What We do

Neurological Rehabilitation

Neurological physiotherapy is a specialist area of physiotherapy. It focuses on assessing and treating people with movement disorders that have resulted from injury or disease to the brain, spinal cord or extremities of the body. Damage to the central nervous system, including the brain and spinal cord, means that the messages from the brain are not reaching the affected parts of your body. This can result in loss of movement and sensation, uncoordinated movement, weak and flaccid muscles, spasm and tremor. Physiotherapy will help you to maximise your physical and functional ability, you will learn how to manage the changes in your body caused by your acquired or progressive neurological condition.

For more information about neurological physiotherapy please go to: www.acpin.net

Vestibular Rehabilitation

Vestibular rehabilitation is the speciality concerned with the assessment and rehabilitation of people with dizziness and balance disorders. The treatment is mostly exercise-based, and the exercises used have been proven to promote central nervous system compensation for a balance disorder. Vestibular compensation is a process that allows the brain to regain balance control and minimise dizziness symptoms when there is damage to, or an imbalance between, the right and left vestibular organs (balance organs) in the inner ear. The brain copes with the disorientating signals coming from the inner ears by learning to rely more on alternative signals coming from the eyes, ankles, legs and neck to maintain balance. Eye gaze stabilisation exercises are often necessary to improve vision stability, which is the ability to focus on a stationary object while the head is moving. A canalith repositioning procedure is also often necessary to include into treatment for people with Benign Paroxysmal Positional Vertigo, known as BPPV.

For more information about vestibular physiotherapy please go to: www.acpivr.com

Postural Re-education

Postural re-education is used based on the principle of correct alignment, biomechanics and neuromuscular coordination. Postural re-education isn’t just for those that display problems with their posture but other relating musculoskeletal or neurological conditions that are a contributing factor to poor posture alignment. Postural re-education is suitable for those that experience weakness, pain and stiffness with a loss of movement making it difficult to perform normal functional movements.

Gait Re-education

During gait re-education a person is re-trained to achieve his/her most efficient and least effortful walking patterns. Any neurological and musculoskeletal conditions can affect the walking pattern resulting in risk of falls and other injuries. In some cases, gait re-education is recommended post-surgery. Learning to walk correctly again ensures that the body moves in the way it is designed and allows for correct functioning of joints and muscles. Normal gait pattern requires reasonable muscle power, muscle length and adequate joint range of movement. Any trauma to the body can compromise muscle strength and joint range of movement affecting normal gait pattern.  A personalised treatment plan is required based on the specific medical conditions of a person treated. If necessary, a suitable walking support may be considered.

Balance Re-education

Balance re-education helps to improve your ability to sit, stand and walk. An individually tailored exercise programme will be set to help improve posture, develop muscle control, strengthen muscles, build endurance, and improve balance reactions.

An initial assessment will include all the systems involved in balance, such as muscle length and strength, good functioning of the proprioceptive and sensory system, the vestibular (inner ear balance) system, vision, any issues with attention and / or ability to accommodate or react to balance requirements. Subsequent therapy will be specifically tailored to work on and improve the systems that are most affected, or maximise good working of the others to compensate, improving overall functional outcome.

Tai Chi for Health Exercise Classes

See our full timetable of our Tai Chi for health exercise classes.

Some of them are running in partnership with NHS Ealing Borough long term conditions team and Hanwell Parkinson’s UK branch.

From our own experience as clinicians and via application of Tai Chi movements to individual clients training programmes we know that modified Tai Chi/Qigong exercises are highly enjoyable and effective.

In our classes we teach exercises which are selected from the traditional Qigong and basic Tai Chi form movements and adapted when needed; the main focus is on exercising large joints throughout their functional range of movement, loosening the waist, and maintaining upright posture throughout selective stepping sequences. All selected stepping sequences are focusing on maintenance and development of good stepping width, length together with correct heel strike and push off throughout the gait cycle. Tai Chi consists of fluid, gentle, graceful, and circular movements that are relaxed and slow in tempo. Breathing is deepened and slowed, aiding visual and mental concentration. Tai Chi is a sophisticated art with many different styles and forms. Despite the many variations of Tai Chi, its effectiveness for improving health and inner energy derives from a set of essential principles.

