Neurological Conditions: who to see and what helps

Neurological Conditions · Kitchener, Waterloo & Cambridge

This page covers five neurological conditions that do not have a page of their own here: ALS, epilepsy, Huntington’s disease, muscular dystrophy and spinal muscular atrophy. Each is diagnosed and managed by a neurologist or a specialized clinic. What CARESPACE offers is support for movement, daily function and communication alongside that team, not treatment of the disease itself, and a physiotherapist is the usual first visit. Stroke, Parkinson’s, multiple sclerosis and brain injury have their own pages, linked below.

Find the page for your condition

• Stroke Rehab: recovery after blood flow to part of the brain has stopped and brain cells have been damaged.
• Traumatic Brain Injury: damage from an outside force such as a blow to the head. Concussion is the mild form and is covered separately.
• Parkinson’s Disease: slowness of movement, stiffness, tremor and balance problems.
• Multiple Sclerosis: the immune system attacks the covering of nerve fibres in the brain, spinal cord and optic nerves.
• Other conditions with their own pages: Peripheral Neuropathy, Bell’s Palsy, Cerebral Palsy, Functional Neurological Disorder, Trigeminal Neuralgia, Cervical Dystonia, Restless Leg Syndrome and Vertigo.

The five conditions on this page

• ALS (amyotrophic lateral sclerosis). The motor neurons in the brain and spinal cord degenerate, causing weakness, muscle wasting, twitching and stiffness. An estimated 3,000 Canadians live with it. It is progressive and life-limiting.
• Epilepsy. An ongoing tendency to have epileptic seizures, which result from abnormal electrical activity in the brain. It can begin at any age, and not every seizure involves shaking or loss of consciousness.
• Huntington’s disease. An inherited condition that affects movement, thinking and mood and gets worse over time.
• Muscular dystrophy. A rare genetic condition that causes muscle weakness that gets worse over time.
• Spinal muscular atrophy (SMA). A rare genetic condition that can cause muscle weakness. It is most often noticed in babies and toddlers but can start in teenagers and adults, and it does not affect intelligence.

How they are diagnosed

By physicians and specialized clinics. A single seizure does not automatically mean epilepsy, and that diagnosis is made by a health professional. Huntington’s disease, muscular dystrophy and most SMA are genetic, and genetic counselling is part of care for Huntington’s. None of them is diagnosed at CARESPACE.

When to call 911

Call 911 right away for the signs of a stroke. The Heart and Stroke Foundation of Canada teaches them as FAST: Face, is it drooping? Arms, can you raise both? Speech, is it slurred or jumbled? Time to call 911. Do not drive to the hospital: an ambulance will take you to the closest hospital that provides urgent stroke care.

Less common signs are vision changes (blurred or double vision), a sudden severe headache, numbness (usually on one side of the body) and problems with balance. Not everyone has every sign. Call 911 even when the signs last only a few minutes and then pass: that can be a transient ischemic attack (TIA, or mini-stroke), which is also a medical emergency. Note the exact time the signs began and tell the hospital staff. Nobody at CARESPACE can rule out a stroke.

A seizure. Stay with the person and time it. Move hard objects away, cushion their head, loosen anything tight at the neck, and roll them onto their side once it is safe. Do not hold them down, do not put anything in their mouth, and do not give food, drink or pills until they are fully alert and able to swallow safely. Epilepsy Ontario says to call 911 if:

• the seizure lasts more than five minutes
• another seizure starts before the person has fully recovered
• the person has difficulty breathing, is choking, or has trouble waking up afterward
• the seizure happens in water
• the person is injured or pregnant
• it is their first known seizure, or you do not know whether they have a seizure disorder
• the person has diabetes and loses consciousness
• a baby younger than six months has a seizure
• the person is not back to their usual state within five to ten minutes after the seizure stops
• the person asks for emergency help, or their seizure action plan says to call

After a blow to the head, use the emergency list on our Traumatic Brain Injury page. Nobody at CARESPACE can rule out an emergency.

