Season 2 Episode 1, 1 December 2023 (Duration: 0:41:01)

Host: Paul Burns

Paul is back for a second season, this time talking to health professionals and industry leaders. Paul and his guests dive into current thinking on stroke recovery within their respective fields, what’s out there for those with invisible injuries and as usual, he picks up some tips and tricks along the way.

In episode one, Paul talks to senior neuro physiotherapist Jessica Georgy. Jessica has extensive experience in treating a wide variety of patients with neurological conditions, including people who have experienced a stroke.

Neuro physiotherapists help improve movement for people with neurological conditions, but how it is different to exercise physiology or occupational therapy? How can a neuro physio help after stroke? How can you find one? Paul and Jessica explore these questions and more.


Announcer: The information provided in this podcast is general in nature and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified medical professional.

Paul: Hi there. My name is Paul Burns and I'm a young stroke survivor and this season of smashing it off to stroke, I'm chatting with health professionals and industry leaders.

We dive into current thinking on stroke recovery within their respective fields. What's out there for those with invisible injuries and as usual, pick up some tips and tricks along the way.

My guest today is Jessica Georgy from Revive Neuro Physiotherapy. Jess is a senior neuro physiotherapist who has extensive experience in treating a wide variety of patients, including but certainly not limited to stroke, vestibular disorders, brain injuries, as well as clients with falls and balance issues. We find out exactly what neuro physiotherapy is, how it's different from other therapies, and what the future holds for neuro physiotherapy.

So please enjoy this chat I had with Jess. Thank you so much for making the time.

Jessica: I mean, thank you for having me. This is quite an honour. It's always wonderful to speak with a young stroke survivor and be part of that. So, I'm thankful to you for letting me be part of it. no problems at all.

Paul: The first question I've got is what is neuro physiotherapy in a nutshell?

Jessica: Great question. I think most people, when they envision a physio, they're thinking of a musculoskeletal or a sports physio or, you know, maybe someone who works out of a clinic or who goes and joins a sports team. And neuro physio is obviously a different subcategory of physiotherapy altogether.

And there are lots of subcategories. You know, you've got your women's health physio, paediatric physio, cardiorespiratory physios who work in ICU or in hospital settings and of course the most exciting subcategory of all, which is neuro physio, at least in my eyes. As neuro physios we work with clients who have neurological conditions. So, these are conditions that impact the brain, spinal cord and peripheral nervous system.

And it will include things obviously like stroke or brain injury, spinal cord injuries, Parkinson's disease, multiple sclerosis, functional neurological disorders, Charcot-Marie-Tooth disease. The list goes on, of course. So you know, it's quite a broad field, really. And as neuro physios we work across the continuum of care, you'll find neuro physios in hospitals. You’ll find them in private practice, you'll find them like me - I'm a mobile physio.

I go out to people's homes, but I also work out of the clinic and I see people in their own gym settings or in their pools. We cover a fairly broad area and basically we help people move better. But I think when my four-year-old daughter asks me, Mum, what do you do for work? My response is usually “I help people walk better.”

I think that's a huge part of what we do is - we help people with their gait and with their general movement.

Paul: So how is it different from occupational therapy or something like exercise physiology, for example?

Jessica: Yeah, I mean there are lots of differences and I can really only speak from my experience and what we do. As physios, how we differ from something like exercise physiology, I guess it's because we spend a lot of time on analysis, diagnosis, you know. So if someone walks through my door after a stroke, let's say, and they want to work on their gait, will spend a lot of time analysing that and working out, well what is it about their physical function that is impacting their gait and stopping them from walking close to normal, I guess.

And so we are quite specific. We're very much where we do things very specifically in exercises. This is definitely a component that we use, but it's not the only therapeutic tool that we would use. I guess we do lots of different things, so just to name a few, there are lots of different principles, some of the robust principles, motor learning principles, we're quite hands on as well.

I would often utilise hands-on therapy and different techniques like massage or mobilisation of joints to assist with things like pain or to get to facilitate people so that they're in a better position to move better. But we definitely do utilise exercise and we work hand in hand with OTs and EPs. As I said, OT is very, very functional, they’re taking what we do physically and saying, well, how do we implement that to everyday life?

