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,
Mariska
Neurological Medications and Their Impact on Exercise
Most neurological clients are on multiple medications, both to manage symptoms and in the cases of chronic diseases such as MS and Parkinson’s disease, to slow disease progression.
What does that mean for you as a teacher?
First, you need to understand that many of the medications for neurological symptoms cause… wait for it… neurological symptoms. That’s right – dizziness, confusion, depression, tremors, and more can all be symptoms of these drugs. So, knowing someone’s medications and the side effect profile for them is important.
In terms of some interesting specifics, anti-spasticity medications such as Baclofen and Zanaflex are spinal muscle relaxers which relax all of the muscles in the body – those that are in spasm and those that are not. They causes dizziness, similar to having had a couple of drinks. Plus, muscles that are in spasm appear to be toned when they are actually quite weak. When someone takes a spinal muscle relaxer, you will be able to see the true strength (or rather, weakness) of the muscle you otherwise might confuse as being stronger. That means you WANT them to be taking the medication before you work with them so you are seeing how strong they actually are.
Some clients may be on a Baclofen pump, which delivers the medication to the intrathecal space directly to the spinal cord. This enables a lower dose of the medication, but it also has an internal pump that limits flexion and rotation.
Steroids, which are commonly used for MS relapses and other inflammatory neurological diseases, are notorious for causing bone weakness, including osteopenia and osteoporosis. So, if you’re working with a client with a history of steroid use, you will want to know if he or she has had a bone density test, and adjust your workout accordingly, following osteoporosis protocols as needed.
Finally, many of the MS drugs are injectables, and a common side effect is injection site reaction, causing painful welts and bruises. Putting pressure on these spots (often the outer hips) can be quite uncomfortable. So you would have to modify side lying positions.
My best advice? Get a run down of your client’s condition AND their medications, and do some research. Make a plan around both their condition and the medications that accompany it.
In health,
Mariska
The Sex, Drugs, and Rock & Roll of Neurotransmitters (and the Main Issue in Parkinson’s Disease)
I have a favorite neurotransmitter, and chances are, it’s your favorite, too. Neurotransmitters are brain chemicals that relay signals between nerve cells, and dopamine, in addition to (importantly) regulating movement, activates the reward and pleasure pathways in the brain. Party!!
Let’s go on a dopamine reward journey similar to one I’m sure you’ve taken. You log into Facebook to see what your friends have been doing. Scroll down and see a Buzzfeed video about puppies try to catch bubbles. Adorable. That reminds you of the bubbles you used to play with as a child. Do they still make them? A quick google search says yes! Actually, here’s a Pinterest article on how you can make your own bubble wands with pipe cleaners! You just need to get some pipe cleaners. Surely, the sell them on Amazon, so you head over there to pick some up, and realize that the book by Claire North you wanted to read is still in your basket. What was the other book she wrote? Google her up to find out… You know who would be GREAT at playing the main character in a movie? Tom Hardy. Hmmmm…. What was the last movie he was in? IMDB would know.
Where did the last two hours of your life go? They disappeared in a natural dopamine rush. You see, dopamine motivates us, and it gets boosted when you follow information – looking for new things at every turn. It used to be necessary when we lived as hunter gatherers.
In addition to activating the pleasure centers of the brain, dopamine is crucial for movement. In Parkinson’s diseases (there are several types), dopamine production is reduced, and movement is impaired. Without enough dopamine, people can literally become frozen, a condition called bradykinesia.
The good news for Parkinson’s sufferers is that it is possible to boost dopamine naturally, extending the time that a person may remain medication-free, and reducing the amount of medication a person would need to take. One of the best ways to do that? Exercise. Yep, exercise is a natural way to boost the production of dopamine. Adding novelty to exercise boosts it even more, and more dopamine can lead to greater neuroplasticity – the ability of the brain to change (often very positively for persons with neurological disease).
Instead of getting sucked into an internet vortex, might I suggest more exercise? It’s the healthiest way to boost dopamine and feel great.
In health,
Mariska