Going for A Walk-Part 5

Dec 01, 2010
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Adaptability-

When Kerry is inactive or is overstimulated, her body becomes less pliable, and she loses ground much faster than people that do not have a physiologic hurdle. When the answers to my basic evaluation questions are not favorable, my goals are to assist Kerry to:

1. Manage the presenting difficulty;

2. Ease, to the extent we can, spasticity and other affects of CP; and

3. Implement strategies to re-establish mobility and function.

Once in a while this means setting the big goals slightly aside, making adjustments, and adapting routines to re-establish a base of function so that we can return our attention to achieving her goals.

I use several techniques to work with Kerry. Some are simply asking her to move in ways she is not used to, but others are slightly more complicated. We use elements of neuromotor training and sensory motor techniques, including hands on stimulation. The intent is to reactivate the neuro-pathways. I use gentle squeezing, pressing, or tapping on certain areas of her body to promote a stimulus and response that I want to reach her brain.

James House III and Kerry Wiley working together. Photo Credit to Ms. Nancy Andrews.

If Kerry tries to move some part of her body and it won’t work or if I am trying to manually move it and am getting a negative result, I may have to have her try the same movement on the opposite side or stimulate a completely different limb. Alternatively, I may completely change instructions to elicit the same requested response. Basically, I will misdirect her to achieve what we want by accident and then tell her what happened so that she can use that knowledge to pattern the movement.

I also use several adaptive techniques to ensure that physical activity and peak performance are achieved. Sometimes I will have Kerry box from a seated position or move around with her hands and arms in positions where they are actively stimulated in a way where she cannot use them at all in efforts to support balance and stability (e.g. walking, lifting her arms straight up overhead).

Monitoring-

With all that we do in session, we also have to monitor Kerry’s training recovery rate, so that we limit conditions which can affect Kerry’s mobility such as delayed onset muscle soreness, muscle cramps, or joint inflammation. These conditions can have a significant effect on Kerry’s general functioning. Kerry and I meet on Sundays, Tuesdays, and Fridays. I check to see how Kerry functioned from the previous workout. I monitor the degrees of soreness, fatigue, rigidity, and stiffness she experiences. Kerry reports her experiences of muscle soreness using a number scale. A report of 0 to 3 means minor soreness. A report of 3-6 means moderate soreness, and a report of 7-10 means severe soreness. I gauge Kerry’s thresholds through her facial expressions, breakdowns in posture, her general form and technique, and constant verbal communication with her.

We have to push hard for progression in Kerry’s walking program as disability is not static. Progression is incremental and goals are constantly evolving based upon the presenting needs.

Conclusions-

We have touched upon the themes of partnership and adaptability, communication, and client and trainer roles. Since disability is constant, dynamic, and changing, it requires us to have a variety of tools to share information, communicate, and monitor the effects of CP that are both short-term and long-term.

In our roles of trainer and client, we have a partnership in an organized program that is built on a solid foundation. Exercise itself is a small portion of all the work required to meet a goal like Kerry’s. For any athlete or fitness enthusiast to achieve their goals, they need an intense and tenacious work ethic. The athlete comes in with the intent to follow through on the designed program.

For a person with or without a disability who wants to increase physical activity and improve their overall well being, like Kerry, work and determination will take them to their maximum capabilities. For Kerry, the process to the end result of walking without devices is about learning, expanding a set of options, and expanding available choices. Kerry is choosing where she will go, seeks the tools and supports she needs to reach her goals, and will not be defined by “can’t” or what has been.

This is the last post in the series “Going for a Walk.” Be on the look out for more articles from Kerry regarding her experiences in the future. Special thanks to James House III, Kerry’s personal trainer for his contribution to this piece.

James R. House, III, earned a Bachelor of Science degree from Palm Beach Atlantic University in Physical Education with concentrations in Exercise Science and Athletic Training. He has over 12 years experience  in the sports and fitness field helping people change their lives through guided support and accountability.


Author: Kerry