Training with a damaged nervous system (Stroke)

[Matthias Weinberger]

Hi Mark!

I freely admit that I belong to one of the groups of health professionals that you love the most:
I am a member of the cult that is Physical Therapy.

Also: your rant about PT is pretty much spot on.
The only thing where we differ is that you call it fraud, I call it a cult or a bunch of competing religions.

Since I work in Neuro Rehab my question is this:
"real" training as per SS is movement training. In order to do this, the central and peripheral nervous system have to be intact.

What is your experience with partly damaged nervous systems?
Be it central lesions (altered gait patterns after stroke) or peripheral lesions (where the damage is only partial and will recover over time).
The going theory and treatment approach (at least here in Germany) is one of motor learning starting with passive movements, then assisted movements to active movements without gravity and so on in severely affected patients.

But I'm interested in for example training the squat and a possible influence on the gait pattern of hemiplegic patients.
And pointers would be welcome!

[Mark Rippetoe]

By definition, passive movements (those produced by the therapist instead of the patient) involve no CNS activity, and therefore lack the ability to affect the CNS. Moving a joint through a ROM without the use of the patient's neuromuscular system seems like an excellent way to postpone any therapeutic value that might be obtained in the therapist/patient interaction. In the case of partial paralysis, the patient engages as much of the kinetic chain as possible and obtains adaptation around the completely paralyzed portions of the KC. As nervous function returns, the portions peripheral to the damage continue to assist the damaged areas as their function returns -- IF the gross motor pathway that uses the whole KC has been trained. PT's problem is that it thinks about muscles instead of movement patterns.

So, you get the patient to perform something that looks as much like a squat/deadlift/press as you can. This requires a background in coaching these movements with unimpaired subjects.

[Matthias Weinberger]

Ok, thanks for the input.
Just to clarify: the passive movements are done in completely paralysed patients that have zero active function.
They have to observe the passive movement and at the same time imagine doing it themselves.

It's similar to mirror therapy after stroke where they watch a mirror image of their unaffected side doing the movement.

[jfsully]

By definition, passive movements (those produced by the therapist instead of the patient) involve no CNS activity, and therefore lack the ability to affect the CNS.

Not true.

Entirely passive ROM is really impossible except in cases of total paralysis. If you watch someone moving your arm back and forth, you will exert some resistance or assistance, even if it is not enough to affect the movement.

Aside from this, there is sensory input to the CNS even from entirely passive ROM.

Also, I t’s possible to achieve CNS changes without any movement at all, as in mirror box therapy.

All that being said, active movement has the most bang for the buck in rehab, but you would be wrong to assume that passive ROM is always a waste of time. In early stroke rehab, it’s often the right first step.