What the evidence says, condition by condition

• ALS: exercise has not been shown to do harm. The Canadian best practice recommendations (2020) say people with ALS should be followed regularly by a multidisciplinary ALS clinic. Research on exercise in ALS has not demonstrated harm; a personalized program of strength and aerobic training should be encouraged for those able to take part, and regular stretching and range-of-motion work is recommended for spasticity and pain.
• ALS: nutrition matters. High-calorie diets can improve nutritional measures and possibly survival. Feeding tubes and breathing support are decisions for the ALS clinic.
• Huntington’s: the strongest case for physiotherapy. Clinical recommendations from 2020, drawing on 23 quantitative and 3 qualitative studies, give grade A evidence, which the authors call strong, for aerobic exercise, alone or with resistance training, to improve fitness and motor function, and for supervised gait training. Evidence that exercise improves balance is weak (grade B), and it did not reduce how often people fell.
• Muscular dystrophy: uncertain. A 2019 Cochrane review of 14 trials (428 people with several different muscle diseases) concluded that the evidence on strength and aerobic training remains uncertain. Strength training alone may have little or no effect. Most trials reported no harm beyond muscle soreness or joint complaints, but confidence in that is limited.
• SMA: medicines first, with physiotherapy alongside. UK health guidance describes medicines that target the altered gene as the main treatment, with physiotherapy, exercises and stretches to help maintain strength and stop joints becoming stiff.
• Epilepsy: treatment is medical. Anti-seizure medicines help many people control their seizures, and they should not be stopped or changed without the prescriber. The UK guideline says to recognise that a diagnosis can significantly affect mental health, and to offer assessment and mental health support for people with epilepsy and depression. None of the sources we read gives exercise or hands-on therapy a role in controlling seizures.

What your specialist team provides

The following sit with your specialist team and are not provided at CARESPACE: disease-specific medicines, including the gene-targeting medicines for SMA, steroids for Duchenne muscular dystrophy and anti-seizure medicines; breathing support and feeding tubes; heart care and surgery in muscular dystrophy; and genetic counselling.

How each CARESPACE service can help

Physiotherapy

A physiotherapist can assess movement, strength and walking and build a program suited to the condition: stretching and range-of-motion work for stiffness in ALS, aerobic exercise and supervised gait training in Huntington’s, exercises and stretches to maintain strength and stop joints becoming stiff in SMA, and help with movement and pain in muscular dystrophy, where the case for strengthening is uncertain. These conditions call for specific experience, so ask when you book whether a physiotherapist who works with your condition is available.

See our physiotherapy team →

Occupational Therapy

Occupational therapy helps with day-to-day activities in Huntington’s disease and muscular dystrophy, and daily living is one of the areas an ALS team covers. An occupational therapist can work out other ways of doing tasks that have become difficult, including mobility equipment and adaptations at home.

See our occupational therapy team →

Speech-Language Pathology

Speech and language therapy is part of care for Huntington’s disease. In ALS, when speech becomes hard to understand, the options run from letter and picture boards to speech-generating and eye-gaze devices. A speech-language pathologist can assess communication and help choose among them. Swallowing changes in any of these conditions should go to your specialist team first.

See our speech-language pathology team →

Kinesiology

In Huntington’s disease, where the evidence for regular exercise is clearest, a kinesiologist can supervise aerobic and resistance training and keep it going. In ALS and muscular dystrophy the program is set with your specialist team’s agreement.

See our kinesiology team →

Counselling & Psychotherapy

Depression and anxiety impair quality of life in ALS, a diagnosis of epilepsy can leave people feeling excluded and stigmatised, and talking therapies such as cognitive behavioural therapy are among the treatments for depression in Huntington’s disease. Counselling at CARESPACE is provided by Registered Psychotherapists and Registered Social Workers, and includes cognitive behavioural therapy. Caregivers are under strain too, and counselling is open to them as well.

See our counselling team →

Nutrition

In ALS and SMA, the nutrition plan and anything to do with swallowing or feeding are set by your specialist team: in ALS that plan aims to keep calories up, and in SMA diet changes are one way swallowing problems are managed. A Registered Dietitian here can help you carry that plan out day to day, and does not replace it.

See our nutrition team →

Other services people ask about

Massage therapy: none of the sources we read for these five conditions makes a recommendation on it, for or against.

