Murderball

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

2. Murderball • http://www.youtube.com/watch?v=_kaT5dDiISw

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

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 • http://www.youtube.com/watch?v=0dneU_ZrF0E

25. Multiple Sclerosis (MS) • Most commonly diagnosed neurolgicaldiease 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 • http://www.youtube.com/watch?v=voMQ26IW3Wg

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: 30-60 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 • http://www.youtube.com/watch?v=rjLD2BpoL1c