I have a client had has neurological impairment on her left side from the removal of a brain tumor. She was paralyzed right after surgery but with physical therapy she regained feeling and mobility but she still has issues with the left side, her left side just can’t always keep up with the right and there are just some things she can’t do. I focus on exercises that don’t isolate one side. For example, we don’t do lunges we do squats instead but I’m also trying to work on balance with her.
Right now, my biggest challenge is that she wants to run a 5k at the end of May. She’s not so much out of shape, just limited by the neurological impairment. We just started a few days ago. She can’t seem to run more than 2 minutes at a time so right now I’m having her do 2 minutes on, 2 off. I’ve been out of town so I haven’t been with her yet to be there while she’s running. Might be better when I’m there to encourage her to go a little longer but I’m wondering if part of it is the treadmill. I know some people with balance issues can run outside but can’t run on the treadmill. I know this is more than just a balance issue. I’ve never worked with anyone like this so I’m wondering if anyone has any suggestions. Thanks in advance for your help.
I work with a few clients with neurological challenges. The one thing that is challenging is that every client presents a slightly different picture even if there is the same diagnosis. Yes, there are commonalities, but you will have to use a process of elimination and sometimes even trial and error (as long as done safely) to find the best path.
One thing I usually do is work unilaterally, and also work on isolating before integrating. I often find that – while there are neurological causes for imbalances – there are also often just imbalances as you would find them in any other person. That is particularly true when one side has been paralyzed for some time.
You are right: running or walking on the treadmill is different from a normal outside surface. I have a client with Parkinson’s who used to do great on the treadmill even if he was struggling otherwise. It is certainly worth exploring. Even though her goal to run a 5 K by the end of May sounds a little optimistic, I would absolutely not discourage her to aim for a 5 K even though the time frame may need to be adjusted.
If you feel I can be of help, you are more than welcome to contact me beyond this forum. Contact information is on my web site.
I wish you and your client good luck.
Grab water bottle and a snack, this may be a doozy…
First let me say this (disclaimer). In this case, you are in a post-rehab phase, so your job is continue the progress of the PT in whatever capacity you’re qualified to do it. More importantly, you MUST be present with this client when they are training, or at the very least have someone knowledgeable (whether a staffer or a family member) monitoring them for contraindications. If you don’t feel comfortable working with this client or if you are not qualified to do so, I strongly suggest referring this client to someone who can help them better than you can. Remember, this is about the health and QOL of the client, not your ability or pride as a trainer.
Second, I have to say that I have not assessed this client and I am not aware of her abilities, so obviously you must use your judgement in sorting and applying any advice that comes your way.
Now that the disclaimers are out of the way, here are the goodies…
I currently have a client with neural issues as well. He is a high functioning special needs with an epilepsy disorder. He also has tremors and motor issues in his right side, so although he shoots a basketball right handed, he does fine motor stuff like writing with his left. Although my client is able to do more advanced progressions, there are some parallels here.
Nearly the entire warm-up with my client is unilateral band work and body weight exercise. Don’t run away from this, improve it. The neurological adaptations have been tremendous. When we started, his lunges looked like he was surfing, he was swaying back and forth. Thursday he used 10 pound dumbbells, stiff as a board with perfect form. Two reasons: better neurological control, and more strength. In the upper body use all the major movements, push and pull in both vertical and horizontal planes. In the lower body, consider all the movements of the knee and hip. Use light band work to challenge the nervous system in every way possible.
We work on core stability every workout. I use anti-rotation, isolation, and dynamic stability exercises. A stronger, more stable core has made everything better and every exercise easier.
And as I have indicated, strength training. Strength will improve stride, speed, balance, coordination, and stability.
Of course, for the sake of specificity, you need her to run or walk. I think intervals are the right idea. Also try different machines like cross trainers, Precore AMT, etc. to see if anything is easier for her.
If you only have time for band work and intervals, that’s what I’d prioritize.
One final thought. The body is a chain, and a master of compensation. And a chain is only as strong as its weakest link.
Best of Luck,