, presumably diagnosed by X-ray. The photographs show 8 Ib (3.6 kg) conditions’, level 3, 45 points. The RCACP organised the first such traction was applied in a vertical line course in January 1990. The second directly above the patient’s head, in sitting. I suggest this would provide little or no course will take place from January 1992 to January 1993 and will include both traction force to the cervical spine, let alone occupational therapists and nurses, cause distraction of the zygo-apophyseal making it multidisciplinary (by popular joints (2-joints) or discs. Work by Judovich showed that with traction applied in sitting, demand). We have been approached by nurses, weights of 9.07 kg (19.95 Ib) were needed physiotherapists and occupational to straighten the cervical curve, and 11.3 kg therapists with a view to organising this (24.86 Ib) to cause measurable separation course annually as opposed to bi-annually. of the 2-joints between C2 and C7. It is assumed that the patient’s condition This has been given due consideration by the Course Panel, and we would was caused by the degenerative changes welcome comments as to the viability of of cervical spondylosis, detected by X-ray. There is a wealth of evidence that X-ray this venture. Those interested are asked to contact findings do not correlate to pathological the course leader for further information. causes for cervical pain and that the average person over 30 years of age Nora Price MCSP will show degeneration at a constant Course Leader rate irrespective of any pain-producing Anne Spaight MCSP pathology. Miss Gilworth also assumes that Elveen Harvey MCSP most of the cervical problems on which she Jill Lloyd MCSP uses this technique arise from the 2-joints. Course Tutors As far back as 1959 Cloward showed that this assumption may be unfounded. Please contact Mrs Price at: He points towards the disc as a possible Physiotherapy Department source of cervical pain. Cannock Community Hospital Twomey has recently shown that Brunswick Road whiplash type injuries can cause disc Cannock WSl1 2XY damage and lesions of the disc rim. Due to the innervation of the disc, these lesions Neurology could also be a source of cervical pain. MADAM - In July 1991 I conducted a It would be necessary to read around survey regarding post-registration the subject of mobilisation and manipulation education in neurology. of the cervical spine before attempting a The response rate was 66% and I would research project on this traction with active like to thank the members of the movement. Association of Chartered Physiotherapists I believe that the traction described kept in Neurology and the Association of District the patient in one position long enough for and Superintendent Chartered Physiother- him to carry out repeated active rotatory Rheumatology
Physiotherapy, March 1992, vol78, no 3
mobilisations of the cervical spine. The staff member who benefited from the method by turning in one direction while in traction may have been performing repetitive end-range rotation type exercises similar to those described by McKenzie. I would be happy to supply references to anyone interested in these views. David Poulter BSc MCSP DipRG&RT MAPA PO Box 128 Numurkah 3636 Victoria, Australia Mrs Gilworth replies: I appreciate Mr Poulter’s constructive comments on my case study ‘Cervical Traction with Active Rotation’ (Physiotherapy, November 1991). The discussion points that accompanied that case study were very much my initial ideas as to why this technique might work rather than a compreherlsive proven list of its effects. Further research into this technique will be aimed at establishing its effectiveness at reducing neck pain and stiffness without speculating on the exact cause of such symptoms. I have not made any assumptions that the patients that are helped by this technique have any one particular pathology in common; and have certainly not ruled out the possibility of it helping with neck pain of discal origin, eg in the case of whiplash. If any other readers have any other ideas or comments on the technique and its clinical application, I would be grateful if they could let me know.
Re-discover PNF MADAM - I was concerned to read in the December Journal that the next PNF course at Westminster Hospital has had to be cancelled due to lack of applicants. While appreciating that there are still some physiotherapists who would like to learn the skills but are prevented by lack of availability of funding and study leave, I do believe that there is a declining interest in PNF, as a therapeutic skill, within the profession in this country. In this ever-changing Health Service I would commend the approach to all physiotherapy managers. Accurately applied, PNF can speed up an effective outcome for a variety of conditions, sometimes used alone, often used as an adjunct to other modalities. It can reduce treatment time and the number of attendances. It is satisfying for the patient who sees results, is cost-effective for the Service, and should give job satisfaction to the physiotherapist. However, it does require a committed approach from physiotherapists and also hard physical work. I wonder if this has any bearing on the situation? When working under pressure with heavy workloads, I have always been pleased to have a skill which would allow me to be effective in a relatively short space of time. I urge the profession to re-discover PNF. Marilyn A Harrison FCSP Leicester