Pilates For A Post Ischemic Stroke Client

PILATES FOR
A POST ISCHEMIC STROKE CLIENT
By Susanna Cecchi
November 2014
Course year 2013
Pilates In Tuscany, Prato
Italy
Abstract Summary
L’ischemia celebrale, dal Greco ισχαιµία, isch= riduzione, -emia = sangue è la
mancanza assoluta o parziale di un adeguato afflusso di sangue al cervello,
causata da un problema del sistema cardiocircolatorio. Parametri importanti
per definire l'entità del danno da ischemia sono: l’entità ischemica, la velocità
di comparsa, il tempo di durata ed la porzione di tessuto coinvolto. I tessuti
che per primi vengono colpiti sono quelli del cervello che presenta danni
irreversibili dopo solo 4-5 minuti. La conseguenza più comune è la demiplegia,
ovvero la paresi di una metà del corpo. Questo avviene perché, insieme al
danno celebrale, vengono danneggiate anche le funzioni mentali, cioè, i
processi cognitivi, che permettono il movimento stesso. In particolare viene
danneggiata l’immagine motoria, cioè la capacità di immaginare il movimento
prima di eseguirlo. L’ischemia celebrale, danneggia solo e esclusivamente il
cervello, ed i processi cognitivi, NON i muscoli.
l nostro sistema nervoso centrale gode di plasticità, ovvero può modellarsi sulla
base delle esperienze che viviamo. Recuperare da un’ischemia celebrale,
significa imparare, apprendere nuovamente a sentire e muovere il corpo, un pò
come abbiamo fatto da bambini.
La qualità del recupero del paziente è ovviamente legata alle esperienze a cui è
sottoposto. La riabilitazione assume un ruolo centrale nel processo di recupero
di un’ischemia celebrale, e la qualità del recupero sarà determinata dal modo
in cui verranno recuperati i processi cognitivi alla base del movimento.
Table of Contents
1. Title Pages
2. Abstract Summary
3. Table of contents
4. Physiological description of a stroke
5. Anatomical description of the muscles involved
6. Case Study
7. Conditioning Program
8. Conclusion
9. Bibliography
STROKE CAUSES
A stroke occurs when the blood flow in part of the brain is blocked, after just a
few minutes the start brain cells begin to die .
Normally the brain receives blood via two major pairs of arteries which branch
throughout brain tissue and supply
your brain cells with a constant flow of
oxygen and nutrients necessary for their functions.
In one type of stroke ‘’ ischemic stroke’’, an artery in your brain narrows or
becomes completely blocked preventing normal blood flow.
The Blockage maybe caused by a blood clot also called a thrombus which
forms in an unhealthy artery of the brain.
The lack of blood flow causes the tissue the artery supplies to become starved
or ischemic.
Similarly the blockage maybe due to embolus a blood clot that forms
elsewhere in the body and travels to the brain.
The embolus lodges in a narrowed artery and obstructs blood flow.
In
contrast during a hemorrhagic stroke abnormal bleeding disrupts normal
blood flow for example in and intra cerebral hemorrhagic stroke a blood vessel
bursts spilling blood directly onto your brain while rubbing the intended tissue
of nourishment .
Both the hemorrhage and ischemia destroy brain tissue. A subarachnoid
hemorrhagic stroke occurs when a weak spot in a blood vessel wall called
aneurism, bursts and leaks blood into the tight space between your brain and
your skull the high-pressure bleeding result in serious damage to brain tissue.
Immediate treatment for stroke may help to minimize brain cell injury and
death.
If you have an ischemic stroke you maybe give a medication to break up the
clot causing your stroke. Later your doctor may recommend surgery such as
carotid and directed me to reduce your risk of having another ischemic stroke
in the case of hemorrhagic stroke emergency surgery may be necessary to
repair damaged arteries or reduce the pressure of the blood on your brain you
may be given medication to help the brain blood flow returned to normal
Anatomical description of the muscles involved
Case Study
Name: Cristina
Female Age: 60
Limitation after the ischemic stroke: Abnormal sensations in the right side of
the body, weakness and semi-paralysis of the right arm and the right leg.
Partial loss of vision, dizziness, slurred speech, problems saying the right word,
inability to recognize parts of the body, imbalance and falling, trouble with
starting and coordinating body movements (apraxia).
Upon arrival at the studio after a long period of rehabilitation with her
physiotherapist: Abnormal sensation and weakness of the right side of the
body, inability to recognize parts of the body and imbalance and falling, trouble
with starting and coordinating body movements.
Conditioning program
Warm up: MAT (1-3 week)
Pelvic Curl: At the first Pelvic Tilt to try to activate the right pelvic muscles.
