QUESTION:
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 & has about 40-50% mobility on his left side. My aim for the first 4 weeks is to include pin loaded machines, bike & rower (has a higher than normal seat). Any other suggestions?

Train the Movement, Not the Muscle!:
The key to rehabilitating any client is an understanding of the/their 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 in lets 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 3 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 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 or authors, 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). As well as 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. 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.

1. You need to assess your client both physically, nutritionally and 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. As well, knowing possibly within his life and diet could have contributed to it, will help facilitate recovery, as well as it not coming back. We are what we eat! So if one is eating a diet high in caffeine, refined carbohydrates, lots of artificial sweeteners, and alcohol, well that is what the body uses to function. Crap in = 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

2. 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 as well hold a 5 day Dynamic Neuromuscular Stabilization course here in the states in LA 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 1 years of age (when most should walk). Another good book is called Wisdom of the Body Moving.

3. 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 300-500 poor movement patterns to create a faulty motor engram and takes 3500-5000 good quality movements to unwind it.” Train the software, not the hardware!

4. 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.

5. 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 R-L brain interaction. This will ensure that you 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, as well as being able to handle extrinsic and intrinsic loads.

6. You need to assess your client’s life. What are their biomotor abilities required for their life? Ex. Strength, endurance, skill, agility, coordination, flexibility, balance, power and speed.

7. Have you assessed your client’s movement patterns or what Paul Chek calls Primal Patterns? This will give you an answer of their skill level, compensations as well as how much “chunking down” you have to do---giving you a baseline of where to start their program.

8. 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.

9. 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 possible treatments by someone certified in Brain Gym.

10. When it comes to any brain rehabilitation, one of the most important paths that I feel most miss is R to L brained interaction. He has L side paralysis, so his R brain is affected. Our R 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 their brain.

Joshua Rubin, OTR/L