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Exercise and spinal cord injury recovery

Exercise and spinal cord injury recovery

Posted by AskNurseLinda on Sep 14, 2015 11:15 am

Locomotoer TrainingRequest from Nurse Linda: What you are doing to exercise and how you have worked exercise into your schedule? If you have any ideas, feel free to post. You might be doing something that you feel is pretty average but it might be something that others have not yet thought. Post in the comments below!

Many people accept the concept that once you have a spinal cord injury, recovery is not possible. This is simply not true. Recovery is possible now and in the forefront. Healthcare professionals were taught, until recently, that recovery from paralysis would not occur but it does and always has. Traditionally, research assessing recovery was measured over a two year period. Individuals were not provided with therapy other than for maintenance and recovery was measured. Without any stimulation, nothing occurred so it was deemed that it would not.

Just within a short period of time, the above information has been demonstrated to be incorrect. Recovery does occur and can be stimulated to occur in a very positive direction. Consequences from spinal cord injury, stroke or other nerve injury leading to paralysis can be reduced and improved with functional gains being made. There are several strategies that can enhance your recovery process.

Prevention of complications from paralysis is going to be the primary concern for treatment. Making sure that your body stays healthy without muscle contractures, pressure sores, infections and clots will be important to keep you moving forward. All body systems such as your respiratory, skin, bladder and bowel must remain healthy so you can move forward and not be trying to catch up after illness. You can do a lot to prevent secondary complications by monitoring your skin, turning and performing pressure releases. Maintaining hygiene in bowel and bladder training as well as coughing and breathing deeply will help you to keep your body in shape. Work pressure releases and deep breathing into your day in a timely fashion by performing them to some sort of ritual such as at TV commercials, or some other cue in your life that happens every 10-15 minutes. It then becomes an automatic part of your day rather than a chore.

Activity is an integral part of the recovery process. Moving your body frequently is important to provide input to the nerves and muscles below the level of injury. Providing range of motion exercises and stretching is the perfect opportunity to provide input to your body. Gentle moving in your wheelchair is also important to your total body.

Movement in the form of range of motion and stretching repeatedly is patterned movement. Years ago, in the polio epidemic, patterned movement was discovered to be a source of improvement for individuals with paralysis from polio. Today, it is noted to be a factor in providing stimulation from an external source to be able to keep joints supple and muscles strong. Providing this input through moving your limbs at a minimum of two times a day is a good start. You may do this yourself or have someone help you. Just as a person stretches when they wake and prior to sleep is providing your body with stimulation as well as avoiding the complications of paralysis.

Electrical stimulation to provide patterned movement is taking exercise to another level. In this case, the stimulation is provided from an outside source to cause movement to muscles to contract and release as well as stimulating nerves to send impulses to the brain. Thinking about moving a body part while having the input electrical stimulation has been known to make connections at the level of injury to increase the process of recovery. The nerves may reconnect or other nerves may take over to allow the desired movement.

Brain remapping is what is done when new nerve routes are stimulated by patterned movement or electrical stimulation. The brain can use other connections to take over for nerves that are not working up to full steam. The nervous system is much like a computer in that there are typically alternative ways to perform any one function. The nervous system is much the same as the brain will adapt to send messages past the level of injury if it is provided with an alternative route. Sometimes, it may take a while to learn the new signaling path and how to harness it but this can be done through therapeutic intervention.

Patterned movement and electrical stimulation will cause an increase in the development of new nerve cells. The nervous system creates new nerve cells throughout your life. The exact mechanism of this process is under study but great strides are being made in understanding the way this works. One thing that is known is that regardless of how the new nerve cells develop, they do so with increased movement. It would be great to know exactly how this happens so it could be harnessed and stimulated but even without knowing the how, we do know it does work.

Investigative research about nerve transfers and grafting, stem cell research, implants, medications, prostheses, halting cell death, inflammation promoting nerve regeneration are all understudy. How to reduce the secondary complications and effects of paralysis is being understood more clearly. Yes, there is more research to be done but what we do know should be used now. That being movement helps bodies function.

Movement has been demonstrated to be helpful in other neurologic illness such as Parkinson's disease and Alzheimer's disease. Individuals with these conditions do much better cognitively or with their thinking when movement is provided. Therefore, we know that movement is a favorite of the neurological system. We also know that individuals in general have better function and quality of life with movement. If movement results in a cardiac workout, other body systems remain healthy.

Exercise is a difficult goal to accomplish in anyone's life. People buy gym memberships but fail to attend. Many New Year's resolutions are quickly broken because, let's face it, exercise is not always fun. It is a challenge to be able to accomplish the goal of exercise on a regular basis. The key might be to make it a normal process in your day as opposed to an onus. Ranging and stretching should be worked into your routine. If you can find an exercise that is entertaining to you, a person is more likely to stick with it. Rolling out doors in good weather might be a time to get exercise but also to clear your mind and relax. If swimming is possible and enjoyable, that is another possibility. Many communities offer warm water pools with adaptive opportunities. Some people roll through different stores to see what is new. Therapy can offer exercise.

What you are doing to exercise and how you have worked exercise into your schedule? If you have any ideas, feel free to post. You might be doing something that you feel is pretty average but it might be something that others have not yet thought.

Thank you for your ideas.

I'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

Leave a comment any time by clicking the reply button. Let's get the discussion going!

Nurse Linda

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Re: Exercise and spinal cord injury recovery

Posted by AskNurseLinda on Sep 16, 2015 8:54 pm

Everyone, thank you for comments about exercise. There are some wonderful ideas posted on Facebook, including those that are quite active and some with little to no start up funding. It can be a hard endeavor to obtain approval from funders to become involved in some of the higher level therapies but there are wonderful ideas that do not have costs associated with them to get started. Keep up the great ideas. I am learning from each one and I hope you see things that can get you moving, too.  Nurse Linda

Re: Exercise and spinal cord injury recovery

Posted by zuzu on Sep 17, 2015 3:05 am

Thank you Nurse Linda for letting us share our conversation from FB on your post here.  There was an interesting discussion there and it had to do with the difference between people who were able to exercise on their own as paraplegics and ones who couldn't as quadriplegics needing assistance and who no longer qualified for help with paying for longterm exercise/rehab therapy programs and couldn't afford to private pay.  I copied my comments about these issues to this discussion and a few of the comments from FB to share here.
 
Deborah Gregson Not many are fortunate enough to have insurance coverage or private money to pay for exercise. Sometimes it highly irritates me that so many articles are posted here about treatments that are not available to the majority of people with SCI as if they are.
Like · Reply · 14 · September 14 at 6:39pm
  • (someone made a comment about being able to go to the gym several times a week to keep in shape and gain strength, the person was a para, to which I responded-)
  • Deborah Gregson I'm responding for those who are quads like my mom and several friends. If you're a para you can do your own exercises, but quads must have exercise assistance, and you won't get that once you are done with the three months out of the rehab after your acute hospital stay unless you have some type of special insurance or private pay. The special programs that CRPF offers are not available to most people unless you are able to raise money through fundraising campaigns, are able to get a grant or have a benefactor. That means most people don't get this special help to stay healthy and strong and will not be able to benefit from the advantages of weekly exercise physically or mentally. This is one of the things I wish that the charitable organizations would give some focus to, along with better support of in-home care, because until a cure is found and available to all, the majority of SCI/TBI people are still stuck at home or in facilities in their chairs.
    Like · Reply · 15 · September 14 at 7:42pm

    Christopher & Dana Reeve Foundation Hello Deborah Gregson. Thank you for commenting on this post. We would invite you to comment further in the Reeve Foundation community to foster a real time dialog around the valuable points you have addressed (www.spinalcordinjury-paralysis.org/discussions). Separately, please feel free to connect with our information specialists who may have additional resources or information for your mother. They are available toll-free at 800-539-7309 from 9:00 am to 5:00 pm Eastern U.S. Time, Monday through Friday.
    Like · Reply · 7 hrs · Edited

    Deborah Gregson Ok kids we're taking this discussion to the CRPF discussion community. If you haven't signed up, it's free, and they have tons of wonderful people to talk to on lots of issues I'm sure you'll enjoy. Let's put this under the topic of health or exercise, I know they have that. I'll copy and past my two comments here so they are there. But your comments and mine are still here also for any of your friends and mine on the outside to talk about too.
  • I'd like to see Medicare and Medicaid cover more longterm aggressive rehab exercise not only for SCI but other conditions like ALS, MS, Parkinson's, stroke and TBI recovery. There are so many people who can benefit from this type of exercise over a long period of time. Medicare pays for "Silver Sneaker" programs for elderly people, why not for this? And if Medicare covers something, then Medicaid and private insurance usually follows their lead. It would reduce a lot of the secondary medical issues people with SCI have, greatly improve mental attitudes and prepare people for any kind of therapies that may allow people to recover the ability to walk once more.
  •  
    • (other comments that were made on FB, but I'll not identify the posters)
    • 3 days a week at local YMCA with personal trainer costs me $900/8 weeks. I am lucky to have good disability insurance; and have put exercise at top of list. Leg and arm strength improved significantly. On off days, stretch like mad and aides help me with weights on arms/legs. Am just past 2 years post accident which left me at C4 incomplete. Can now get upto 300 steps in a walker; left arm doing well and right arm now starting to come back to life.
    •  
    • I am a c4-c-5 incomplete quad and over the past 9 years I have done different kinds of therapy in many places. It was expensive and not consistent enough. I found a website called "sci total fitness"  and it has a trained physical therapist who posts different exercise videos weekly for people living with a disability. You can do cardio, strength training, a guided weight loss program and you can also track your progress. It's not expensive and I love that I can workout from home everyday at any time I want. I am now consistently seeing progress and I feel better than ever.
  •  
  • I do the T25 workout videos by beachbody, they have good core and upper body videos. It's good for those who can't afford to do therapy.
are these on YouTube? Thanks
  • Im not sure my wife purchased the dvd's off of eBay for herself to do and the whole family decided to do them. She paid around 70.00 for a complete set with the ropes, meal plans and charts but u can get just the dvds for cheaper than that.
  •  
  • Christopher & Dana Reeve Foundation We also have a few Reeve Health Minute videos that Candace Cable put together for us that provides tips on staying fit that are FREE.  Check them out at ChristopherReeve.org/Minute under the "Tips for Staying Fit" category.
  •  
    • 3 days a week at local YMCA with personal trainer costs me $900/8 weeks. I am lucky to have good disability insurance; and have put exercise at top of list. Leg and arm strength improved significantly. On off days, stretch like mad and aides help me with weights on arms/legs. Am just past 2 years post accident which left me at C4 incomplete. Can now get upto 300 steps in a walker; left arm doing well and right arm now starting to come back to life.
    • I'm curious as to what type of insurance doesn't pay for therapy as often as needed? I have never had a problem with mine paying for whatever was needed.
      • Deborah Gregson Medicare will not pay for rehab therapy after a fairly short period of time and most places they send you don't have the complex machines like they have at the places like Craig, Kessler, Project Walk. If you can go to one of these places you have to be able to pay for your lodging on your own and your own assistant, which limits you to the rehab facilities in the areas around your home.
         
        *Thank you Deborah, I had no idea that they didn't pay for it, as long as a person needs it. My daughter was 3 when she was injured, she's now 18. We were in Atlanta for a while, they weaned her off the vent and went to Shriners in Chicago for another while before coming home. We've got a really good rehab facility near us and she goes there weekly during the school year and does a lot of aquatics during the summer at home. I guess where she was a child things were more accessible to her. It would be great if there were facilities similar to Shriners for adults. Everyone should be able to have access to resources needed for health improvements.
         
        Deborah Gregson Shriners is the BEST, they are great for kids. Some changes are happening with Medicare in terms of rehab, but it's really hard to get rehab exercise ongoing on the level that Eric gets it at the Reeve Foundation, or people do at Kessler, Atlanta or Craig. Most of these are young people on their parent's private insurance or their own private insurance. Once on Medicare or Medicaid the rehab coverage is very limited, and only done to "maintain at the level they are" not to improve fitness level and get further progress in function.
        *My daughter is a c2-c3 incomplete SCI. She was a quad, but has now regained 90% mobility. She has done aquatic therapy and a lot of other types also. I felt like the aquatic done more for her and she is currently using a Geo machine by Reha technology and the improvement she has shown is unmatched to any of the other machines she has used.
         
        *I'm 60 y/o with 31+ years as a C4 quad. I hurt everywhere with arthritis and don't have the funds/funding needed to get the exercise that my body might still be able to tolerate.September 14 at 7:00pm
        • Deborah Gregson I'm sorry. That's the situation with my Mom, although now she's 84.


          *I'm a C5 incomplete, so there isn't a lot that I can do on my own. I was

          able to have physical therapy for 3 hours, twice a week, for the first 4

          years. I found that my abilities didn't change much after 3 years, but I

          kept going for another year in ho
          pes of gaining strength or ability.

          Unfortunately, I didn't gain anything in the additional year and stopped

          going to therapy. I've been able to maintain my level of ability for the

          past year without therapy, but since I'm an incomplete I move around

          and transfer more than a complete might be able to.



          September 15 at 6:15pm

          *I was an open water swimmer prior to my spinal stroke 3 years ago. I am a t 11 para. I currently swim about 1 1/2 miles in a pool 6 times a week. I use a short wetsuit and floating sneakers for buoyancy. I purchased a Nustep cross trainer and use it for an hour almost every day for cardiovascular exercise. I am 63 years old.
           
          *The problem I have is if you don't have the money you can't get what

          is needed for the most part. That's the frustrating part.

          *Try to keep it simple after work. M, W, F: FES bike 2 hours, also standing. Tuesday and Thursday weight training.

          *I tried Beachbody on demand. Streamed workouts at home and gives me options to find ones to work upper body and cardio. I particularly love cize...it's a dance workout anyone can do. I also bought a handcycle and go to the Y to swim.


          (that was the end of the FB comments as of Sept. 17 @3:02am)

          Christopher & Dana Reeve Foundation
           Thank you to everyone for contributing to this conversation! We encourage you to register for Nurse Linda's live webchat on Wednesday, September 23rd at 3PM ET to continue the discussion! Sign up here: https://cc.readytalk.com/r/nt8okwps6xsl&eom
          Like · Reply · September 15 at 1

Re: Exercise and spinal cord injury recovery

Posted by AskNurseLinda on Sep 17, 2015 11:43 am

zuzu: there are a lot of interesting postings about exercise and activity. Individuals can participate at different ability levels which is just fine for activity as long as the body is moving or being moved. My hope is for people to get away from the idea that activity can only take place in the therapy setting or with expensive equipment. Moving your body or having it moved is important to your general health. Nurse Linda

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