We’ve come a long way since 1780 when Luigi Galvani first made the legs of a dead frog hop using an electric shock. Nowadays electrical stimulation uses are many and varied, from localised pain relief to assisting in the delivery of medications. However, concerning those with neurological conditions, one area is attracting the most attention, Functional Electrical Stimulation (FES). Every movement we make begins with the brain. Let’s say you wanted to scratch an itch on your nose right now, a series of actions need to happen in the background beforehand. First, sensory information from the skin on your nose travels to the brain. Consciously or not you accept the mission to remove that itch. The brain dispatches an electrical signal which travels down the brain stem, onto the spinal cord where it meets its contact, the motor neuron, on the 5th vertebrae of the cervical spine. Quick as flicking a light switch the motor neuron takes that message from the spine to the belly of the bicep where it covertly recruits just enough muscle fibres as necessary to pull on your radius bone, bringing your hand to your face. Meanwhile, a second objective is simultaneously carried out to recruit muscle fibres on your triceps, just enough to ensure you don’t overshoot and end up picking your nose by accident. Sensory information again relays to the brain that the itch has been terminated, and with the mission accomplished another message is sent to the muscles to stand down. If there is that much involved in simply scratching your nose, just imagine the complexity of something like walking. The nervous system is an electrical superhighway of information starting at the brain and travelling to and from every other part of the body. If any part of this pathway is disturbed or broken, like in a spinal cord injury or stroke, information crossing that point is either impeded, or stopped altogether. Consequently, that command or movement cannot take place. The purpose of FES is to jump in beneath that disruption and replicate the electrical signal coming from the brain, allowing the muscle to forcefully contract, resulting in meaningful movement. With this intervention an individual with paraplegia could start cycling training with the assistance of an FES unit. Once electrodes are attached to the quadriceps and hamstrings of both legs, the unit can cause the muscles to contract and relax in sequence, facilitate the cycling movement. That’s great, so what? Well, once appropriately set up, the applications of FES are limited only by you and your therapist’s imagination. For example, the first commercially available FES device treated foot drop in stroke patients. A switch on the heel of the patient’s shoe would activate an electrode near their shin, stimulating their peroneal nerve, which in turn lifted the front of their foot. This simple application reduced tripping, increased safety, and improved the patient’s walking pattern. FES could be applied to generate a reach a grasp pattern to a stroke affected arm to assist in a self-feeding goal. Stimulation could be used to augment a patient’s own function, such as assisting the core in rolling. If timing or strength is lacking, then FES can assist, like initiating standing or coordinating walking. Or it can be used to provide practice where there is no active movement and give the muscle of your choice a real thorough workout. When properly implemented with a properly qualified therapist, this technology can be a valuable contribution to any training regime. Though it is an area of continue research and development, especially in the realm of neuroplasticity and the restoration of limb function, FES has come a long way and has become standard practice in many clinical settings. If only Galvani’s frogs were alive to see it. References: Frotzler A, Coupaud S, Perret C, Kakebeeke T, Hunt K, Eser P.Effect of detraining on bone and muscle tissue in subjects with chronic spinal cord injury after a period of electrically-stimulated cycling: a small cohort study. J Rehabil Med. 2009;41: 282-285
Griffin L, Decker M, Hwang J, et al. Functional electrical stimulation cycling improves body composition, metabolic and neural factors in persons with spinal cord injury. J Electromyogr Kinesiol. 2009;19: 614-622
Martin, R., Sadowsky, C., Obst, K., Meyer, B., & McDonald, J. (2012). Functional Electrical Stimulation in Spinal Cord Injury: From Theory to Practice. Topics In Spinal Cord Injury Rehabilitation, 18(1), 28-33. doi: 10.1310/sci1801-28
How To Protect Yourself From Shoulder Injuries If You Are A Wheelchair User
