Yes, the whole muscle car analogy is a tactic to keep you interested in what I’m writing. I needed to do something, I don’t want to bore you to death with so much detail about our neuro-protocol. I keep forgetting that not everyone thinks the most perfect evening ever is kicking back with a glass of red wine and a 300 pg manual on neurology. Ok, off to the races we go!
Protocol Part One: Structure
First up is the Structure stage, which has to do with the condition of a client’s body. In particular we look at the tone of their muscles and the range of motion of their joints. What we’re assessing is the POTENTIAL for their body parts to move, and what we’re shooting for is that those parts move with as little restriction as possible.
Muscle hypertonicity is common with neurological injuries. If you don’t know what that is, imagine flexing as hard as you can indefinitely and you’ll have an idea. Other complications we commonly see are scar tissue, fascial adhesions, edema and inflammation, all things that potentially interfere with movement. Another big problem is that when your body doesn’t move for a long time, all your moving parts start to stick together and stiffen. In fact sometimes they’ll get so gummed up that’s like trying to move while wrapped in duck tape!
So how do we deal with this? We take off the duck tape. If there’s hypertonicity, deep tissue massage can lengthen the muscles to their normal resting length, or EMS (Electrical Muscle Stimulation) can fatigue them enough that they relax. Fascial adhesions and scar tissue can be released with various kinds of tissue manipulation. Edema and inflammation can be cleared using acupuncture, lymphatic drainage massage or therapeutic laser. Regardless of what factors have caused the client’s body to lose it’s potential for movement, our first priority is to get those tissues ready for action. Think of it like making sure your engine is tuned up and ready to go BEFORE turning the key.
Protocol Part Two: Awareness & Intent
All right then, let’s fire up that engine! Or in this case, stimulate your nervous system.
Our Awareness and Intent stages of protocol relate to sensory and motor nervous system stimulation respectively. Confusing? Nah, it’s easy. Quick physiology 101 recap… Sensory nerves collect information about everything you need to know – what position you’re in, tension in your body, the angles of your joints, your weight distribution etc., and then sends this info to your brain. This is how you know what’s going on both in and around you at all times. It’s common with neurological conditions to receive confused, random and inaccurate sensory information.
Motor nerves originate in the brain and on your command zap signals to muscles when you want to move. It’s a pretty straight forward process. Sensory info comes in, motor signals go out. In terms of our therapy, sensory information is stimulated through your awareness, while motor signals are generated through your intent.
How do we stimulate these systems? There’s one key ingredient… your brain! At this point assisted movement technologies like the Lokomat and FES (Functional Electrical Stimulation) become very useful. The idea is simple. To stimulate sensory awareness, the client pays attention to what they feel while they’re moving. To strengthen motor signals, the client focuses their intent on doing the movement.
We’ve also created a unique series of assisted active exercises that utilizes the client’s weight, position, and movement, to aid in reorganizing sensory information and strengthening motor output potential. It’s very simple and repetitive work, but it’s been very effective. By just working on awareness of sensory signals, I’ve seen paraplegic clients go from only having random and unorganized feeling in their legs to having excellent awareness of weight distribution and position! (I’ll discuss these exercises in more detail in future posts).
It’s crucial to emphasize the importance of client participation in this stage of therapy. Remember, if the client isn’t using their mind in an engaging way, then all that neuroplasticity talk is out the window. Going back to our car analogy, having the client not engaged in what they’re doing is like not having a driver in the car, when the goal is to drive!
Protocol Part Three: Action & Function
Ok so now we’re driving, perhaps just in the slow lane, but at least we’re on the road!
With even minimal movement, a client enters the Action stage and we start employing various forms of active rehab, FES, Lokomat, and Armeo. All these therapies will help to strengthen nerve conduction and improve the client’s control of their own body. As movements improve, and we enter into the Functional stage of our protocol, we introduce more complex and unique exercises programs that develop strength, coordination and rhythm. Think of this as teaching you to drive in the fast lane while drinking a coffee, listening to music, AND planning what’s for dinner!
I better wrap up soon, because by now I’m sure you’re thinking about hitting me over the head with that big ol’ neurology manual (just don’t spill the wine ok?). Throughout all stages of our protocol, we continue managing the condition of the client’s body structure, making sure they’re bodies are always in optimal shape for therapy. We continue to apply acupuncture for sensory and motor signal stimulation, pain management and any other physiological side effects of their condition. We supervise our client’s diet and suggest supplements as needed. Most importantly, we take the time to talk to our clients. They learn from us and we continue learning from them. We spend a lot of time with our clients, so we might as well get to know each other, right? Besides, nobody else will listen to me go on and on about this stuff.