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3.

Pilates

Little Miss Sunshine Healing is committed to making Pilates accessible to all; no matter health, size or ability. Our owner and founder is a stroke survivor who gets it. With this in mind: we made a little corner of the internet that caters to fellow colleagues in Pilates and beyond to help showcase what a stroke is, and how things can be easily modified to include stroke patients within this setting.

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There are two types of strokes that are the most common. The first type is an ischemic stroke. The second is hemorrhagic, which means an artery ruptured/burst.

So, What Is a Stroke Anyway?

For Ischemic Strokes:

This means that an artery got blocked (either from a blood clot or a stenosis). A stenosis means that the artery collapsed and blood flow was stopped. The damage can differ.

 

Treatment for Ischemic Strokes:

With an ischemic stroke a strong intravenous medicine can be administered to help thin the blood in an attempt to dissolve the clot and thin out the blood to get it to all parts of the brain, even the damaged areas. 

The medicine is called "Tissue Plasminogen Activator" , commonly referred to as a tPA in everyday healthcare jargon.

Generally there is a small window of time this medicine can be administered, due to this, it can only be administered to a patient that has an exact stroke start time information. If this information is missing, a tPA doesn't get administered.

Depending on where the clot is, it is possible to remove it through a thrombectomy, which is an invasive procedure to remove the clot.

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For Hemorrhagic strokes:

The medicine  called "Tissue Plasminogen Activator" , commonly referred to as a tPA in everyday healthcare jargon cannot be administered for a hemorrhagic stroke as the more blood that touches brain tissue, the more damage is done; we don't want the blood to get thinner  and spread in this instance. 

 

Treatment for Hemorrhagic Strokes:

The treatment for a hemorrhagic stroke is significantly different from an ischemic stroke. A hemorrhagic stroke requires physical intervention through brain surgery. There are a couple options on how to treat a hemorrhagic stroke. One is “clipping” it which means the neurosurgical team goes in and “clips” the artery to stop the bleeding, they can also drain the areas with excess blood in hopes that more brain damage can be avoided. The most minimal form of intervention/treatment is drilling Burr Holes into the brain, which is a less invasive way to release pressure on the brain. 

In extreme cases a hemorrhagic stroke patient  may require a craniectomy, where a piece of the skull is removed, to allow the brain to heal itself and reduce the swelling. In severe cases, this may mean the patient is in a medically induced coma. If a patient is stable enough to not need a coma, then they wear a special helmet to protect the brain. 

Side Effects of Having a Stroke

The most well known side effects of a stroke are hemiplegia (paralysis of half the body). This side effect is part of the way to quickly identify when a non brain stem stroke is occurring. However, depending on where the stroke occurred, the damage can vary. It is also important to remember that the same injury can present differently in different people as each person's brain develops differently. 

 

In some instances, a stroke can leave limbs unaffected, but can affect balance, dizziness and vertigo, such as a brain stem stroke. Ultimately, the deficits left by a stroke depend on where in the brain the stroke occurred. The side effects are not a one-size fits all. They may have similarities, but they are not guaranteed for each person. After all, all of our brains develop differently. 

What to Look For->

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Due to hemiplegia or weakness on the affected side, the client may be over compensating in other areas of the body, which should be as discouraged as possible. When necessary and only with consent, give your client the tactile cue they require to fix it.

 

  • For lower limbs it's important to pay attention for any hip hiking, foot drop and knee valgus.

  • For upper limbs, it's important to pay attention to any shoulder subluxation, wrist flexion and internal rotation of the arm, compensation thru shoulder elevation and compensation with the trunk for external arm rotation.

  • It is also extremely important to keep in mind that after a stroke, the affected side experiences heightened amounts of tone.

  • Tone is a non controlled spinal cord reflex and can be very painful.

  • The common misconception about tone is that because the muscle is consistently contracting, it must be strong. The muscles on the affected side are all extremely weak, so they can't fight the body's default setting of tone.

  • Tone can be lessened through stretching warmth and weight baring where applicable and safe.

    • In extreme cases, the client may receive Botox treatment to decrease tone, this essentially paralyzes the muscles experiencing the tone, so that the contraindicated muscles can work. Common areas of Botox injections in stroke patients are, the plantar flexors, the wrist pronators and the pectoralis. Keep this in mind when building a flow for the client who uses Botox.

Pilates to the Rescue:

After the brain experiences a trauma, it can lose certain abilities. A way to regain those abilities is putting demands on the brain in an attempt to direct neurons to pick up that responsibility. The more demand a patient has, the  more likely they are to develop another area in the brain to perform this assignment instead of the now damaged area. It was once believed that once a part of the brain experiences trauma, it's completely dead and useless; however recent research has debunked this belief. Dr. Gary Steinberg of Stanford University has been conducting research on the brain and the use of stem cells. He has been injecting stem cells into the damaged areas of the brains of stroke patients. With time, he has found that the patient was able to regain whatever ability was lost due to the trauma of the stroke. It may not have always been a full recovery, but as a stroke survivor, I can attest that any small improvement after a stroke has millions of ripple effects. 

Things to Keep in Your Pocket:

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Depending on what point your client is in their stroke rehabilitation journey, is what the programming will be. As each person’s injuries and subsequently their healing vary; what might work for one, may not work for another. When in doubt, remember that first and foremost the goal of stroke rehabilitation is to reintroduce the body and brain's line of communication. If your client is still at this point; then you want to assist them simply with the motion, without any weights or resistance. If we introduce weights or resistance too early, we risk injuring our client and thus delaying their rehabilitation journey. 

 

Another thing to keep in mind is how the brain works in cross- brain communication. This is essential for choosing unilateral versus bilateral movements. Unilateral movements can be helpful for reminding the brain that there is a limb there that needs to work. Bilateral movements can be helpful with supporting the injured side thru the non injured side. The brain uses cross brain communication to communicate through the corpus callosum to get each hemisphere talking with the other. This creates a situation in which the non injured side is assisting the injured side to communicate the right motor commands to the limb. With time and repetition, the injured side of the brain will be able to give these motor commands through isolated, unilateral movement. With stroke rehabilitation, the most important thing to remember with exercises is what can be applied to functional movement. The better and safer a stroke survivor client can independently function, the better their quality of living will mean the more likely they'll get back to living their life on their terms.

Pilates in Motion:

1 / Lower Limbs

  • IMPORTANT: always start with bilateral movement for cross-brain communication; once client is ready, proceed accordingly to unilateral movement.

  • Heels on bar

    • external rotation for variation if they naturally internally rotate

    • internal rotation for variation if they naturally externally rotate

  • Toes on bar

    • external rotation for variation if they naturally internally rotate

    • internal rotation for variation if they naturally externally rotate

    • prancing to introduce isolated leg movement, shifting of weight

  • Bridging

    • prepare with pelvic rocks

    • Modify by lowering feet to the platform

    • assist client with foot stability

    • mid bridge for variation

    • pulses for variation

2 / Upper Limbs and Trunk:

  • Lower & lift

    • Modify by not including straps, once form looks good, advance accordingly

  • Roll Down

    • supported with the dowel at the springboard; progress accordingly as client improves

  • Lat Press

  • External Rotation

    • modify with a light resistance band and proceed accordingly

    • prevent over compensation by putting a tactile cue at the elbow

  • Toe Taps

  • Knee Folds

3 / IMPORTANT NOTES:

  • Just because a person has a physical disability, that does not mean that they have a cognitive disability. 

  • Just because a person may have a speech impediment or delayed speech, does not mean they can’t process information or are cognitively disabled.

  • If a client is expressing that the movement/weight is too much for their body; LISTEN TO THEM.

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