A push may help stroke vic­tims with lin­ger­ing weak­ness

The Hamilton Spectator - - HEALTH - ERNIE SCHRAMAYR

I was for­tu­nate enough to at­tend a pro­fes­sional week­end sum­mit of the Med­i­cal Ex­er­cise Spe­cial­ists Mas­ter­mind group in Katy, Texas, last De­cem­ber. We met at the Med­i­cal Ex­er­cise Train­ing In­sti­tute for a week­end of hands-on learn­ing and skill de­vel­op­ment and bonded over suc­cess sto­ries, brain­stormed about chal­lenges and cel­e­brated with good ol’ Texas BBQ!

The high­light of the week­end was ob­serv­ing an hour-long train­ing ses­sion with a post­stroke client. He had gone as far as he could go in his phys­io­ther­apy program and was left with “func­tional deficits.” He was no longer con­sid­ered “acute,” but, was not ready for a reg­u­lar gym rou­tine. The deficits he was work­ing on in­cluded left leg, arm and hand weak­ness along with an over­all low level of func­tion. This past month I was able to watch an­other ses­sion with a sec­ond client re­cov­er­ing from stroke via Face­book Live. Isn’t tech­nol­ogy won­der­ful!

While much of what I saw could fit into a phys­io­ther­apy program, there are a few dis­tinct fea­tures of Med­i­cal Ex­er­cise that made the ses­sion dif­fer­ent. First of all, the client had gained as much strength as pos­si­ble dur­ing six months of phys­io­ther­apy and … in his own words; it was “time to be pushed harder” and the fo­cus of his program at the Med­i­cal Ex­er­cise Train­ing In­sti­tute was to re­store func­tion. Un­like a stan­dard gym program, his out­comes would not be mea­sured in weight lifted or in sets and reps, but, in his abil­ity to per­form ac­tiv­i­ties of daily liv­ing.

The Med­i­cal Ex­er­cise Spe­cial­ist di­vided the client’s needs into three parts: core sta­bil­ity, im­proved shoul­der func­tion and greater mus­cle re­cruit­ment of his left leg to im­prove gait.

From my ob­ser­va­tions, I was able to iden­tify three dis­tinct tech­niques that were used dur­ing the train­ing ses­sion.

1. When it comes to the move­ments we are try­ing to im­prove in stroke sur­vivors, it is im­por­tant to break them down into the small­est, most sim­ple com­po­nents pos­si­ble. For ex­am­ple, rais­ing the arm from the waist to reach­ing over­head can ini­tially be trained by work­ing from the waist to the ster­num. This is done to be able to fo­cus on in­di­vid­ual mus­cles through­out the en­tire range of mo­tion.

2. The client had flac­cid ro­ta­tor cuffs; mean­ing that they were not con­tract­ing and not sup­port­ing the shoul­der as it moved. This re­sulted in lim­ited range of mo­tion and pain. Our MES used a se­ries of tech­niques to iso­late the ro­ta­tor cuffs and force them to con­tract to the point of fa­tigue. Once he did this, there was de­creased pain and in­creased range of mo­tion in the client’s shoul­der. Called mus­cle “ac­ti­va­tion,” it meant that once the mus­cles got to the point of fa­tigue, they con­tin­ued to con­tract in a more ap­pro­pri­ate way. We saw a demon­stra­tion of this in the leg as the thigh mus­cles were re­peat­edly flexed to the point of ex­haus­tion. When this hap­pened, there was more sta­bil­ity around the knee and the gait was smoother and more re­li­able.

3. In stan­dard fit­ness train­ing, we count sets and rep­e­ti­tions be­fore rest­ing and do­ing an­other set. In Med­i­cal Ex­er­cise, the fo­cus is on ex­er­cise time, there­fore, reps and sets are ir­rel­e­vant. We saw a client per­form com­plex move­ment pat­terns, while sta­bi­liz­ing with his weaker leg, in a lim­ited range, for up to 10 min­utes at a time. The ac­tiv­ity ended when the client could no longer main­tain a proper move­ment pat­tern due to fa­tigue.

An im­por­tant take-home mes­sage from the ses­sion was that tim­ing in re­cov­ery is crit­i­cal. There is an ab­so­lute need for phys­io­ther­apy for some­one re­cov­er­ing from a stroke, but there is also a time when some­thing “more” is needed. With ex­per­tise, a plan and a bit of a push, there is a like­li­hood that im­prove­ment can con­tinue and func­tion can con­tinue to be re­stored be­yond what we may have ac­cepted in the past.

Ernie Schramayr, CPT, is a Med­i­cal Ex­er­cise Spe­cial­ist in Hamilton who helps his clients man­age med­i­cal con­di­tions with ex­er­cise. You can fol­low him at ernies­fit­ness­world.com. 905-741-7532 or ernies­fit­ness­world@gmail.com.

Newspapers in English

Newspapers from Canada

© PressReader. All rights reserved.