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Clients with Spinal Cord Injury, Multiple Sclerosis, Epilepsy, Fibromyalgia, Lupus, and Cerebral Palsy.

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Presentation on theme: "Clients with Spinal Cord Injury, Multiple Sclerosis, Epilepsy, Fibromyalgia, Lupus, and Cerebral Palsy."— Presentation transcript:

1 Clients with Spinal Cord Injury, Multiple Sclerosis, Epilepsy, Fibromyalgia, Lupus, and Cerebral Palsy

2 Murderball


4 Spinal Cord Injury Spinal Cord Injury (SCI) results from the impairment or loss of motor function, sensory function, or both in the trunk or limbs due to irreversible damage to neural tissues within the spinal cord

5 Spinal Cord Injury SCI may be classified as tetraplegia or paraplegia
Tetraplegia (Quadriplegia): Injury occurs between C1 and T1, impairment of the arms, trunk, legs, and pelvic organs Paraplegia: Injury to T2 to T12 which causes impairment in the trunk, legs, and/or pelvic organs.

6 SCI Cardiovascular Conditions
Autonomic Dysreflexia Postural Hypotension Cardiac Atrophy Congestive Heart Failure Sudden death Atherosclerosis

7 Autonomic Dysreflexia
A sudden dangerous increase in blood pressure Medical Emergency! If not treated promptly, it may lead to seizures, stroke, and even death

8 Autonomic Dysreflexia
Common Causes: Kinked catheter (sitting on catheter) Overfilled bladder due to a blockage Bladder infection Inadequate bladder emptying Stones in the bladder Bladder spasms Skin irritations Pressure sores

9 Signs and Symptoms of Autonomic Dysreflexia
Hypertension An increase in 20 mm Hg or more in systolic blood pressure Pounding headache Caused by the elevation in blood pressure Heavy sweating Flushed (red) Face Blurry vision Dyspnea (difficulty breathing) Chest tightness Hypertension and Pounding Headache are most common symptoms

10 Autonomic Dysreflexia Treatment
Stop ongoing activity! Check blood pressure Have person sit up with head elevated Loosen clothing Check urinary catheter for kinks and straighten any Continue to monitor blood pressure and call 911!

11 Postural Hypotension Blood pressure drops to dangerously low levels in response to an upright posture If it is not treated immediately, the person may lose consciousness. Symptoms: Light-headedness Pallor (pale) Visual changes

12 Postural Hypotension Treatment
Check blood pressure Recline the wheelchair Continue to check blood pressure and call 911

13 SCI Exercise Testing and Training
Acquire medical clearance Because of the high risk of cardiovascular impairment, maximal exercise testing should be administered in medical settings

14 SCI Exercise Concerns Many people with SCI cannot regulate body temperature which can lead to hypothermia or heat stroke Extreme temperatures should be avoided! Beware of freezer burn from cold packs or burns from heat packs Maintain a constant exercise environment Have clients wear lose fitting clothes and breathable materials Adequate hydration is necessary

15 SCI Exercise Induced Injuries
Most common exercise induced injuries occur at the shoulders, elbows, and wrist Incorporate exercises that will restore or enhance balance around functional joints; strengthen muscle groups of the posterior shoulder and back and stretch muscles of the anterior shoulder and chest to reduce risk of injuries

16 SCI Exercise Guidelines
Avoid exercise two to three hours after a meal Digestion can impair the ability to shunt blood to the working muscles during exercise creating a decrease in cardiac output and blood flow The client should avoid exercise during illness and bladder infection

17 SCI Aerobic Exercise Guidelines
Intensity: 40-60% Mode: Arm bike, wheelchair basketball, swimming Duration: 10-20 minutes Frequency: 3 days per week or every other day is recommended

18 SCI Dynamic Warm-Up Guidelines
3-5 repetitions of: Chin Tucks Neck Flexion/Extension Lateral Neck Flexion Neck Rotation: Turn chin toward left shoulder then rotate it right

