The Program Framework

Sep 04, 2015
Tagged with: The Program Framework

Kerry and I began training together about nine months ago. As a Nursing student and Trainer, I have had some clinical experience with Cerebral Palsy (CP), but prior to working with Kerry, I had never worked with a person with CP in functional movement training. Kerry’s goal to walk without assistive devices full-time was a big undertaking and a bit daunting.

Kerry insisted that I look beyond the medical and clinical teachings that I was accustomed to and instead look at more creative or in her words “innovative” ways of training. I spent our early sessions observing how Kerry reacted to different forms of training such as: sled pushing, passive range of motion (PROM) stretching, balancing activities and body weight exercises.

I learned what I could about Kerry’s condition and how her limbs functioned during rigorous activity. I observed that Kerry’s range of motion (ROM) would improve after an initial strenuous activity and then PROM stretches. These gains translated to improved gait during walking. Kerry’s muscles would loosen and relax from exertion. We also learned that over fatiguing her body had negative effects.

In session, I ask Kerry throughout the sequence of a movement, where she is feeling stimulus in her body. I ask how that stimulus is affecting her central nervous system (CNS). Our conversations are a mixture of technical information, terminology, and Kerry’s sensory descriptions.

I need to know what she feels and experiences doing the workout or sequences of movement. The success of some exercises requires a constant level of feedback from Kerry to help me make needed changes based on her personal observations.

Our training has revisited some past success. Kerry and I are working outside, specifically practicing walking on uneven surfaces. We are also working on ascending small hills without the use of her assistive devices. We are practicing abrupt and gradual stops without the use of devices.

During the “abrupt stop” and “gradual stop” drills, I ask Kerry to maintain a tall posture and control her stride length. We commonly perform the drills at the start of our hour- long workouts, so that I can observe Kerry in her most optimal, non-fatigued state.

Passive stretching follows, with the most emphasis placed on gaining mobility in the hamstring, calves and glutes.

During stretching, Kerry provides feedback about her CNS response in relation to the intensity of stretch. If a muscle group is stretched too vigorously a CNS response, which Kerry calls the “burn” is elicited. When this “burn” sensation kicks in, it can be a sign that we have gone too far, and Kerry needs to pause and let her CNS “settle” before we can resume.

After stretching, we move on to patterning counter movements, lateral movement, and back stepping. During these drills Kerry will gain her most upright position and with my assistance will pattern specific movements with her lower limbs.

Most recently we have been practicing the back step. This has proved to be challenging because of the spastic nature of Kerry’s hamstrings. The drills we are working on are building base skills that will allow Kerry to move more optimally.

The work that Kerry and I have accomplished has fostered a creative spirit and a level of communication that my professional practice was lacking. Our training sessions have challenged me and I have grown not only as a trainer but also as a future nurse. Working with Kerry has expanded my knowledge about working with someone with Cerebral Palsy. I have increased my use of what Kerry calls “interdisciplinary collaboration”, communication, and have actively applied person-centered care principles in the work and progression toward Kerry’s goals.


**Kerry’s Co-Author Nicholas Elia is a Certified Personal Trainer with a Bachelor Science in Dietetics from SUNY Oneonta.


Author: Kerry

  • bobl07

    It is so great to have the perspective a healthcare professional that sees the benefit of working with people with disabilities. Keep up the great work. This is winning team.