I have a recently obtained a client with spina bifida. Do you have any suggestions about how to train someone with this condition?
Spina Bifida (open spine) comes in many different forms. The different types vary dependent on how much of the spinal cord, the spinal cord cover (meninges) and skin cover are involved. These degrees of spina bifida will influence how many problems there might be associated with the nervous system. Hydrocephalic (increased fluid levels in the head) conditions are also common with this condition.
Dealing with special populations takes extra thinking time when designing your workouts. One of the first issues to deal with is to find out if the person can or should train? Getting the health care team involved is essential. Let them know what you plan on doing for training. Feedback may be helpful to everyone, because data on exercise and spina bifida is difficult to find.
I know very little about your client. Sometimes, a person with spina bifida does not age well. I do not know the age of your client, the level of spine involvement, if your client is male or female and if they have any neural damage. So to help you design a training program, you must think about what part of the spine is involved and work from there.
In general, spina bifida and other spine disturbances can have sensory loss or impairment, motor loss and impairment and some sphincter control issues. This may influence how aggressive a training program you place your client on (i.e., resistance training, aerobic only or swimming pool work). Below are a few things to think about while working with your client and where in the spine the problem occurs.
- Cervical Spine - This area of the spine is unlikely to have the closure problems spina bifida produces. However, if your client does have involvement here, then neck stiffness is likely, respiratory problems can occur, nystagmus, shoulder and arm pain, weakness, motor control issues and possibly increased reflexes are likely.
- Thoracic Spine - This area of the spine is more likely to have an involved site of the spine. Sensory loss, paralysis, pain in the chest and back, muscle atrophy, foot drop, weak leg muscles and bowel and bladder issues may occur.
- Lumbosacral Area - This is the most likely area of concern. It is the most common area of involvement from spina bifida. It has the potential to have all of the above mentioned items and low back pain and a decreased or absent ankle to knee reflexes, making balance an issue.
It is difficult to suggest exercises for special populations without real specific information. Your keen eye and reason is the key to safe and progressive exercise. I would suggest an in depth health history of your client and contact the health care people to find out of there may be any contraindications. Then, if able, start on balance work. Search the PTN Exercise Library for exercises performed on a stability ball. Pick those exercises that do not place direct pressure on the part of the spine that was involved. Also, try some cable work while the person is standing. This may enhance their balance feedback loop and work the trunk muscles. From there, your experience and the PTN Exercise Library will help you enhance the training program gradually. Good luck.