Okay, so yes, you want to be able to walk and stand – now how are you going to use that to be able to cook and to be able to maintain your domestic tasks or to achieve any sort of day-to-day activities?

And EPs is on the other hand, they're focusing on your general fitness and cardiovascular health. How do we prevent you from having another stroke and how do we stop you from developing secondary complications? But oftentimes, I think what works best is when we're working really closely together and there's always going to be a little bit of overlap for sure.

But I work with EPs and OTs all the time and it's wonderful. And I think that's when people really thrive is when they've got that good team around them.

Paul: Absolutely. And I've had that personal experience as well. So is it fair to say that with your physio it might be a case of this is the what but the OT helps you get rubber on the road. And this is how we can apply it and EP is sort of around the outside of all of that.

So is that a correct understanding?

Jessica: Yeah, that's a decent way to think about it. Oftentimes an OT will say to us, look, we're working on, you know, let's take an example of working on someone's ability to stand and shower independently. This person really wants to be able to stand and shower themselves.

Then what we'll do as physios is identify, well, what's stopping them from doing that from a physical point of view? Is it their standing balance or is it their tolerance? Is it their endurance? Are they getting fatigued when they're standing in the shower, or is it their upper limb function? You know, are they able to actually move about and wash themselves the way they need to?

Similar to things like standing and cooking or when they go grocery shopping. What’s limiting them? Is it their walking ability? And if so, then we'll look at, well, how do we improve that walking ability? So I think as physios we’re movement specialists, that's what we're good at and we utilise lots of different techniques to help someone move better. And we're very, I would say, every client I see is different and every program I give someone is different.

So my therapies, it changes depending on what someone's goals are and what it is that I think is impacting on them achieving that goal. And I think that's a great way of thinking about it. An OT is the functional tasks – “hey physio, can you fix these things so we can achieve that task?” and they'll do a lot of that task specific practice and the EPs are there to back this all up and to make sure that the person is maintaining their general fitness at the same time.

Because obviously after a stroke for a lot of people, if they've got those physical impairments, it is hard to get back to exercise and to maintain their cardiovascular health.

Paul: And it impacts across so many things. I mean, people sort of say, well, you know, we understand the physical component, but now the mental health component of not being able to do things independently, like it's absolutely huge.

So you can have that sort of impact. That must be quite.. what's the word I'm looking for.. fulfilling.

Jessica: For sure. Yeah.

Paul: Is that one of the reasons what attracted you to neuro physio? What is it that you personally sort of like about it?

Jessica: Yeah. I mean, I didn't know it existed when I started studying physio.

Like most people, I thought I was going to end up either in the clinic or working with a sports team. And I, you know, the first year of uni, that's what you tend to study is, is musculoskeletal and sports physiotherapy. But I wasn’t so passionate about it, I didn't feel like I could envision myself doing that.

Yeah, it's fine work don’t get me wrong, my husband's the musculoskeletal and sports physio so I'm not going to, you know, I've got nothing bad to say! but it just wasn't for me. And as soon as we started studying neuro, I had this fantastic neuro professor Prue Morgan, who I think still works at Monash Uni.

And she also she, she does a lot of work in the cerebral palsy field, and she's, she was incredible. She was really inspirational. So that sort of ignited the spark. But definitely, I think as soon as I started working, one of my first jobs was at the Kingston Rehab Centre working on a stroke unit.

And it was just amazing, you know, I think it's a time in someone's life that they're incredibly vulnerable. You know, as you would know, it's such a difficult time and it's a huge, life altering event, isn't it, to have a stroke?

Paul: Yes, it certainly does change things significantly. And I think regardless of the impact that your injury has, when you get off, you know, what would be considered as light versus, you know, catastrophic. Anyone that goes through that kind of trauma, anyone that goes through that kind of event is going to come out differently at the other side. And it's just the way it is for sure.

Jessica: I mean, I can only imagine if you wake up one day to be fit and active one day and then wake up completely different the next. And I would watch these incredible physios at Kingston having an impact on someone's life in that way. And it is very fulfilling and very rewarding work. And you're just a small part of someone's journey.