Tai Chi has been shown in research to strengthen lower limb muscles, improve flexibility, posture and balance which results in prevention of falls. In deconditioned and sedentary population, it improves cardiovascular endurance. Tai Chi aids mental relaxation and increases sense of well-being. It is especially suitable as a therapy for chronic conditions because its movements are slow and gentle, and the level of exertion can be adjusted to suit each person’s physical condition.

For more info on Tai Chi for health please go to : www.taichiforhealthinstitute.org

Individual Exercise Prescription

When choosing a suitable exercise for anyone with existing physical difficulties many aspects needs to be considered. Some exercise may be more suitable to some than others. Firstly, the clarification of individual needs is acquired to establish the motive for exercise. Secondly what is needed is to identify individualised attainable goals and objectives for exercise. Thirdly, a safe convenient and well-maintained area or facility for exercise needs to be identified. What is further useful is to identify social support for exercise if possible. Monitoring is often required with an emphasis on the acute or immediate effects of exercise. Finally, what is needed is to establish a regular schedule for exercise.

Meet The Follow Steps Team

Michaela Zelenkova - Follow Steps - Neurological and Vestibular Rehabilitation

Michaela Zelenkova

BSc Hons

Michaela is registered with The Health and Care Professions Council (HCPC) and is an active member of the Chartered Society of Physiotherapy (CSP), The Association of Chartered Physiotherapist in Neurology (ACPIN) and The Association of Chartered Physiotherapist in Vestibular rehabilitation (ACPIVR).  Michaela works for the North West London NHS Trust  Community Neurology Outpatients Clinics in Southall and South Ealing.

Michaela qualified with BSc (Hons) degree in Physiotherapy in 2007. While training she worked as a Physiotherapy assistant and further to that as a GP Exercise referral scheme instructor. She has over sixteen years of experience in exercise prescription, including over eleven years as qualified Physiotherapist. For the past seven years she has been supporting clients with neurological conditions  with their physical management in domiciliary and outpatient setting.

Michaela works with in neurological and vestibular rehabilitation speciality areas of physiotherapy treating  clients with multisensory impairment and complex medical history.

Michaela herself is a keen cyclist, swimmer and ex squash player has always been comparing and examining varied types of exercise and their benefits but also demands on human body. Seven years ago she came across Tai Chi and she continues to practice it to the level that  Tai Chi  has become the go to tool in her Physiotherapy tool box when retraining posture and balance, and also when improving standing tolerance, general leg strength, reduced range of movement  and coordination.

Michaela believes that anyone regardless of their physical limitation should and can exercise. What’s needed is to find the right place, right exercise and adapted to a suitable level so it can be fun and enjoyable. That way it becomes part of ones life.

David Bouchet - Tai Chi for Health Instructor

David Bouchet

David also works for London North West Healthcare University NHS Trust in the community rehabilitation service for people with neurological conditions. As a Rehabilitation Assistant, his role involves working across Physiotherapy, Occupational Therapy and Speech and Language Therapy. David very much enjoys the variety of the job, which allows him to promote independence and a good quality of life for people suffering from ill-health or disability. He has extensive experience in health and social care services, having worked with people with learning disabilities, mental health problems, substance misuse and physical health problems, always keeping a strong focus on empowering and motivating people to work towards their chosen goals while remaining positive.

David spends most of his spare time studying with the Open University towards an open degree in subjects related to psychology and exercise science. He studies mainly for pleasure but also to keep his mind active and to better understand how the body and mind work.

David considers himself very fortunate to have been introduced to Tai Chi by Michaela while at work. His passion for Tai Chi has grown progressively ever since, and he soon qualified as a Tai Chi for Health instructor certified by the Tai Chi for Health Institute. David believes that Tai Chi brings a wide variety of benefits to participants, such as improved balance, strength and coordination, but also positive mental well-being, increased confidence and togetherness in a non-competitive, friendly and fun atmosphere.