I am about to commence training a client who suffered a brain tumor some years ago. He was operated on and recently has been given the “all clear.” He is 58 years of age and has about 40 to 50 percent mobility on his left side. My aim for the first four weeks is to include pin loaded machines, bike and rower (has a higher than normal seat). Any other suggestions?
The key to rehabilitating any client is an understanding of his body. As Jeff Okeson states in his book Management of TM Disorders and Occlusion, “You cannot successfully treat dysfunction unless you know dysfunction” and “Nothing is more fundamental when treating clients than knowing anatomy.” I think this is important within our health care field. If you don’t know anatomy, you cannot treat dysfunction and progress it to function.
Why am I saying this? Well, since you wrote to us, let’s use your question as a quick example. You mention using machines, a bike and a rower. As Bobath states:
“The body knows nothing of muscles, only of movement. During the constant adaptive changes that must take place in order to preserve our equilibrium while moving, the body is constantly activating an array of muscles in patterns of coordination in which muscles lose their identity” (Karl Bobath).”
So if you understand that the body only knows movements, stores engrams, goes through the three stages of learning (cognitive, associative and autonomy: Read Motor Learning and Performance by Schmidt), follows the S.A.I.D. Principle (Specific Adaptations to Imposed Demands), and if you know that ALL movements are stored at the spinal cord level, than using machines will not make sense. If you research any of the above topics, you will see that muscles are dumb. They do not have memory. It is the brain, spinal cord and engrams that create movement. If you isolate the body, you will train it to move in isolation (S.A.I.D. Principle) and vice versa. But if you understand that when you move through our multidimensional environment, you are using many inner unit and outer unit systems in integration to produce movement, reduce movement and to stabilize joints, then what machine helps you with that? None of them. They do it for you. So the end result is decreased performance, increased injury and lack of progress.
When it comes to training anyone with muscle paralysis, here are some things that you need to look at. I am going to give you a generalized direction, but since this is such a complex case, you need to do more research and choose the path(s) that best fit his needs.
- You need to assess your client both physically, nutritionally, mentally and emotionally. If you don’t know how, refer out! If you don’t assess, you are just guessing! Your goal is to be the coach and to create the team that is needed to help this client. Exercise is one of the pieces, but there are many more. Paralysis can arise from many areas of the R side of his brain, from the level of the atlas, brainstem, spinal cord, etc. This is where assessing comes into play. Also, knowing possibly what within his life and diet could have contributed to it will help facilitate recovery. We are what we eat! So if one is eating a diet high in caffeine, refined carbohydrates, lots of artificial sweeteners and alcohol, that is what the body uses to function. Crap in equals crap out! A couple of great books to read are:
- The Metabolic Typing Diet by Bill Wolcott
- How to Eat, Move and Be Health by Paul Chek
- Nutrition and Physical Degeneration by Price Pottenger
- Any book by Dianna Schwarzbien
- A couple of the pioneers in training clients with such issues, as well as rehabbing any neurological issue, are Janda, Lewitt and Voijtr. Their books are hard to find, and their courses are in Prague. They also hold a five day Dynamic Neuromuscular Stabilization course in Los Angeles this May and June. In short term, it teaches you how to assess, treat and progress someone through developmental/neurodevelopmental training. This means from the inside out OR how we develop neuron-developmentally as a child. When someone is injured, you can assess this and regress the movements back to that stage in order to work them through breathing quality movements, navel radiation, homologous, homolateral, contralateral and gait pattern specific movements. This is basically assessing movement patterns from in utero, up until one year of age (when most should walk). Another good book is called Wisdom of the Body Moving.
- You need to understand and assess how we move. We store motor engrams: "A motor engram is a series of processes or commands associated with any cognitive goal or task. Once automatic, an engram is expressed at the subconscious level.” What does this mean? We respond to external and internal stimuli, identify it cognitively, pick a response selection and then pick a response programming. This is done in order to produce fluent movements. As Schmidt states in Motor Learning and Performance, “It takes 300 to 500 poor movement patterns to create a faulty motor engram and takes 3500 to 5000 good quality movements to unwind it.” Train the software, not the hardware!
- You need to assess their Reflex Profile: tilting and righting reactions. This needs to be addressed within their exercise program. With a client such as this, starting with righting and then down the line integrating tilting will benefit both parts of his brain.
- You need to assess static and dynamic posture, as both are part of movement. As well, both are accessed from different parts of the brain. So assessing them and integrating them into his program will facilitate right/left brain interaction. This will ensure that your client will be able to balance his COG (of each joint) over its base of support, enable synergistic force couple relationships both static and dynamic and be able to handle extrinsic and intrinsic loads.
- You need to assess your client’s life. What are his biomotor abilities required for their life (i.e., strength, endurance, skill, agility, coordination, flexibility, balance, power and speed)?
- Have you assessed your client’s movement patterns, or what Paul Chek calls Primal Patterns? This will give you an answer to his skill level, any compensations he has as well as how much “chunking down” you have to do, giving you a baseline of where to start his program.
- I would have some Neuroprotection labs done by BioHealth Diagnostics and/or Metametrix. There can be a lot of issues regarding functional physiology and neurological diseases, such as elevated homocysteine levels, lack of B vitamins, altered lipid metabolism and increased inflammation, altered GI environment leading to systemic dysfunction, detoxification issues leading to widespread toxicity, etc. Another great resource for this is a home study course by the Institute of Functional Medicine called Neuroprotection: A Functional Medicine Approach for Common and Uncommon Neurological Syndromes.
- Other things that are of great benefit are regular acupuncture treatments, soft tissue treatments, getting his atlas assessed and adjusted by a NUCCA Chiropractor, possible treatments for Neuro-optometric Rehabilitation and treatments by someone certified in Brain Gym.
- When it comes to any brain rehabilitation, one of the most important paths that I feel most miss is right to left brained interaction. He has left side paralysis, so his right brain is affected. Our right brain is our more creative, female, yin and expressive part of our brain. Working with someone who can do art therapy, creative expression therapy, Qi gong, etc will help to develop this part of your client’s brain.
I hope all of this helps to start you off in the right direction.
- Bobath, K. (1980). A Neurophysiological Basis for the Treatment of Cerebral Palsy. Clinics in Developmental Medicine No. 75. (2nd ed.) of CDM 23. The Motor Deficit in Patients with Cerebral Palsy, Spastics International Medical Publications, 1980, London, William Heinemann Medical Books Ltd. Philadelphia: J.B Lippincott Co.
- Charles University of Prague 2008: Dynamic Neuromuscular Stabilization According to Kolar (www.rehabps.com/rehabilitation/home.html)
- Chek, Paul. You Are What You Eat, (Audio Series). Vista, CA: A C.H.E.K Institute Production, 2002.
- Chek, Paul. How to Eat, Move and Be Healthy! Vista, CA: A C.H.E.K Institute Publication 2004.
- Chek, Paul, Oliver, Clifford, Remsen, Julie. CHEK Holistic Lifestyle Coaching
Certification. Levels 1, 2 and 3. Vista, CA: A C.H.E.K Institute Publication, 2002.
- Grimsby, Ola. Clinical and Scientific Rational for Modern Manual Therapy. The Ola Grimsby Institute, 1998
- Hartley, Linda. Wisdom of the Body Moving. North Atlantic Books, 1995.
- Janda, V. (1999) Function of Muscles and Musculoskeletal Pain Syndromes. San Diego, CA
- Okeson, Jeffrey P., Mosby Inc. 2008: Management of Tempomandibular Disorders and Occlusion, Edition 6
- Schmidt, Richard A., Motor Learning and Performance. Human Kinetics, 1991