19 SCI Dynamic Warm-Up Guidelines
8-10 repetitions of: Trunk Rotation Shoulder Flexion/Extension Shoulder Horizontal Adduction/Abduction Shoulder Circles Forward and Backward Elbow Flexion Wrist Flexion/Extension Wrist Abduction/Adduction Wrist Circumduction Finger Flexion/Extension

20 SCI Resistance Training Exercise Guidelines
3 sets 8-12 reps for all functional muscle groups Frequency: 2-3 days per week Clients may also benefit from a single set to fatigue of 8-12 reps using 8-12 exercises 2-3 days per week People with SCI are prone to Spasticity (exaggerated muscle tone and reflexes) which can impair exercise

21 SCI Resistance Training Exercises
Lateral and medial shoulder rotation with tubing or light dumbbells Lat pull-down Rows using machine, cable, or tubing Chest press using machine, cable, or tubing Front and lateral dumbbell raise Dumbbell biceps curl Triceps cable rope extension Dumbbell wrist curl Dumbbell wrist extension

22 Static Stretches (Cool Down)
Hold all stretches for 30 seconds Upper trapezius: Lower the right shoulder and bend the head toward the left shoulder Trunk: Raise the right arm over the head with the elbow by the ear and bend the trunk to the left side Horizontal shoulder adduction/abduction Scapular retraction/protraction Shoulder medial/lateral rotation Doorway pectoralis stretch Flex the elbow to 90 degrees Elbow flexion/extension

23 SCI Exercise Program


25 Multiple Sclerosis (MS)
Most commonly diagnosed neurolgical diease in young adults The cause of MS remains unknown Individuals who are diagnosed with MS are typically between the ages of 15 and 50 years More common in women than men

26 Multiple Sclerosis A degenerating disease of the central nervous system (brain + spinal cord) that interferes with the quality of movement An auto-immune disease in which the body’s defensive system (macrophages) attack the myelin sheath that covers the nerves Loss of myelin, which is the fatty substance that insulates nerves, decreases the speed of conduction and is associated with leaving areas of scar tissue on the covering of nerve cells (sclerosis)

27 Multiple Sclerosis (MS)

28 Multiple Sclerosis


30 Symptoms of Multiple Sclerosis (MS)
Fatigue-primary symptom of MS Pain Muscle weakness Heat sensitivity Impaired balance and poor coordination Muscle spasticity especially in the legs Tremors Blurred or double vision, eye discomfort or rapid eye movements Decreased attention, memory, and concentration Dysphagia: difficulty swallowing Dysarthria: slurred speech


32 Multiple Sclerosis Treatments
Education Management of symptoms Medication Exercise

33 Multiple Sclerosis Exercise Guidelines
Acquire medical clearance Exercise testing should be done under medical supervision Heart rate and blood pressure must be monitored throughout the exercise program, and intensity might need to be decreased. This can be due to decreased blood pressure in response to exercise

34 Multiple Sclerosis Exercise Guidelines
Exercise may ease the symptoms of MS, but it is important to take certain precautions: People with MS suffer from fatigue, muscle spasticity, and heat sensitivity Optimal time of day to exercise may be in the morning Fatigue may be reduced by aerobic activity Muscle spasticity may be managed with a stretching program

35 Multiple Sclerosis Exercise Guidelines
Many people with MS experience a temporary worsening of their symptoms due to the following: Very hot or humid weather Overheating from exercise Sunbathing Fever Taking very hot showers or baths

36 Multiple Sclerosis Exercise Guidelines
Heat Sensitivity: May lead to fatigue, loss of balance and visual changes Create a cool environment with fans Air temperature should be cool Avoid swimming if pool temperature is too warm Drink water to stay hydrated Wear loose-fitting, light-colored breathable clothing—dark clothes retain heat If exercising outdoors, try early morning or evening hours due to overheating

37 MS Aerobic Endurance Exercise Guidelines
Mode: Walking, swimming, aqua classes, chair aerobics, stationary cycling Stationary cycling, swimming, aqua and chair classes may be best due to leg weakness, impaired balance, and coordination Frequency: 3-4 sessions per week Duration: 10-30 minutes per day or two to three 10 minute sessions throughout the day

38 MS Aerobic Endurance Exercise Guidelines
Intensity: 40-70% of THRR with progression over 3-6 months to 50-70% Some people with MS demonstrate blunted heart rate responses to exercise- a condition in which the heart rate does not increase with exercise intensity due to medications. Therefore utilize RPE scale. Do not exercise to fatigue!

39 MS and Benefits of Water Exercise
Water reduces the effects of gravity, and the buoyancy or weightlessness that occurs in water Helps a person with weak muscles attain a greater range of motion Chest-high water can provide support, enabling persons with MS to stand and maintain balance for exercises with less effort than on land

40 MS and Benefits of Water Exercise
The resistance that water provides can be used for muscle strengthening Water also helps reduce body heat that can be generated by exercise Water temperatures of 80° to 84°F are usually recommended

41 MS Flexibility Guidelines
People with MS experience spasticity which leads to muscle stiffness and tightness, pain, and decreased range of motion Stretching should be performed slowly Overstretching a neurologically weak muscle may cause injury! Reps: 2-3 for each stretch Duration: second hold Frequency: 5-6 days per week

42 MS Resistance Training Guidelines
Over-exercising neurologically weak muscles may lead to muscle spasticity, fatigue, frustration, and discontinuation of the strength program Primary considerations are fatigue, safety and balance Be aware that balance difficulties may lead to falls and injury Avoid complex skill oriented exercises! Resistance train on non-aerobic training days Avoid using dumbbells if individual has decreased sensation Exercises should be performed in a seated position when possible Use exercise machines

43 MS Resistance Training Guidelines
A strengthening program is indicated after a motivated client has successfully maintained an aerobic and flexibility program Total body routine Sets: 1-2 Reps: 6-10 Intensity: Low-to-moderate Rest: 60 seconds Start slow and gradually increase reps/intensity. Monitor fatigue levels!

44 Epilepsy Defined as two or more unprovoked recurring seizures Seizure:
An uncontrolled discharge of nerve cells which may spread to other cells nearby or throughout the entire brain. It usually lasts only a few minutes. It may be associated with loss of consciousness, loss of bowel and bladder control and tremors. May also cause aggression or other behavioral change

45 Epilepsy Acquire medical clearance
In many people with epilepsy aerobic exercise may contribute to improved seizure control However in 10% of individuals, vigorous exercise may be a seizure precipitant Personal Trainers can apply the same exercise principles for people with epilepsy as for healthy populations In general there are no restrictions to exercise (exercise and sports should be encouraged)

46 Epilepsy It is safe to administer sub-maximal exercise testing to establish cardiovascular fitness, muscle strength and endurance, flexibility, and body composition

47 Treatment for Seizures
Time seizure episode A seizure that continues for more than 5 minutes call 911! Approach calmly Do not restrain client! 4. Loosen any tight clothing 5. Keep objects out of clients path! 6. Do not place anything in the client’s mouth! 7. Allow seizure to end without interference!

48 Treatment for Seizures
8. After seizure, check for breathing and turn the client to his or her side in recovery position to prevent aspiration (entry of secretions in the trachea or lungs) 9. Remain with the client until he or she is fully awake 10. Alert the client’s family

49 Treatment for Seizures


51 Fibromyalgia A chronic condition that affects soft tissues-muscles, tendons and joints Often characterized by pain stiffness and tenderness. One of the most common diseases affecting the muscles Cause is unknown Not accompanied by tissue inflammation so there is no deformity or body damage

52 Population Affected by Fibromyalgia
Women (over 80%) between 30-50 years of age Rare with men, children, and older adults 2% of the population in the U.S. have Fibromyalgia

53 Signs and Symptoms of Fibromyalgia
Three symptoms commonly observed: Fatigue Soft tissue pain Non-restorative sleep Very low pain threshold Pain is widespread to several parts of the body

54 Signs and Symptoms of Fibromyalgia
Pain in the neck, lower back, and trapezius Joint swelling and stiffness Depression Mental and/or emotional disturbances Anxiety Irritable Bowel Syndrome

55 Fibromyalgia


57 How is Fibromyalgia Diagnosed?
No definite blood or x-ray test to determine Fibromyalgia Diagnosed through a physical exam and physician looks for “tender point” areas While a blood test doesn’t determine it, it is important to have one because it rules out other medical complications Difficult to diagnose because other medical problems can mimic the symptoms (hypothyroidism and cancer). It can also be associated with other diseases such as rheumatoid arthritis.

58 Fibromyalgia Aerobic Endurance Training Guidelines
Acquire medical clearance Aerobic training should begin very gradually Allow for a longer warm-up (at least 10 minutes) Start with light walking or biking for five minutes and add two minutes every week until at least 30 minutes of continuous activity can be performed at least three days per week Aquatic exercise a good. Avoid water that is too warm or cold as this can exacerbate symptoms Allow at least 48 hrs of rest

59 Fibromyalgia Resistance Training Guidelines
Strength training should not be performed until the client can tolerate walking and stretching without becoming exhausted Begin with one exercise per muscle group and perform one set. Sometimes only a few repetitions can be tolerated in the beginning Perform the exercises without weights and then progress to resistance bands or machines that limit eccentric movements that lengthen the muscles, which are associated with increased muscle tears in people with fibromyalgia Machines that can be utilized include hydraulic machines and minimal weight pulley machines

60 Fibromyalgia Resistance Training Guidelines
2-3 minute rest intervals between sets is required since the body takes longer to replenish energy stores. This time can be used for stretching the muscles you are working Work towards completing a strength training routine two to three days per week and increase the number of sets and reps slowly, as tolerated. Free weight exercises can be introduced once the client achieves a higher fitness level, although this may take many months to reach.

61 Fibromyalgia Flexibility Guidelines
Stretching should be done following the warm-up and after cooling down Each stretch should be held 20 to 60 seconds, and the routine should not involve getting up and down from the floor The benefits of stretching include: Improved circulation Relieving pain symptoms Loosening tight muscles (specifically around the neck and shoulders) that seem to be more tense in fibromyalgia clients

62 Fibromyalgia Contraindications
Client cannot progress as fast Allow more time to increase weight, sets and repetitions in training programs Shorter, more frequent exercise sessions are preferred over one long session If chronic fatigue, troubled sleeping or headaches develop, cut back the intensity of your workouts

63 Fibromyalgia Contraindications
Avoid the following exercises: Shrugs Pull-ups Rowing machines Leg extensions Squats Cable crossover machines These exercises place too much stress on tender areas

64 Cerebral Palsy


66 Cerebral Palsy (CP) Non-progressive, non-contagious disorder that affects muscle tone, movement, and motor skills (ability to move in a coordinated and purposeful way) CP is usually caused by brain damage as the result of injury or disease at or before birth (i.e., premature babies, meningitis, malnutrition, shaken baby syndrome) The term cerebral refers to the brain’s two halves, or hemispheres, and palsy describes any disorder that impairs control of body movement

67 Cerebral Palsy One of the most common congenital (existing before birth or at birth) disorders of childhood About 500,000 children and adults in the United States have the condition. The three types of CP are: Spastic cerebral palsy — causes stiffness and movement difficulties Athetoid cerebral palsy — leads to involuntary and uncontrolled movements Ataxic cerebral palsy — causes a disturbed sense of balance and depth perception

68 Characteristics of Cerebral Palsy
Muscle tightness Muscle spasticity Muscle weakness Incoordination Difficulty maintaining posture Difficulty maintaining balance Involuntary muscle movement Difficulty with fine motor tasks: Writing, cutting with scissors

69 Characteristics of Cerebral Palsy
Dysphagia: difficulty swallowing Speech impairments Deficiencies in sensation and perception Impaired vision and hearing Seizures Cognitive Dysfunction Learning deficiencies Breathing difficulties Postural deformities

70 Management of Cerebral Palsy Symptoms
Mostly involves managing the secondary symptoms: Muscle spasticity, seizures, joint pain, posture deformities Seizures occur in 60% of people with CP May be on anti-seizure medications, muscle relaxants or anti-spasmodic medications May also be on medications that control joint pain, posture deformities, and bladder dysfunction

71 Exercise Guidelines for Cerebral Palsy
Acquire medical clearance Screen for musculoskeletal abnormalities, heart disease, and other chronic diseases such as diabetes, arthritis and hypertension Clients with CP may have tremors, avoid using dumbbells and barbells

72 Exercise Guidelines for Cerebral Palsy
Exercise can help prevent the weakening or deterioration of muscles and avoid contracture, in which muscles become fixed in a rigid, abnormal position

73 CP Exercise Program Goals
Aerobic Endurance : To improve the respiratory system Increase stamina Strength: Prevent muscle atrophy Prevent muscle contractures Prevent muscle imbalance

74 CP Exercise Program Goals
Flexibility: To avoid muscle contracture To increase range of motion and maintain joint flexibility To reduce tension/stress Increase body awareness Encourage/facilitate making a mind body connection

75 CP Exercise Program Goals
Coordination, balance, and core training: To challenge the body’s proprioceptive system (muscle spindles and golgi tendon organs) Improve trunk stabilization Improve postural alignment and control Improve gait (walking) Improve weight transfer movements

76 Exercise Guidelines for Cerebral Palsy
The personal trainer will need to be creative and often modify equipment and exercises because of limitations client may have

77 Aerobic Exercise Guidelines for Cerebral Palsy
Moderate to vigorous intensity: 50-85% of VO2 or RPE of 4-6 on 0-10 scale Duration: 30 or more minutes Frequency: 4-7 days per week Mode: Elliptical, swimming, stationary bicycle, walking In very de-conditioned clients: Duration: 5-10 minutes twice per day Frequency: 4-7 days per week

78 Resistance Training Guidelines for Cerebral Palsy
Frequency: 2-3 days a week Volume: 2-3 sets 8-12 repetitions Intensity: 40-60% Focus on addressing muscle imbalances, weakness and areas that are most susceptible to atrophy Some exercises will need to be modified because of spasticity

79 Types of Resistance Training
Free weights With caution due to tremors Medicine balls Machines Resistance bands Sand or water filled equipment Water Exercise balls (air filled)

80 Lupus Lupus is a chronic inflammatory autoimmune disease that can damage the skin, joints, and/or organs (heart, brain, kidneys) Lupus can range from mild to life-threatening It is most common in women of childbearing age-15-44 Men and children can develop it too No gene or group of genes has been proven to cause lupus Individuals who are Asian, African, Native American, or Hispanic have a greater risk of developing lupus, which may be related to genes

81 Lupus It takes some kind of environmental trigger to set off the illness or to bring on inflammation Examples include: Ultraviolet rays from the sun A cold, virus, or infection Emotional stress, such as a divorce, illness, death in the family Surgery Pregnancy, or giving birth

82 Symptoms of Lupus Extreme fatigue Fever Headaches
Painful or swollen joints Anemia Edema in the feet, legs, hands, and/or around eyes Pleurisy- chest pain during deep breathing Shortness of breath Butterfly-shaped rash across cheeks and nose Sun or light sensitivity Hair loss Anxiety Depression Memory Loss Raynaud’s Disease: fingers turning white and/or blue when cold Mouth nose ulcers

83 Lupus and Exercise There are no specific guidelines as to how much exercise a person should do or when they should do it Some people with lupus can exercise daily for minutes without a problem while others may not be able to Everyone is different, so you need to listen to your client

84 Lupus and Exercise Exercise can reduce the symptoms of Lupus, increase endurance and strength, improve mood, and mobility Exercising is contraindicated during symptoms (flares) Rest is necessary Aerobic exercise is most appropriate Swimming, yoga, walking, cycling, Elliptical machine Isometric exercises should be performed with caution Increases blood pressure

85 Lupus and Exercise Avoid outdoor exercise in the sun because sunlight can trigger symptoms Exercise daily when stiffness and pain are the least Perform gentle active range of motion (AROM) exercises in the evening to reduce stiffness Modify exercise to avoid increasing joint pain

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