But for me, you're a small part, but for you it's it feels like you're doing something really worthwhile. And so I've been in love with neuro since pretty much since second year uni, and I haven't really looked back. So I, I worked at Kingston and then eventually ended up at Eastern Health in the community as a grade two neurological physiotherapist and then had a couple of kids decided I need a slightly more flexible working arrangement and went private and now I own my own practice, seeing neurological clients in the community.

Paul: So what sort of issues and patients do you encounter? I mean, you mentioned stroke and so what sort of people do you see?

Jessica: So we often will see like particularly if we're talking about stroke patients, I mean, obviously there are lots of different conditions that we treat, but we'll see the kind of clients who have ongoing mobility concerns. That can include things like they're still having difficulty moving in bed or transferring, getting out of bed and moving towards a chair or obviously walking is the big one.

People who have gait difficulties, a lot of clients post a stroke will have what we call hemi paralysis or hemiplegia, which is where one side of the body is quite weak. And for many that does recover. But for some they still have that residual deficit. And we need to tap into that neuroplasticity and get the brain rewiring and re firing again so that they can utilise that affected limb a lot better. And it's not impacting on their walking or on the way that they stand and move.

We also work on the upper limb. We don't want to neglect the upper limb. And I think there’s a huge issue with that. Oftentimes in hospital we're quite focused on, let's get people walking, let's get them up and moving because that's what they generally need to get home.

But the beautiful thing about working in the community is that I do have the time and the ability to then target that somewhat and sometimes neglected upper body because you do a lot with your upper body, you know, you need to be able to hold a cup or get yourself dressed or brush your hair, put on clothing, whatever it is - that's important.

And so if people have that hemiplegia upper limb where they're not moving their arm quite as well, that's definitely something we address. That's strength. But there's lots of other symptoms that someone might have post a stroke that we would look at such as spasticity or increased tightness in their muscles, you know, just to name one of them, for example.

Paul: You guys deal with like fine motor as well in hands and fingers and that, is that part of it?

Jessica: Look, to be honest, I would normally defer that to occupational therapists because I think they do that better than we would.

Yeah. So oftentimes physio, if we're using, if we're focusing on the upper limb, we're doing more. So stability in the shoulder and reducing sort of spasticity or tightness and building up strength. But the more fine motor skills, I think OTs do a little bit better than we do.

Paul: So, it's more of the macro type movements.

Jessica: Exactly. More of the macro, more of the strength training. Yeah. And ensuring that the, the muscles are the right tone so that they're not too stiff, too tight.

Paul: Yeah. So what's your approach to treatment? Like, if someone finds your services and they come in off the street, what can they expect? Like how do you engage with a new, with a new patient? Like how does it happen?

Jessica: It starts like any physio. We've got the principles which starts with your really, really thorough assessment.. identifying.. and that's based around what someone's goals are because it's all about what the client wants to achieve at the end of the day. So we’ll identify what their goals are, get a good picture of what their life looks like, who are they living with?

What are they doing day to day? What are their hobbies? What do they want to get back to doing? Especially in the community. That's a huge thing. It's not just about getting home now. You’re home? Yes, you’re home, which is it's a big deal. But now you want to get back to surfing or you want to get back to work or looking after your children, getting onto the floor and playing with the kids.

So we get a really clear picture of what the client's goals are. And then we do our physical assessment looking at all the different elements that might impact on those goals. So for example, if someone wants to be able to get on and off the floor, well, what's the strength in your legs and your core like? What's your balance like?

What is your ability to get on and off the floor? Oftentimes we'll assess and look really closely at the different tasks that someone is finding challenging. And then once we've done that, we will consider, okay, well, you've got this task of getting on and off the floor. What are the different components of the physical skills that you need to achieve that?

So let's look at your strengths. Let's look at your balance. Whatever it is. Let's look at your core. What's your upper body strength like as well? Can you push off your arms? Can you get on your knees? What are your knees looking like? And we break out those different physical impairments, assess them really carefully, find out where are the gaps.

Okay. Oftentimes strength is a big one, if you don't have strength, that's going to impact on a lot of how you physically function. We know that's one thing that is a big one. So I often start by, let's target your strength. Then we set up a program for them, which would include lots of different things.

It oftentimes is a big component of exercise training, which will be either strength retraining or balance retraining or stretches, and extending someone's mobility, mobility retraining. But then we also use different components like task specific practice. So if someone's goal is “I want to be able to walk” we will often practice different components of the walking, break up the movement and practice that.

And then we also do a bit of hands on because what we want to do is, what we're trying to do really, is teach the brain how to move again in as close to normal as possible. And sometimes that means we as physios need to use our hands to help the person move in a way that we want them to.

And then we reassess. We have a look and we see, well, how far have we come? So we might give someone a program for a few weeks and work with them in the clinic, but also give them something to do at home, either on their own if they're capable, or with support workers or family just targeting those specific impairments we want to work on.

And then we re look at their goals and we say, well, we've been doing this for 4 to 6 weeks. How far have we come? Are we on the right track or do we need to reconsider what we're doing? And oftentimes in that process, we're pulling in the OTs and the EPs and other members of the team to ensure that we've got the full picture.

Paul: Do you sometimes have to help a client delve into their goals to be a little bit more specific?

Jessica: Yes

Paul: I remember Captain Grumpy Pants over here who when he first came out of, you know, very early days in recovery, was not what I would call an easy personality to deal with, looking back on my time now. So, you know, fun things like “I just want to walk again!” used to come out of my mouth.

Do you find, you had to sort of.. you sometimes have to drill in to some of these sorts of things?

Jessica: Yeah. Goals are best when they're specific. We talk about SMART goals all the time, so you want them to be specific and measurable. And so we do have to delve in a fair bit.

You know, it's often like how you want to walk better. What does that actually mean? Is it the speed of your walking? Is it how far you can walk? Do you want to be using a stick or a walker? Or is your goal to be walking independently? And if so, then how do we achieve that? Because if you give someone a stick or a walker, that's what they're going to get good at doing.

And sometimes, not to say that's wrong, sometimes that's necessary, but we definitely do have to go back and get quite specific. And I think that's the importance of doing a really good subjective assessment where, you know, we oftentimes will look at, well, what were you doing before your injury and where are you now and where do you want to be?

You know, because that gives us an idea of what's your life like? How do these goals fit into your day to day? There is a definitely a lot of digging in. It's hard to set goals.

Paul: It's extremely hard, particularly these two components to it. Some people may not know what they don't know. And then there's - if I get too specific with my goals and this can be quite an instinctive thing I'd imagine, if I'm too specific with my goals, is that setting me up to fail?

I mean, what, because I don't know what I don't know. And if I'm early in my recovery, no one can really map a recovery trajectory because it's not like breaking an arm. Nine times out of ten, if you'd follow ABC steps, your arm is going to be okay. Do you ever find people sort of hesitant to set specific goals? Because that could be super scary.

Jessica: Yeah, that's a really good point. And I definitely agree. I think they can be scary. And I think what we what we try to reassure clients is that we're starting with your SMART, maybe short term goals, but we are going to look at your, what we call “dumb goals” at some point, which are.. these are your dream goals.

These are the things that may not be realistic, but they are the things that give you hope. And I often like to have clients think about both of these things. Okay. So, yes, you've just had your stroke so let's look at the short term. Let's look at what we want to achieve in the medium term. Let's look at the long term, but let's also look at the dream goals.

What is it that you really want to do? And I can picture this young client I have in my mind, who had a traumatic brain injury and he was young and his goal was to get back to surfing. And I remember him sort of being like, I want to surf, but I don't think that's ever going to happen.

And by the time he was discharged, he was doing box jumps literally over my head. So, listen, it's about saying we may not know what you're going to achieve, but if we don't aim high, then you're only going to get below that, aren't you? So I do think that I'm in the business of building clients hopes. You know, it's not about being unrealistic.

You don't want to create false hope, but you also don't want to crush someone's dreams and aspirations.

Paul: I guess you must be also in the business of building confidence - one victory at a time.

Jessica: Yeah, definitely, definitely. And as physios I think, oftentimes we do take risks with our clients, calculated risks, but sometimes that's what you have to do is you do have to push people fairly hard.

And I'm quite clear with my clients, if your goal is that you want to walk and you're still not able to do that or you're not moving at all, well, we're going to have to put in a lot of work. But if you're willing to put in that work and you're motivated and then I'm going to work with you and I'm going to challenge you and push you and support you through that.

But it's a tough one. A lot of it is a balancing act of how hard do we push someone? How many risks do we take and when do we rein it in? And oftentimes, I utilise the rest of the team to rein us in sometimes.

Paul: That must be a massive part of your role as well. I mean, I think it's very easy to sort of sometimes, you know, in any role, doesn’t matter, in any field. But, you know, to get fixated on the nuts and bolts, that ability to communicate with people and the ability to read a person and where they're at, to change your message must be huge.

Like, so how like people with, you know, memory issues and mood issues and all those sorts of things.. Like I’ve been in therapies myself and people have said, we need to do A, B, C, and D. And then I'll sit there and nod and absolutely agree with that and then walk out and be sidetracked by, I don't know, a packet of Tic Tacs or something.

I don't know how, how do you deal with people that particularly, you know, stroke survivors that aren't the same when they come out of an injury like how do you how do you navigate that?

Jessica: That's a huge one, you know, and I think that's why neurological physiotherapy, oftentimes students graduate and they're like, it's so complicated.

And that's because it's that you're not just dealing with the physical, right? You are dealing with all the other impairments that might be impacting. Which, you know, like you said, you've got some cognitive difficulties which make it, you know, which does add an extra element that we need to consider. And there are lots of different things that we would do.

But it does start with being able to read and clearly understand. You know, that is part of the picture that we need to gather. It's not just about understanding the physical, but it's also understanding what other impairments that you're facing, what is your cognition like? And that's where we go back to the multidisciplinary team, go back to the OT or the neuropysch and understand, well, what is this person's capacity to understand what I'm going to prescribe here?

Am I giving really, really basic, simple instructions? How am I going to avoid overwhelming them with too much information? What are the tips and strategies I can use? So oftentimes I go back to the people who are more skilled than me and ensure that I've got a good picture of the strategies I want to use. How do we utilise their support team, their family, or the support workers to ensure that they're not forgetting appointments or that they know what sort of things they want to work on?

And I often have to catch myself because I can get quite passionate and excited and I have to sort of make sure I'm not overwhelming someone with too much information. But when you know that background of there are cognitive impairments or there is speech or communication difficulties, that's sort of when you restructure how you might do things, because that is that is a huge component of working with stroke survivors, is that it's not just the physical, you know, unlike maybe spinal cord injuries where they don't have the cognitive impairment associated, but you do have to definitely restructure how you do things.

Paul: So how often do you see people with invisible injuries per say? Do they come across your office often, people with invisible injuries?

Jessica: Help me understand that a little bit more. What do you mean by visible injuries?

Paul: Well, I would probably classify myself as someone with invisible injuries. If you saw me down the street, you wouldn't know that I had a stroke.

However a lot of my issues, again, are cognitive. And that comes with a whole bunch of different considerations because I found sometimes in my recovery, and I've compared notes with others, because I don't physically look like I need a lot of physical help. But coming across services, that would be typically in that realm, such as exercise physiology. I think game changes for me. Do you find that?

Jessica: We do to some degree, but oftentimes when we.. I guess because physical ailments, they are visible, they're oftentimes really visible other than pain, which is often something we'll see that isn't necessarily that visible. But oftentimes if someone comes to me and they're quite physically well, that's when I refer them on to EP.

Not to say we don't see that sort of client at all. You know, there are the physical symptoms that are not as obvious that we would work with, you know, particularly vestibular issues as well. You know, people who feel quite dizzy after a stroke or even without a stroke. We do treat a lot of those conditions. They’re often more complex because, you know, you're getting that pressure from the outside world and you look fine, that can be quite complex and challenging, I imagine.

Paul: Yeah. It's one of those things where I found like, for example, if I turn to my left too quickly and there's a lag between what the inner ear tells me and that can be quite confronting. If I'm having a bad day and, you know, highly fatigued, I can just kind of go haywire. So do you encounter people with that kind of stuff going on?

Jessica: Definitely. Vestibular rehab is a big part of what we do for sure, and it can be so debilitating. Obviously, if you're walking around and you feel like you're on a rocky boat all day long or every time you turn your head, you know, you think about when we're walking and we're scanning our environment or you're driving and you've got to turn to do your head checks and things like that.

That's incredibly debilitating. And so we do have lots of different ways that we assess and provide therapy for vestibular clients as well. The thing about vestibular is that there's a bit of an overlap, you could see a musculoskeletal physio for that, but oftentimes neuro physio will also be more experienced in the vestibular field.

Just depends on what's causing the vestibular deficit. But particularly after a stroke, you would, you would obviously see the neuro physio for that.

Paul: Does treatment change based on that kind of..

Jessica: Yes, yeah, Yeah. And I think this is where physiotherapy is so important because you can't be generic at all. There could be lots of different things that are causing someone to be dizzy.

Dizziness can be caused by the location of the stroke, for example, in the brain, or it could be caused by the middle ear, or it can even be caused by a neck stiffness or by musculoskeletal issues. So it's so important that you're very thorough about your assessment and that you have a clear picture of what's causing the actual dizziness.

And if you don't, then it's really important that you refer on. And I'm really lucky because I do. Obviously my husband's a ‘musc’ physio and I work out of, I do consult out of the clinic surrounded by musculoskeletal and sports physios as well. So I get their expertise as well at any time, any time I see something and I'm not too sure of, I just call onto them and get their assistance on board, which is great.

But yeah, the therapy definitely changes.

Paul: So if there's somebody out there that has had, you know, post injury and is having, you know, balance, dizziness issues, those invisible things that may not get caught in the heat of battle during acute recovery, which happens, it's nobody's fault. Everyone's you know.. Your services, this is something that can definitely assist those people?

Jessica: Definitely. Even fatigue. Even endurance. You know, people will say, I am walking and I'm walking, okay. But as soon as I get beyond 5 minutes, that's when I start to notice my foot is dropping or I'm tripping over my feet. Then that's definitely something that myself and an exercise physiologist would be helpful for.

Paul: Yeah, it's fatigue. Such a funny one because, is it fatigue because there's something in your brain that like you're having neuro problems or memory problems because something structural has gone wrong? Or is it because there's fatigue that's affecting that?

I can’t tell the difference some days. But that must be something that comes across your desk a bit?

Jessica: Yeah, fatigue is.. I find fatigue really complex. And we know that stroke patients do suffer a lot of fatigue.

We work quite closely with the occupational therapists on education as well. You know, people often will go hard, hard, hard, and they do the whole boom and bust. And it's about, well, how do I restructure what you're doing to avoid that. How do we restructure your activities throughout the day and also from a physio point of view, exercise we know does help with fatigue.

If you’re not getting momentum in your gait and it's really quite slow and every step is effortful. That's huge. That's really fatiguing. And so that's what we do in physio. We work really closely with the occupational therapist in that setting to identify, well, how do we restructure their day so that they're not going to bed at 4 p.m. because they're exhausted at the end of the day?

And also how do we incorporate exercise to improve fatigue?

Paul: Okay, so from a fatigue improvement perspective, how you approach things, it's not only just strategies of how to make sure that you don't go too crazy and break yourself, which is what I do from time to time. But it's about understanding movement and making those things that you have to spend cognitive effort doing as automatic as possible so it doesn't cost you so much.

Is that a fair assessment?

Jessica: For sure. Ideally, you know, when you don't have a stroke and you're walking, it doesn't require any cognitive capacity. You just get off and you go and you walk. But obviously after stroke, there is a lot more planning. It's no longer about automatic. A lot of our stroke patients will have sensory deficits so they don't feel their leg.

And so now they have to really think about where am I placing my leg, but also just not having that strength to lift the leg. Now you're doing all these compensations that are fatiguing and taxing because you want walking to be efficient. And if you're doing that, then it's not efficient anymore, is it?

Paul: And this is the bit that's always confused me as a survivor: is you need to do more planning in order to get through your day to day.

However, the bit that I use to plan is the bit that got broken. Yeah, it's got a life. Yes. And that's a real tricky thing to overcome. Like how you how do you approach something like that?

Jessica: Yeah. I mean I can only imagine how hard that is. I think cognitive impairment on top of what you're already trying to achieve and the fatigue makes it so much more challenging.

And I think that's where we utilise lots of different things. You know, for example, technology's great these days, you know, and that really does help take away some of that cognitive overwhelm when you can get on to… We use lots of different things. For example, there's a program called Maslow or I think one of them is called Family Lounge, and that's something that we use with our clients to either give them one place where all of their appointments are listed and one place where they can access their therapy programs.

For example, you know, you can upload your physio program, your professional therapy program, and so everything's in one location so that you're not having to bounce from different calendars and so on. So I'm not sponsored by either of them!

Paul: No, no, no, no. Sorry. We should probably be a little careful about that. But it's good to know that those solutions are out there and people can speak to their professionals, because I found, particularly in the early days, and it has changed a lot in five years and my background was in I.T. so I went off and did a lot of this on my own.

But there's a lot of paper that gets passed around with exercises on it and things like that and that just gets lost. So the fact that those solutions are out there.. so is that something that people could speak to their professionals about and say, how do we make these technology-based so it’s easier for me to deal with?

Jessica: Yeah, it definitely exists and technology's evolving all the time, but there are definitely ways to streamline things so that you're not jumping, you know, you're not trying to collect a folder of therapy programs and so on. Everything's just up to date. I think, you know, there are a lot of our clients are on the older end and they, they do prefer paper, but it's about checking in.

You know, you can't just prescribe a program and say, I'm going to trust that you're going to do that now. It's about each time you see me, I'm clarifying, have we actually done it? Or do I have a system where we're touching base? And I think that some of these systems have that where you can tick off that you've done your programs, that the physiotherapist knows you have been on top of this.

Then oftentimes I will say to clients, unless I know that you're doing what you're doing at home, I can't determine if what we're working on is actually effective. And so we we need to work with our clients and consider what's going to work best for them.

Paul: Yeah, absolutely. And people, the older generation and actually that's a generalisation because I know people that are sort of my generation that just don't do tech and that's perfectly okay.

Jessica: I'm not tech savvy!

Paul: But I like the fact that there is, for those that are technologically interested, that there are potential solutions out there where they can interact on a portal or on some kind of solution and tick the things off and give you guys the visibility into what's going on. Because it also saves time at the end when you go into an appointment and somebody says, “So how have you gone?”

And Mr. Memory? Well he goes, “Yeah, I think it went well. I can't remember what I did yesterday.”

But if you can automate that process and give you guys what you need and give us the ability to tick things off as we go, that's hugely powerful.

Jessica: Definitely.

Paul: So how do people find a neuro physio?

Jessica: I mean, there's lots of different ways to find us. I'm happy to give my details at the end of this. If anyone needs you in the area, they can always reach out to me and I can guide you in the right path just knowing different physios around. But your GP or a neurologist should hopefully be able to recommend someone as well. You know, most of us have websites online, so if you if you've had a neurological condition, don't just go to your local musculoskeletal physio.

Hopefully, hopefully they'll be you know, if you came through this clinic, for example, they'll definitely say, okay, we've got a neuro physio, we know who she is, go and see her. But it's like if you had a stroke and you went to see an orthopaedic surgeon instead of a neurologist, you're just not going to get the same level of care, are you?

You want that expertise, for sure. So, you know, most of us, if you Google neurological physiotherapist in your area, likely something will come up. And the other thing is, considering do you need someone to visit you at home? Because if you do have a cognitive impairment or if you've got specific goals that are related to your home environment, that might be more relevant.

And lots of neuros will travel to different homes or aquatic centres or gymnasiums, depending on the client's goals.

Paul: So who do you find that refers to you guys the most, or is it very much a mixed bag?

Jessica: It's definitely a mixed bag. I'm, actually right after this, I'm going to speak to some GPs up the road. They've asked me to come and have a chat with them. So we do get referrals from GPs, but a lot of our referrals now are from support coordinators under the NDIS.

That’s where I get a lot of referrals from now, but also from occupational therapists and exercise physiologist, other allied health we get, we get referrals through there and also through our website.

People are getting on Google and making an inquiry that way, a bit of a mixed bag.

Paul: So what does the future look like for neuro physio? What's coming down the line? What leadership is going on? Are there cool things happening in that space?

Jessica: There are some very cool things happening. I actually just saw a post about the use of virtual reality training.

Paul: Ooh that's cool.

Jessica: Yeah. Yeah. Which I've always thought that that would be fantastic. I used to have a VR set at home, so. But yeah, just the ability to use VR for retraining or things like balance vestibular problems. I don't know if you've ever put on a VR said, but it's a great way to challenge your balance system.

You know, it used to be Nintendo Wii and I've worked in multiple clinics where we have had a Wii and we've used that a lot in training because therapy needs to be fun, doesn't it? So there's lots of there's lots of space happening in that field, which I think is really exciting. And I'm hoping, hoping to get a VR set myself in this clinic so that we can push clients therapy that way as well and make some more fun happen in the gym.

There's also a lot coming out in the world of robotics. I recently looked at a few exoskeletons for a spinal cord injury client, but yeah, that's definitely a really interesting world. Not a cheap one, but a really interesting one. For retraining gaits and for getting people able to move when they don't have that strength.

Yeah, which I think is really interesting. Watching this space really closely.

Paul: Yeah, I think I saw something online. It's a real risk of getting my nerd hat on.. There seems to be some advances and people talking about exoskeletons to help Parkinson's patients retrain to do things. So that sort of stuff. So is that something you've come across as well?

Jessica: Yeah, I have. I have. And I think it's really exciting. I mean, especially in the world of paraplegics, get that idea that perhaps they can get upright and be standing when they may not have for many years. I think that's really exciting and I think technology's fantastic and I think it's going to really blow up the world of neuro physio, hopefully as things keep evolving.

There's also lots, a lot of things that are emerging in the space of multiple sclerosis and how we're managing that. There's so much new information about how exercise can be neuroprotective, what we call neuroprotective, and how it protects the brain from some further progression of disease. There's already a tonne of evidence around how it impacts cognitive function in the space of preventing and delaying Alzheimer's disease.

But I think it's.. now we're seeing lots of evidence emerging that it can actually impact progression of diseases like M.S. and Parkinson's. So that's really, that's really interesting, too.

Paul: Fantastic. Well, the final question I usually ask all of the people that I chat with and to put you on the spot, is there any one tip or one nugget of wisdom you'd like to share with regards to, you know, stroke survivors and what they can do to assist themselves in recovery or any.. shortcut isn't the right word.

But, you know, every now and then there's a nice little nugget of wisdom out there that people go, I can relate to that. Have you ever stumbled across anything?

Jessica: I mean, the thing I would say mostly, and then I find myself saying to all my stroke clients is that recovery doesn't stop. Oftentimes there's this misunderstanding that in the first 6 to 12 months, yes, you might make the most progress, but that doesn't mean that after that there is no room to progress.

I think our brains are really powerful and what we tell ourselves and what we believe is incredibly powerful. So having this belief in yourself of I can achieve my dream goals and I can continue to work towards them, and coupling that with this idea that there's no shame, there's no pressure, It's just I'm going to work towards that.

I'm going to work hard, I'm going to exercise. And exercise doesn't mean I have to do a full hour of getting my heart rate up and feeling dead the next day. The 5 minutes counts. All of it counts, you know. So I think that would be my nugget of wisdom - that there is no deadline for stroke recovery.

Just continue working towards your dream goals and little difference is a little… little things count. They make a big difference and they add up.

Paul: Fantastic. Thank you so much. I'm going to go away and have a little bit… just think of that myself to be better. So I do appreciate your time. It's been a brilliant chat. Thank you for your time.

Jessica: Just thank you for having me on board.