Chapter 10 E-materials

Author profiles

Jackie Clifford MSc BA Cert. Management GradDipPhys MCSP

Jackie Clifford is a specialist physiotherapist in mental health working as a self-employed Rehabilitation Consultant, based in Worthing in West Sussex.

Jackie has been involved in mental health physiotherapy for over 20 years, and possesses extensive experience of working in acute adult and older adult mental health and in adult learning disabilities services.

Jackie has been an active committee member of national and regional physiotherapy professional networks (CPMH) for physiotherapists working in mental health; and responsible for establishing the regional physiotherapy professional network (CPMH) in London and the South East in 2004.

Jackie has also been involved in Chartered Society of Physiotherapy (CSP) steering groups and in (CSP) publications including guidelines for manual handling, UK information papers on mental capacity, research priorities group for mental health and well being, and a national strategy for the role of physiotherapy in mental health.

Kerry Gibson BSc(Hons) MCSP

Kerry Gibson is a physiotherapist working in Men’s Forensics and Neuropsychiatry at Birmingham and Solihull Mental Health NHS Foundation Trust. Previously Kerry was working within acute services in mental health for the same Trust. Currently involved in the management of the clinical education of students, and liaising closely with local universities regarding the current physiotherapy course curriculum; Kerry has recently been appointed Education Lead for the CPMH Committee.

Caroline Griffiths GradDipPhys MCSP

Caroline has worked in various areas of Mental Health both in Primary and Tertiary settings over the last eleven years and is currently the Professional lead for Physiotherapy, Mental Health Division, at Oxford Health NHS Foundation Trust.

An educator in clinical and academic settings she has contributed to many published works on the role of Physiotherapy in Mental Health.

As Chair of Chartered Physiotherapists in Mental Health Caroline was part of the team which created the CSP / CPMH strategy for Mental Health.

Now vice chair and Professional Network representative Caroline sits on the Education Committee of the Chartered Society of Physiotherapy.

Venkat Narayanan MSc BSc(Hons) MCSP

Venkat Narayanan is a Senior Physiotherapy Practitioner working with older people in acute mental Health setting at Oxford Health NHS foundation Trust. Venkat has 11 years of Physiotherapy experience predominantly worked in Neurological Rehabilitation and older people care. He is currently involved in a research project funded by NIHR for evaluating falls prevention in acute inpatient mental health setting.

Appendix 10.1 Laura mitchell relaxation

Background

Laura Mitchell was a physiotherapist who worked in London in the 1960s. She used her knowledge of how muscle groups worked to devise this effective relaxation method.

Many muscles work in opposing pairs, for example the ‘biceps’ and ‘triceps’ muscles in your arm. When one contracts the other must relax. So when you bend your arm, your ‘biceps’ muscle contracts. To enable it to do so, your ‘triceps’ muscle (at the back of your arm) must relax. It has no choice! The following relaxation method is based on the simple principle of contracting certain muscles to encourage their opposites to relax.

Begin

Lie down in a comfortable position without crossing your legs. If you can’t lie down for any reason you can still do this sitting up. Make sure you are comfortable with your arms and legs uncrossed, your feet flat on the floor, and your arms loosely resting at your sides with your hands gently resting on your lap or on the arms of the chair if it has some.

You can start at your feet and work up or start at the head and work down, it’s up to you!

Breathing

Close your eyes and notice your breathing. Don’t try to change it, just notice and let your attention softly focus on your breath, gently letting go of any other concerns for a short time and allowing yourself to rest here for a few moments.

Feet

Gently point your toes away from your body if you are lying down, or push your feet into the floor if sitting. (Stop if you experience cramp and bring your toes in the opposite direction towards your body.) Hold this position while you count to 5, and then relax. Notice how your muscles feel … and allow your muscles to rest in the position where they naturally return to.

Repeat.

Legs

Roll your knees apart a little way.

