Your Health Team: Neurological Physiotherapist - MSNZ
Neuro Physiotherapists specialise in movement and function for people with neurological conditions like MS. They help people maintain mobility, manage symptoms, and stay as active and independent as possible. . . .
Neuro Physiotherapists specialise in movement and function for people with neurological conditions like MS. They help people maintain mobility, manage symptoms, and stay as active and independent as possible. We spoke with Clinical Lead and Neurological Physiotherapist Gilly Davy, Founder & Director ofMS Get a Head Start, to learn more about this important role. Can you tell us about your role as a Neurological Physiotherapist?I am one of those lucky people, who loves what they do for work. I have the privilege of working with individuals living with neurological conditions to maximise their quality of life. Regarding my role as a neuro physio working with people with MS, I am specifically assessing people’s balance, walking, muscle strength, fatigue, reaction speeds, spasticity, pain, hand function, and any area that the individual is concerned about. I then work with the individual to provide a range of hands-on treatment, education, and exercise prescription to help improve their impairments and maximise function and quality of life. My role is to provide the HOPE that a better life is possible now with MS with the right exercise and exercise volumes. How can MS affect movement, balance, and mobility?As the demyelination can happen anywhere on the central nervous system, a wide range of individual presentations of weakness, spasticity, and sensory changes for example can occur. It is common for people with MS to experience balance changes which can be due to a range of reasons, weakness, visual changes, vestibular changes or ataxia for example. When we experience balance changes this directly reduces our activity levels as people are fearful of falling and hurting themselves. Weakness makes moving difficult and often people with MS develop compensatory patterns while trying to keep moving. Compensations can lead to pain and movement deterioration. It is common that someone with MS will notice weakness in their foot or hand first, and typically the weakness pattern gradually gets worse. However, it is important to know that movement, balance and mobility can all be improved with MS at any stage of the journey with the right treatment and exercise prescription. What are some early signs someone should consider seeing a Neurological Physiotherapist?It is never to early to see a neuro physio, ideally everyone living with MS should see a neuro physio at diagnosis. By the time someone is diagnosed with MS there is already changes to their central nervous system which will be impacting on how their body moves, even if only very subtle changes. It is reported that 85% of people diagnosed with MS will present with balance changes within the first 12 months of diagnosis. Even if you have no symptoms we still strongly encourage you to see a neuro physio at diagnosis. Exercise and physical activity are the most powerful tools someone living with MS has to slow disease progression and stimulate remyelination. Seeing an experienced neuro physio at diagnosis can help to establish how to exercise safely and successfully with MS. If you missed seeing a neuro physio at diagnosis, you should be seeing a neuro physio at every stage of MS. A neuro physio can help with your balance, reduce falls, improve your walking, transfers, hand function and any function you are concerned about and want to improve or manage better. How do you support people to stay active safely?Although there is lots of common symptoms with MS, everyone living with MS is individual. This is an important factor when I am helping people to engage in exercise safely. The biggest concern is balance and falls risk, and ensuring the exercises are challenging but safe. However, another really important element of safe exercise with MS, is also about having positive experiences and enjoying the exercise. Due to heat sensitivity and neuromuscular fatigue, many people with MS will struggle to exercise as they previously did or have negative experiences, such has visual or balance changes after exercising. This can be scary and really put you off exercise. It is important to understand that exercise prescription is very different for someone living with MS. For example, we will make all cardiovascular exercise intervals, such as 30 seconds to 3 minutes, and avoid long endurance exercise. We also drop the repetitions down in strength training to 5 to 6 reps only and then increase the number of sets. This helps to manage the neuromuscular fatigue. What role does exercise play in managing MS?Exercise is powerful for protecting your brain health! Regular exercise, that gets you puffing out of breath and challenges your muscles has been shown to slow MS progression down, improve cognitive function, improve balance, strength, mobility and day to day function. Exercise is the biggest driver of remyelination and neuroplasticity, and these positive effects can occur throughout the disease journey. Exercise not only builds muscle strength, it also builds nervous system speed, allowing you to move easier. Although exercise is not going stop or cure MS, it will significantly improve an individual’s function and quality of life compared to not exercising. How do you tailor exercises for different levels of ability or fatigue?Everyone living with MS is individual, so their exercises need to be set to their impairments and their goals. This is why seeing a neuro physio is important to establish what is best for you personally. All stages of MS can positively benefit from exercise. Those who are mobilising with a wheelchair will need more access to equipment and a support person to help them complete the exercises. To help fatigue, firstly we work on hydration, 2 litres of water a day. Ensuring someone is taking a brain break in the middle of the day and then ensuring the exercise programme is set up specifically for MS. As mentioned above, all the exercises will be delivered in short intervals to ensure someone has adequate time to recover between each repetition or set. Sipping on ice cold water or wearing an ice vest also helps to manage fatigue when exercising. How do you work with other members of the health team?I work very closely with a range of different health professionals. For example, I work closely with occupational therapists, on hand therapy, equipment to assist independence and wheelchair prescriptions. With orthotists on foot drop splints and devices, with pelvic floor physios. I also work closely with psychologists, neurologists and urologists. Working together as a team means we can support an individual with MS in all areas of their life. What are some simple exercises or movement tips people can try at home?If you are walking, my top tips are practise standing on one leg. The goal is to be able to balance on one leg for 20 seconds. If your balance is less than 20 seconds you are more likely to fall. Walking is all about balancing on one leg while the other leg swings through. So, practicing this is vital. Another great exercise is standing up out of a chair without using your hands to help. I recommend working on trying to complete 100 stands a day throughout the day in sets of 5. If you need to use your hands to start with that’s okay. If you are in a wheelchair, the best thing you can do is work on getting your heart rate up. Try sitting forward in the wheelchair and then air boxing as fast as you can for 10 -15 seconds and repeat this 3 to 4 times. It can take several months of practice before you see changes, improving your nervous system takes time! Ensure the environment is safe to complete the exercises. What’s one key message about movement and MS?Some exercise is always better than no exercise! It can often be overwhelming how much exercise the research is recommending. I encourage people to remember something is always better than nothing. If you had planned to do a 30-minute programme at home but have run out of time, 5 minutes of the exercises is still beneficial. If you have missed the opportunity to complete the 15-minute walk or wheelchair push, then try to complete just a couple of minutes. Then on the days you have the time you are more likely to complete the full programme as you’ve been chipping away with the consistency. What helps you stay balanced or recharge outside of work?I’m a sports lover and a nature lover, so I combine these with trail running most weekends. I also play hockey and love time in the garden. When I need some quiet time you will find me sat at the sewing machine. Thank you Gilly for sharing your time and expert knowledge with us. Last Updated July 27, 2026