Where most people start

For the four movement conditions, a physiotherapist, who assesses and begins treatment at the first visit. For epilepsy, where the support we offer is about mood and living with the diagnosis, the first visit is with a counsellor.

How your team works together

The specialized clinic is the centre of care, most of all in ALS. Anything you do at CARESPACE should follow what that clinic has advised, and the clinic should know you are doing it.

Browse by service: physiotherapists, occupational therapists, speech-language pathologists, kinesiologists, counsellors and registered dietitians.

What to expect at your first visit

1. From your specialist clinic. Bring your diagnosis, a list of your medicines, any letters or exercise advice the clinic has given you, and the aids or braces you use.
2. What the clinic has advised. You may be asked what has changed recently, what you have been told to do or avoid, and what you most want to keep doing. If you have seizures, it helps to say what they look like and what your seizure action plan says.
3. A physical check. For a physiotherapy visit, that can cover strength, range of motion, walking and balance.
4. Next steps. You leave with a plan; with a physiotherapist, treatment also begins at this visit.

What you can do at home

• Keep up the stretching or exercise program you have been given.
• Take prescribed medicines as directed; do not stop or change anti-seizure medicine on your own.
• Family and caregivers: look after your own health too. The ALS recommendations ask clinicians to watch caregivers’ physical and emotional well-being.

Outlook

ALS, Huntington’s disease and muscular dystrophy get worse over time. In SMA the outlook depends on the type and on how well treatment works. Many people with epilepsy control their seizures with medicine. Across all five, the aim of the support described here is to keep you moving, communicating and doing what matters to you for as long as possible.

Support for neurological conditions in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Kinesiology in Kitchener, Counselling in Kitchener and Nutrition in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Kinesiology in Waterloo, Counselling in Waterloo and Nutrition in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge, Counselling in Cambridge and Nutrition in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is exercise safe with ALS?

Research has not shown that it does harm, and a personalized program of strength and aerobic training is encouraged for people able to take part. Set it up with your ALS clinic’s agreement.

Should someone with muscular dystrophy do strength training?

The research does not settle it: little or no effect from strength training alone, and no clear sign of harm. Ask your neuromuscular clinic what is right for your type.

Can CARESPACE treat epilepsy?

No. Epilepsy is treated medically. What we can offer is counselling for the effect on mood and daily life, and care for other problems with a practitioner who knows about your seizures.

Do you see children with muscular dystrophy or SMA?

Ask when you book. Our Central Reception Team can tell you which practitioners see children.

Is this support available in Kitchener?

CARESPACE offers Physiotherapy in Kitchener, Kinesiology in Kitchener, Counselling in Kitchener and Nutrition in Kitchener. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Shoesmith C, et al. Canadian best practice recommendations for the management of amyotrophic lateral sclerosis. CMAJ, 2020;192(46):E1453–E1468.
• Quinn L, Kegelmeyer D, Kloos A, Rao AK, Busse M, Fritz NE. Clinical recommendations to guide physical therapy practice for Huntington disease. Neurology, 2020;94(5):217–228.
• Voet NBM, van der Kooi EL, van Engelen BGM, Geurts ACH. Strength training and aerobic exercise training for muscle disease. Cochrane Database of Systematic Reviews, 2019.
• Epilepsy Ontario. Seizure first aid and What is epilepsy?
• National Institute for Health and Care Excellence. Epilepsies in children, young people and adults (NG217), section 9. Last reviewed November 2025.
• NHS. Huntington’s disease: treatment (reviewed March 2025), Muscular dystrophy: treatment (reviewed June 2025), Spinal muscular atrophy and its treatment (reviewed August 2024).
• Heart and Stroke Foundation of Canada. Signs of stroke, FAST signs of stroke: are there other signs?, the FAST poster and What is stroke?
• For the one-line descriptions of other pages: Brain Injury Canada, Traumatic brain injury; Parkinson Canada, Symptoms; MS Canada, What is MS?

Related conditions

Stroke Rehab
Parkinson’s Disease
Multiple Sclerosis
Traumatic Brain Injury

Ready to book?

Book online with a physiotherapist, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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