Hold while you count to 5 again, then relax.

Repeat.

Buttocks

Clench your buttocks.

Hold while you count to 5 again, then relax. Remember at each stage to notice how your muscles feel … and allow your muscles to rest in the position where they naturally return to.

Repeat.

Back/abdomen

If lying down, push the small of your back into the floor.

Hold while you count to 5 again, then relax.

Repeat.

If sitting: pull your abdominal muscles in and sit upright.

Stress-reduction resources from Ruth Hadikin Associates: Supporting Stressed Out Professionals!

Hold while you count to 5 again, then relax.

Repeat.

Shoulders

Pull your shoulders down, away from your head, and slightly back.

Hold for a count of 5, then release.

Repeat.

Elbows

Move your elbows slightly away from your sides. Hold for a count of 5, then relax.

Repeat.

Hands

Stretch your fingers to make them long, hold for a count of 5, then release.

Repeat.

Eyebrows

Raise your eyebrows as though surprised. Hold for a count of 5, then release.

Repeat.

Jaw

• Keeping your mouth closed slowly stretch your lower jaw downwards.

• Hold for a count of 5, then release.

• Repeat.

• Allow yourself to relax. Notice how your body feels.

• Notice your breathing.

• Imagine you are somewhere that is peaceful for you …

• imagine the sights … sounds … smells …

• Allow yourself to rest here a while.

• When you are ready, slowly bring yourself back to the present moment. Get up slowly.

• Once you have learned the technique you can adapt it and do those parts that are more suitable for you.

• For example the shoulder relaxation is helpful even if you are at work, especially if your work involves sitting at a computer for long periods.

• It is always beneficial to go through the whole routine at least once a day, so your muscles remember the process of letting go and release, and your body doesn’t hold on to tension.

Taken from Dreamcoach, © 1999–2011 Ruth Hadikin Associates, with permission. http://www.dreamcoach.co.uk/LauraMitchell.htm

Case Study 10.1

Background

• Mary, 72 years old, female diagnosed with psychotic depression.

• She has a medical history of Parkinson’s disease with frequent falls.

• Her mental health has declined since her husband died a few years ago.

History of present condition

• Mary was admitted to the acute mental health inpatient setting for her current episode of psychotic depression.

• She has had many recent falls.

• She referred for physiotherapy for falls prevention, management of her Parkinson’s disease and to improve her physical and mental wellbeing.

Assessment

Psychological and social

• Mary was particularly withdrawn and declined to participate in activities.

• She cited a lack of energy as the main reason for her non-participation.

• She refused to engage in conversation with staff and other clients.

Physical

• Reduced facial expressions, poor eye blink, with a general look about her that displayed sadness and a depressed outlook.

• Poor posture, with tendency to have flexed hips and knees.

• Bradykinesia particularly in her lower limbs.

• Freezing, this was spasmodic and very much on or off.

• Freezing often occurred when Mary experienced panic attacks.

• Festinating gait.

• Dysarthria, speech was poorly articulated (hypokinetic).

• General weakness of all muscle groups and poor endurance, which was considered to be a result of her reduced participation in exercise and activities.

Baseline assessment

• EMS (Elderly Mobility Scale) produced a score of 4/20 which indicates she is dependent on ADL.

• STRATIFY (Falls Risk) Mary scored 3, which indicated that Mary was a high risk for falls.

Treatment planning

Key aims

• Facilitation of safe discharge, promote independence and quality of life.

• Falls prevention.

• Promote her mental and physical wellbeing through physical activities, e.g. group and one-to-one exercises.

• Manage her Parkinson’s symptoms through evidence-based treatment approaches.

• Improve her physical strength and endurance through progressive graded strengthening exercises.

Short-term goals

• Improve therapeutic engagement.

• Reduce the risk of falls.

• Improve gait, balance and physical strength.

• Increase client participation and socialisation.

• Increase awareness of falls risk and prevention.

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