Ten Tips for Working with Neurological Clients

Program design for clients with central nervous system problems is pretty similar, regardless of what the problem is – stroke, multiple sclerosis, Parkinson’s disease, head injury, etc. Sure, there are differences between the disease processes and treatments, but as exercise professionals, there are certain things that hold true for all of them. Here are my top 10.

1. Information comes in to the body from the senses. If there is damage along the pathways that process that information, there can be sensory loss. You want to INCREASE sensory feedback in every way you can. That means adding more tactile feedback, but also increasing feedback through the other senses.

2. The feet and hands are the furthest body parts away from the brain. It is almost universally true that you will see issues there in neurological clients. That means exercising them is very important.

3. Balance problems are prevalent. Often, those balance problems will be easy enough to fix if they are caused by muscle imbalances. Other times, it’s because of poor proprioception or spasticity or rigidity limiting movement. You always need to work balance, but you also have to figure out why balance might be off.

4. “It’s always the glute med.” Ok, maybe that’s not true (except it probably is). When people have gait problems, always look to glute med weakness as a problem. Foot drop and other issues can make glute weakness a bigger problem, but to work on gait, you always have to work on the hip stabilizers.

5. Neuro clients tend to be hard-working. Have you worked with lazy clients? Annoying, isn’t it? When someone has lost the ability of their body to do basic things most people take for granted, they tend to be willing to work very hard to get them back. And they’re grateful when it works. Sure, setbacks are common, but determination is, too.

6. Add in upper back extension. On top of spasticity and rigidity causing tightness in the pecs, persons with neurological conditions often look down when walking for fear of tripping. Try to get your clients into the best posture possible for them.

7. Give praise. Praise actually helps learning “stick.” That’s part of neuroplasticity – or how the brain can change itself. It’s changes in the brain that make neurological recovery possible.

8. Know that muscle spasticity and rigidity and muscle tightness are not the same thing. You can’t stretch muscle spasticity away (and sometimes, you don’t want to). Range of motion exercises are always a good idea. Deep stretches sometimes aren’t.

9. If you’ve seen one case of neurological injury, you’ve seen one case. Everyone is different, with a different set of problems and a different set of solutions. Learning the basics will help you pull together a program that is specific to the individual’s needs (might I suggest trying one of our courses? We cover this).

10. Don’t be afraid to try. If something doesn’t work, try something else. I have personally been a guinea pig through a variety of exercise protocols, and I still am. I am a constant work in progress. The good news when something doesn’t work is that you can just try something else. 

Most of all, don’t be scared to work with clients with neurological conditions. We’re fantastic, and grossly underserved by the medical field. Much disability is preventable or correctable. And with the proper tools, you can make a huge difference.

In health,

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