Pelvic Curl . Modified Spine Twist Supine with foot on the mat. Modified Chest
lift with towel under her back, to help her to get up head, neck, and chest,
without using the neck muscles so much. Chest lift with rotation: with towel,
but she don’t feel the right part of her body. Leg Lift: she don’t feel the right
part of her body. Modified Leg Circle with bent knees. Spine Stretch
Foot Work: REFORMER or CADILLAC
Parallel Hells. Parallel Toes. V position. Open V Hells. Open V Toes. Calf Raises.
Prance. Single Leg Hell. Single Leg Toes
Abdominal Work: REFORMER or MAT
Reformer: Hundred prep
Mat: Hundred prep
Hip Work: REFORMER or CADDILLAC
Reformer: Frog. Circle down/up she try to close legs at the same time.
Openings, her right leg arrived before left.
Cadillac: to improve her imbalance, and her inability to recognize parts of her
body. Extended single leg supine. Frog, Circle down/up, Hip Extension, Bicycle
Stretching: REFORMER
Standing Lunge, she don’t feel the right part of her body
Arm Work: REFORMER
Arm Supine Series: Chest expansion, Adduction, Up Circle, Down Circle,
Triceps.
Leg Work: MAT
Modified Gluteals Side Lying Series:(without weight). Side leg lift, Forward and
lift, Forward with drops
Lateral Flexion/Rotation: MAT
Side Lift, she doesn’t fell the right part of her body
Back Extension: MAT
Back Extension, Cat Stretch
Warm up: MAT (3-6 weeks )
Pelvic Curl: At the first Pelvic Tilt to try to activate the right pelvic muscles.
Pelvic Curl . Spine Twist Supine. Chest lift without any props. Chest lift with
rotation without any props. Leg Lift. Leg Circle. Modified roll up with bent
knees. Spine Stretch.
Foot Work: REFORMER or CADILLAC or WUNDA CHAIR
Parallel Hells. Parallel Toes. V position. Open V Hells. Open V Toes. Calf Raises.
Prance. Single Leg Hell. Single Leg Toes
Abdominal Work: REFORMER or CADILLAC or WUNDA CHAIR
Reformer: Hundred prep, Hundred
Cadillac: modified Roll up with roll up bar, with bent knees, Mini roll up, mini
roll up with oblique.
Wunda Chair: Standing Pike, Standing Pike Reverse.
Hip Work: REFORMER or CADDILLAC
Reformer: Frog. Circle down/up she try to close legs at the same time.
Openings, her right leg arrived before left.
Cadillac: Frog, Circle down/up, Walking, Bicycle.
Spinal Articulation: REFORMER or CADILLAC or WUNDA CHAIR
Reformer: Short Spine
Cadillac: Tower Prep
Wunda Chiar: Pelvic Curl.
Stretch: Pole series
Full Body integration I: REFORMER or CADILLAC
Reformer: Scooter, Down Stretch.
Cadillac: Sitting Forward, Side Reach.
Arm Work: REFORMER or CADILLAC or WUNDA CHAIR
Reformer: Chest expansion, Biceps, Rhomboids , Hug - a - tree, Triceps.
Cadillac: Arm Standing Series. Chest Expansion, Hug - a - tree, Circle Up/
Down, Punches, Biceps.
Wunda Chair: Triceps Press Sit.
Leg Work: REFORMER or WUNDA CHAIR or MAT
Reformer: Hamstring Curl
Wunda Chair: Hamstring Curl, Leg Press Standing
Mat: Gluteals Kneeling Series.
Lateral Flexion and Rotation: REFORMER or WUNDA CHAIR or MAT
Reformer: Side Lift
Wunda Chair: Side Stretch
Mat: Side Lift, Saw
Back Extension: REFORMER or WUNDA CHAIR or MAT or CADILLAC
Reformer: Breaststroke prep
Wunda Chair: Swan Basic
Mat: Back Extension, Cat Stretch, Swimming
Cadillac: Prone I
Conclusion
Recovering from a stroke can be very frustrating. It is common to face
depression and have some setbacks. You may make strong improvement at
first and then feel like you have lost some of what you gained. Cristina and I
made a good job together, because she never lost the fortitude to go on her
rehab. Step by step she began to fell her body again and she lost the abnormal
sensation and weakness of the right side of her body. At first I divided each
exercise in tree steps: 1. I showed her the exercise to improve the imitation
through her sight. 2. I guided her movement with my hands. 3. I let her do the
exercise by herself guided only by my voice. I’m very proud of our goal, and
now she fells more strong and safety, and she has started to do a normal life
again.
Bibliography
Texts:
Body Arts and Sciences 2000-2013
Study Guide Body Arts and Sciences 2000-2012
Movement Analysis Workbook for Mat Auxiliary
Cadillac, Reformer, Wunda Chair, Ladder Barrel
Website:
Stroke and Post stroke rehab
Ischemic Stroke
Anatomy of the brain