1. The significance of prior sport and exercise involvement in the management of stroke and multiple sclerosis
Erika Borkoles1 and Remco Polman1
1Victoria University, Melbourne, Australia
The significance of sport and exercise participation prior to developing a chronic disease is poorly understood. Knowledge of one’s physical body, its capabilities, the feeling that arises when using it in an exercise setting is not well documented. Pacing and effort needs to be relearnt and adjusted after having a stroke or MS. Knowing the body and how it responds provides a reference point for those who had been active. Little is known how this prior knowledge of body influences rehabilitation or adjustment to the management of the disease. The aim of this study was to have an in-depth understanding the carry over effects of sport and exercise participation into the rehabilitation process after having a stroke and living with a chronic disease (MS).
Introduction
Data Analyses & Findings:
A mixed-method (QUAN-QUAL) integrated analyses revealed that prior sport experience played a key role in his rehabilitation after stroke and whilst living with a disabling chronic disease such as MS. Using his exceptional body awareness and understanding of his body’s past capabilities that he acquired through formal training up to the day of the stroke, this former athlete was able to make an exceptional gain in relearning basic movement skills. The shift from training the body for performance to independent living was difficult. However, he was able to adjust his pacing and effort appropriately to his current physical status that allowed him to live an independent life again.
Mixed-Method Results
The Case Study: Gabe
Balance:
“After the stroke, one of first things was the concern about my balance. It’s a pretty frightening thing when you have no control of your body. Whenever anyone experiences that it will be quite a shock that there is your body and you cannot do anything about controlling it. Particularly when I had that seated balance problem. When I first had the stroke I had no balance. I think on the first day in the hospital I still couldn’t sit up. The had me mainly lying down because I couldn’t sit up. But that quickly improved I thought because I actually took myself to the toilet without the nurses knowing”
This former athlete had the sufficient knowledge from his training that he specifically adapted to improve his balance and making him feel safe when out and about. He used his extended arms to steady and retrain himself.
“I put a pushbike in the hallway so that the walls were nearby, and just sitting on a pushbike and thinking will I be able to be aware that I am losing my balance and fall? At least try to regain an awareness. The the issue of well okay, you’ve got awareness but now can you actually do something about it?”
“My confidence was pretty good about dealing with those problems for a couple of reasons. Even before I got the Nintendo Wii I practiced. I was aware of biomechanical efficiency again coming from the sport, I knew all I needed to do was train myself and be aware of how I keep my centre of gravity. Keeping knees bent. Don’t panic. You know it’s a tough thing to say to yourself don’t panic, but I was trying to say to myself to relax, focus on the things that I need to do like keeping the knees loose and bent so that I can control my balance. So I don’t worry about my balance now. I still have falls, but it doesn’t put me back into this headspace of ‘oh my God its so dangerous. I still feel pretty confident.
The findings of this research suggest that to improve rehabilitation outcomes after stroke or whilst living with a neurological disease we need to understand prior sport and exercise experience of patients.
A strong athletic identity in this research positively influenced the stroke rehabilitation experience of this former athlete. Future research should explore how sport and exercise participation influences the rehabilitation process in larger samples and in individuals with varied neurological diseases.
Take Home Message
Participant:
N= 1 – Single-case study design.
M age: 42
Main sport prior to stroke: triathlon & running
Description of participant:
A formal Australian Master’s athlete who came six at a Triathlon World Championship. At the age of 39 he had a massive stroke then was diagnosed with MS.
Design: A mixed-method study.
Procedure:
The participant filled out a number of validated questionnaires with demographic and sport history information.
Life History and IPA Interviews (IPA; Smith & Osborn, 2008):
Five 4 hours in-depth interviews (n=1) using both life history and IPA interview schedules was conducted. All interviews were recorded and transcribed verbatim.
Methods
Reference
Borkoles, E., Nicholls, A.R., Bell, K., Butterly, R. &
Polman, R. (2008). The lived experiences of people
Diagnosed with multiple sclerosis in relation to
Exercise. Psychology and Health, 23,
Contact Details: Tel: Institute of Sport, Exercise & Active Living