In this second part of the vestibular series, we will discuss the physiotherapy approach to assessing vestibular disorders and dysfunction.

Because describing symptoms of vestibular dysfunction is so personal, subjective and at times emotional, a person-centred assessment must be undertaken to fully understand the extent and severity of the problem. In short, the best way to start treating the inner ear is to lend them one.

Have you ever hit your funny bone? In actual fact, the funny bone is not a bone at all but the ulnar nerve, which supplies about a quarter of the muscles in your arm. But what happens if it is more serious than that?

First, a quick lesson on human physiology.

What is a nerve?

A nerve is a cord like structure that is made up bundles of conductive tissue that forms the peripheral nervous system. Before they branch off from the brain and spinal cord to become nerves, they are called tracts.

Nerves are organised very much like a big fat sushi roll.

Mental imagery has received much attention in the scientific literature because it’s been shown to be helpful in neurological and pain rehabilitation.

It seems simple doesn’t it? That we must first be able to conceptualise and plan what the task is like before we know how we should go about doing it.

Muscles respond to strengthening, but brains aren’t muscles. So why are we strengthening the body that doesn’t move well when there is a problem with the brain?

When I ask my patients who have suffered a stroke why they think they can’t stand, walk or move their arm, they go:

“Because the muscles are weak!”

“And so, what do we need to do?”, I ask.

“We need to strengthen them!”

Truck drivers concentrate for hours, but don’t apologise for the fact that they need frequent breaks. They know their bodies, they know when it’s time to pull over, because their life depends on it. Sometimes, the journey can be so long and monotonous, that it is so easy to just settle into the same frame of mind. But boredom, heat and sitting still, only compounds the fatigue.

Fatigue. That seemingly ever present, nagging feeling of weight and negativity. The more we get it, the more inertia there is to overcome it. Now we’re on a slippery slope.

So what do they do?

If seven years is anything to go by, it’s the fact that seeing 6 patients a day, 5 days a week, 40 weeks a year means I would have had 8400 exercise programs to learn something from.

That means I practically eat, sleep and dream of exercise programs. If exercise were a drug, I would be your shady crack dealer, handing them out to unsuspecting ladies with walkers left right and centre.

But how do we make our exercises more addictive?

Well, here are 7 great ways to make that happen.

Few of us stop to understand fully what is involved in walking, an activity we often take for granted, until something goes wrong. In people with a neurological condition, returning to normal walking can be a challenging task. All too often people learn to use compensatory muscle groups and strategies in an attempt to create efficient forward movement.

Walking is primarily governed by powerful actions of 3 main muscle groups. But first, you must understand the following graphic:

The body is a complex creature with millions and millions of connections that come from the brain and spread throughout the nervous system. These connections that follow tracts or pathways carry signals for sensation, movement and the body’s automatic systems like blood pressure control and digestion.

Did you know that despite the brain being 2% of the mass of the body, it uses 25% of the available oxygen supply?

And did you know that if joined up all the arteries in the brain end to end that it is more than 160,000km long?

That’s a lot of distance to look after, and many places where the arteries could either block up or bleed through, resulting in what we know as stroke.

One of the best ways to look after our blood vessels is by looking after our insides. One key part is diet, and the other is aerobic exercise.

In the lead up to MS Awareness Month in May, I shall tackle a question that we always get asked – how should we approach the walking problem in MS?.

I have to say, the most frustrating thing I hear from people with MS is they never really know what they need to do to help their walking when part of their body fails them.

Sounding familiar? Feeling disempowered?

Today, I will answer one of my most frequently asked questions on this subject: