Shawab Mir, Clinical Specialist Neuro Physiotherapy Expert at Maggie Sargent & Associates, knows first-hand the importance of Neuro Physiotherapy in Brain and Spinal Injury Rehabilitation.  Here he gives an insight into his clinical work and expert witness practice.

1)What is Neuro Physiotherapy?

Neuro Physiotherapy involves the treatment of people with movement and function disorders which are the consequence of a dysfunction within the central nervous system (brain and spinal cord) and neuromuscular system.  These conditions can result in muscle weakness, poor balance and coordination, spasms and tremors, and altered sensation.  Common neurological conditions include;

• Spinal Cord Injury
• Traumatic Brain Injury
• Stroke
• Multiple Sclerosis
• Parkinson’s Disease

2) Why is Neuro Physiotherapy Important in Rehabilitation ?

Neuro Physiotherapy is integral in the rehabilitation of patients with neurological disability because it helps to;

• Re-gain motor function
• Re-train balance
• Promote neuroplasticity through repeated task-specific practice
• Prevent secondary complications such as contractures and chest infections
• Helps to protect range of movement through provision of custom made splints
• Promote recovery through use of electrical stimulation
• Facilitate weaning off tracheostomy and chest management
• Educate carers and family in a therapeutic handling to avoid further injuries to the patient through poor manual handling.

3) What Is Your Current Clinical Role?

I work as a Clinical Specialist Neuro Physiotherapist in a regional inpatient neurological rehabilitation unit.  As a Clinical Specialist I regularly assess and treat clients with catastrophic disabilities arising from neurological injury.  I have developed significant expertise in complex postural management in patients with severe spasticity.  I am often required to make custom-made casts for ankle and knee joints to help to protect range of movement and to prevent contractures.  I am trained to inject spastic muscle with BOTOX for the purpose of spasticity management.  I frequently use electrical stimulation for a range of purposes including the treatment of foot drop.  To help meet respiratory needs of patients with neurological disability, I regularly make use of devices such as Cough Assist and lung volume recruitment bags to help prevent chest infection as well as to facilitate weaning off a tracheostomy.

Individual’s with complex neurological conditions require additional support, high levels of care, and specialist equipment.  Family members and carers provide an important role in the rehabilitation process and it is very important that family members and carers know how to deliver aspects of physiotherapy interventions to enable a 24-hour approach to rehabilitation and help prevent secondary complications.  An important aspect of my work therefore involves working closely with family and carers to advise them of the range of patient-specific issues including the importance of correct seating and lying posture, guidance on active and passive exercises, as well as guidance on correct manual handling to reduce the risk of manual handling injury to both the patient and carers. I am an ROSPA trained manual handling trainer.

4) What Does Your Role As An Expert Witness Involve?

As an expert witness I provide Part 35 CPR compliant reports identifying and advising on an individual’s Neuro Physiotherapy needs for the immediate and longer term.  I advise on recommendations that will assist in reducing the impact of a long-term condition on an individual’s daily life.  Neuro Physiotherapy treatment and equipment is commonly needed throughout an injured person’s life, and this can be very expensive.  It is therefore very important that future needs are costed accurately.  My current clinical experience really assists me as an expert witness to be able to inform the Court on the most appropriate, current Neuro Physiotherapy treatments, specialist equipment, and costings.