Pilates For Cerebral Palsy

Transcription

1 Pilates For Cerebral Palsy Kathy Robinson Costa Mesa 1

2 ABSTRACT Cerebral Palsy is caused by a brain injury or problem that occurs during pregnancy, birth, or within the first two to three years of a child s life. Cerebral means the disorder is related to the brain. Palsy refers to weakness or muscle problem. Most people with cerebral palsy are born with it. This is call congenital cerebral palsy. It can also occur after birth, in which case it is called acquired cerebral palsy. While there are several types of cerebral palsy, spastic cerebral palsy is the most common type. People with spastic cerebral palsy feel stiff and their movements may look stiff and jerky. Physical therapy and controlled mindful movement are very effective treatments, making Pilates the perfect fit. 2

3 Table of Contents Anatomical Description Pg. 4 Introduction Pg. 6 Case Study Pg. 7 Conditioning Program Pg. 8 Conclusion Pg. 10 Bibliography Pg. 11 3

4 Anatomical Description Spastic cerebral palsy begins with damage to the motor cortex of the brain. As a result, bundles of neurons that begin in the brain and travel through the spinal cord in the corticospinal and corticobular tracts are damaged. 60% of these fibers originate from the primary motor area, premotor area, and supplementary motor area of the frontal lobe. The descending corticospinal tract descends from the origin: Through the corona radiate 4

5 Posterior half of the lateral ventricle (lower limb is represented by posterior fibers) Enters midbrain through peduncle (face is represented by medial fibers, foot lateral and hand in the middle) Enters medulla where they form medullary pyramids on either side of the midline Lateral fibers make up 75-90% of fibers. They descend in the posterior part of the lateral funiculus, anterior fibers make up 10-25% of fibers. In spastic cerebral palsy damage to motor neurons lead to the presentation of hypertonia. 5

6 Introduction The damage to the brain that causes spastic cerebral palsy doesn t heal. Spasticity is a form of hypertonia, or increased muscle tone. This results in stiff muscles, which can make movement difficult or even impossible. The effects of spasticity on the body can results in structural changes over time. These effects include: Changes in muscles, tendons and ligaments leading to muscle stiffness, atrophy and fibrosis (changes in the properties of the muscle fibers). Shortened contracted muscles can pull on bony structures leading to bone deformities such as scoliosis of the spine and hip dislocation. Persistent over activity in spastic muscles can cause joint and muscle pain. Muscles appear stiff because the messages are sent incorrectly through the damaged part of the brain. When a muscle is affected by spasticity, the faster the limb is move, the stiffer it seems. 6

7 Case Study Rita is a 21-year-old woman with congenital spastic cerebral palsy. Her chiropractor recommended regular Pilates sessions to lengthen and strengthen her muscles and minimize the structural changes caused by hypertonia. Every three months Rita receives Botox injections in twenty-one sites on her body to help the muscles relax so they can be worked with minimal pain. She also suffers from mental illnesses including manic depression and bipolar disorder. The goal for each session is to create calm and muscle connection beginning in the mind and using the breath to create slow and controlled movement. Because Pilates is mind and body work, Rita experiences an overall feeling of accomplishment and sense of overall calm after her sessions. 7

8 Conditioning Program We begin each session with three roll downs. This serves to quiet her mind and it begins to crate balance for the next hour. Her warm up is a combination of fundamental and intermediate repertoire, the double leg stretch and single leg stretch create length and core stability. Foot work is particularly effective for those with cerebral palsy. Our focus during this block is to create a slow and deliberate pace. Rita s muscles, once activated, want to move quickly. In the abdominal block, hundred prep also serves to create length in her arms by reaching her fingertips to the wall, and coordination creates length from the hips as she reaches actively through her plantar flexed toes. We begin hip work with extended frog and reversed extended frog to create length and control. Spinal articulation with bottom lift and extension allows the spine to be fluid while using control and feeling the full length from her hips to her toes. We use the standing lunge and a modified kneeling lunge for the stretch. The modified kneeling lung begins with her foot on the platform. Some days we get a foot to the bar depending on how her muscles are reacting. We began FBI with elephant because it is a challenge to keep her feet flat. While executing the supine arms series, Rita maintains gentle engagement with a small ball placed between her knees while in table top. This creates several layers of muscle activation, which stimulates her mind body connection. Single leg skating not only works the legs but also helps her to create length by encouraging her to visualize the crown of her head lifting toward the ceiling. A side stretch on the Wunda chair challenges her spacial balance as well as achieving length for each side of her body. Rita loves swan on the Wunda Chair because she feels stability in her core, length in her legs, and it makes her feel pretty. 8

9 Hip work Reformer - 1 blue & 1 yellow extended frog BLOCK PROGRAM extended frog reverse Warm up 3 roll downs circles - up/down pelvic curl openings spine twist supine Spinal Articulation Reformer - double leg stretch bottom lift - 2 red single leg stretch bottom lift with extension - 1 red & 1 blue Foot work Reformer - 3 red Stretches Reformer - 1 blue & 1 yellow parallel heels standing lunge parallel toes Full Body Integration Reformer - V position toes elephant - 1 red open V heels Arms Reformer - 1 red & 1 blue open V toes arm supine series with a ball between knees Calf raises Prances Single leg heel - right and left Single leg toes - right and left (2 red) Abdominals Reformer -1 red hundred prep coordination Hip work Reformer - 1 blue & 1 yellow extended frog extended frog reverse circles - up/down openings 9

10 Full Body Integration A/M Legs not part of program at this time Reformer - 1 red single leg skating Lateral Flexion/Rotation Wunda Chair - 1 on 2 side stretch Extension Wunda Chair - 1 on 2 swan basic Conclusion I have been working with Rita for a full year. In that time I have seen changes in her gait, posture and strength. Her spirit and confidence has increase because she feels the difference in her body and mind. The conditioning program I have shared is fundamental for the most part. The goal is always to lengthen and strengthen her body but also create a sense of calm and mindfully managing her muscle actions with reactions. The biggest challenge is keeping her mind focused. It is an honor to work with Rita, she inspires all of us to work hard to over come any and all obstacles we may face. 10

11 Bibliography Books Isacowitz, Rael. Reformer: Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, 2013 Isacowitz, Rael. Wunda Chair: Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, 2013 Isacowitz, Rael & Cuppinger, Karen. Pilates Anatomy. Human Kinetics, 2011 Journals A.P. Cosgrove, I.S. Corry, H.K. Graham. Botulinum Toxin In The Management Of The Lower Limb In Cerebral Palsy. Developmental Medicine & Child Neurology Websites Cerebral Palsy Alliance Research Foundation