Career: so you want to be a ...neurological specialist?

Exciting progress is being made in the field of neurology, where physiotherapists can change patients’ lives, as Julie Penfold discovered.

Physiotherapists in the neurological field work in a range of settings in the NHS and in private practice. They assesses and treat people with disorders of the central nervous system that affect the brain, spinal cord and nerves. People with conditions such as stroke and Parkinson’s often have complex mobility issues. These include muscle weakness, muscle shortening, joint stiffness and balance difficulties. 
Melanie Falk is a clinical specialist physiotherapist in neurology at South Bristol Community Hospital, part of University Hospitals Bristol NHS Trust. She leads the neuro-physiotherapy outpatient service with another band 7 physio. It takes referrals from local GPs and consultants and treats about 500 patients a year. Many have Parkinson’s but the team also treats people with a range of neurological conditions, including stroke and spinal injuries. ‘We recognise that people with long-term neurological conditions need instant access to support when they have any issues or concerns,’ says Ms Falk. ‘Once a person has been assessed, we provide open access so they can contact us any time for advice or to make an appointment. They really value the service.’ 
The outpatient service also offers a clinic for patients newly diagnosed with Parkinson’s. This runs twice a year and provides a brief introduction to what is available, plus advice on how to manage the condition. The service also offers three weekly exercise groups, including one specifically for people with Parkinson’s. Ms Falk also provides popular Parkinson’s awareness training days to trust staff. These take place every six months and are limited to 40 people. The sessions highlight how hospital care could be improved for Parkinson’s patients. Key messages include ensuring patients are given their medication on time and are kept mobile.


Ms Falk also works as part of a multidisciplinary movement disorders clinic team, which includes an occupational therapist, speech and language therapist and doctor. The team runs a weekly movement disorders clinic.
‘We’re unique as the only clinic in the region where all four disciplines are involved,’ says Ms Falk. ‘We run a weekly clinic on Fridays where, at a two-hour appointment, patients have the opportunity to be seen by the four of us together. We mainly see people affected by Parkinson’s and, collectively, we really understand the condition. Patients can come to see us about condition-related issues such as rapid eye movement sleep disorders. Once the team has identified patients’ needs, they can come and see me during the week.’

Positive message

Ms Falk, who has worked in the field for over 30 years, says the support physiotherapists can offer patients with Parkinson’s is crucial. ‘It is very exciting that exercise has been shown to be incredibly important for people with Parkinson’s. Research has found that high-intensity exercise can actually reverse symptoms. It’s such a positive message for patients now. When I qualified in 1986, I would tell patients that exercise was good for them – now our message is that exercise is vitally important.’
Ms Falk is also on the local Movement Disorders HIT (health integrated team) committee which aims to provide a uniform service for all patients with movement disorders across Bristol and the south west. 

Haka moves

Ms Falk has undertaken Parkinson’s-specific training, including the Lee Silverman Voice Technique, a tool for speech therapists that has been adapted for physiotherapy. She completed PD Warrior instructor training recently, too, an intensive exercise-based programme designed to drive neuroplastic change in people with Parkinson’s. 
However, Ms Falk has found her own approach to high-intensity exercise works well with patients. The haka is an ancient war cry, dance or challenge used in traditional Maori culture. It is a posture dance, usually performed in groups and typified by vigorous movements, including stamping the feet as hard as possible and slapping hands against the thighs. It is famously performed before rugby matches by the New Zealand All Blacks. 
‘Haka moves are all about high intensity and being quite aggressive and forceful with each exercise,’ says Ms Falk. ‘To make a difference with Parkinson’s, patients really have to move. It requires as much effort as they can make. The high-energy moves are beneficial for patients with balance issues and the movements are a lot of fun. Patients love it and tell me they feel so much better afterwards. 
‘The haka is helping to improve patients’ endurance and confidence, especially when they have a fear of falling. The difference the exercise makes is incredible.’
Ms Falk’s interest in neurology grew out of bereavement. Her father had a stroke and died when she was 18 and had just started physiotherapy training. After qualifying, she moved into neurology and has spent her career there. ‘It’s such a diverse and interesting area,’ she says. ‘Most days, patients cry or want to hug you because of the difference you’re making to their lives. It’s a very rewarding role.’ 
  • Melanie Falk is ACPIN’s outgoing honorary secretary and governance officer

Melanie Falk’s tips

What personal skills do I need? 

Patience is a requirement as there is no quick fix in neuro-physiotherapy. You have to be patient and positive. It’s a very different approach to other areas of physiotherapy. Being able to motivate, encourage and support patients to self-manage is vital.

What steps do I take?

It’s important to find someone to work alongside initially. Why not consider joining the Association of Chartered Physiotherapists in Neurology (ACPIN) for support? Members are passionate about this area of physiotherapy and keeping the specialism going, although there is a squeeze to push people into general physiotherapy. 

What training is there?

ACPIN offers courses and study days at reduced rates for members. PD Warrior training is also available. For more information, contact Parkinson’s UK. 

Who would pay for it?

Unfortunately, there is very little NHS funding as the push is to have general physiotherapists. My Parkinson’s skills training has been entirely self-funded. 

NHS or private?

A bit of both, but you don’t get the same multidisciplinary teams in the independent sector. The NHS offers the best experience of working in a team. The multidisciplinary clinic we run every week is fantastic. You wouldn’t get this privately as patients wouldn’t be able to afford it. I feel strongly that the NHS and private sector need to work together more.

How can ACPIN help?

The network provides opportunities to develop as a specialist in a way that the NHS doesn’t so much these days. ACPIN aims to promote research and education, nationally and internationally. It offers specialist training courses, lectures, study days and conferences. ACPIN’s International Neurophysiotherapy Conference takes place in Manchester from 19-20 March.  See
Julie Penfold

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