If you are a wheelchair user you have probably wondered why your shoulders are always sore. Sometimes you may even get random pain and tightness around your shoulder area even though you haven’t changed your daily routines. Unfortunately this is very common as more than ⅔ of wheelchair users have reported experiencing shoulder pain. What Are The Causes? For most wheelchair users their shoulders become the primary loader for transferring and ambulation throughout the community. Using a manual wheelchair puts significant demands on the upper extremities due to some of the following: Repetitive trauma and loading Muscle imbalances Poor seated posture (scoliosis, kyphosis) and shoulder function Incorrect technique used during wheelchair ambulation These factors often lead to chronic overuse which can contribute to ongoing shoulder pain, risk of joint injuries and inflammation. Seated Posture Abnormalities: Source: How can this be treated and prevented? Studies have summarised a combination of regular stretching of the anterior upper body and strengthening exercise for the posterior upper body to treat and manage shoulder pain. There has also been emphasis on early detection of impairments combined with early intervention can help manage shoulder pain and/or injuries thus improving daily function. It has been recommended that a home exercise program needs to be completed a minimum of 3days a week for it to have a significant impact on improving shoulder health. Stretching Benefits: Reduces muscle tightness and soreness Maintains good shoulder range of motion and mobility Assists with correcting postural issues associated with sitting for prolonged hours (scoliosis, thoracic kyphosis, forward head). Strengthening Benefits: Increases muscular endurance and reduces the onset of fatigue By strengthening the supporting muscles around the shoulder this gives it greater support to decrease risk of shoulder injuries. Help joint stabilization, power production for transfers and wheelchair propulsion. Click on the link below to access a few examples of shoulder mobility stretches. Code: btvdqcpo Year of Birth: 1990 If you need help with exercises that can help prevent shoulder injuries, feel free to contact us on (02) 7901 5876 or References: 1. Cratsenberg, K. A., Deitrick, C. E., Harrington, T. K., Kopecky, N. R., Matthews, B. D., Ott, L. M., & Coeytaux, R. (2015). Effectiveness of Exercise Programs for Management of Shoulder Pain in Manual Wheelchair Users With Spinal Cord Injury. Journal of Neurologic Physical Therapy, 39(4), 197–203. 2. Dysterheft, J., Rice, I., Learmonth, Y., Kinnett-Hopkins, D., & Motl, R. (2017). Effects of Daily Physical Activity Level on Manual Wheelchair Propulsion Technique in Full-Time Manual Wheelchair Users During Steady-State Treadmill Propulsion. Archives of Physical Medicine and Rehabilitation, 98(7),1374-1381.doi: 3. Finley, M., Ebaugh, D., & Trojian, T. (2018). Agreement of Musculoskeletal Ultrasound and Clinical Assessment of Shoulder Impairment in Manual Wheelchair Users With Various Duration of Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation, 99(4), 615-622. doi: 4. Van Straaten, M. G., Cloud, B. A., Morrow, M. M., Ludewig, P. M., & Zhao, K. D. (2014). Effectiveness of Home Exercise on Pain, Function, and Strength of Manual Wheelchair Users With Spinal Cord Injury: A High-Dose Shoulder Program With Telerehabilitation. Archives of Physical Medicine and Rehabilitation, 95(10), 1810-1817.e1812. doi:
Resistance bands are a great device to use in a home program and a fun, easy way to add resistance to your work out. This article lists some great exercises that can be used to improve your range of motion, strength and balance. Types of Therabands Resistance bands come in different forms and can be found online or at your local sports store. Band Loops Tube Resistance Bands Flat Bands Key Tips When performing these exercises make sure you are working within your range of motion and are not causing yourself any pain while performing the exercise. Key tips when using resistance bands: Make sure you have a stable base of support. If you have difficulties balancing, do the exercise on a chair or have a stable surface to hold onto. Start with the lowest resistance and gradually increase as the exercise becomes easier. Aim for 10 –12 reps and three sets to achieve the best results. If you have any pre-existing medical conditions, please consult your GP before commencing exercise. Exercises Shoulder Internal Shoulder Rotation Purpose: Strengthens the front of the shoulder and the rotator cuff muscles. Instructions: Begin with one end of the band securely attached. Grasp the other end of the band with your elbow at your side at a 90-degree angle pulling the band inward towards your body. Hold and slowly return. If you have a reduced range of motion, place a towel under your elbow. External Rotation Purpose: Strengthens posterior rotator cuff. Instructions: Begin with one end of the band securely attached. Stand with the band across your body and elbow bent at 90 degrees. Keeping your upper arm steady and rotate your arm out. Shoulder Lateral Raise Purpose: Strengthens the middle portion of the shoulder (deltoid) muscle. Instructions: Standing in the middle of the band, grasp the end of the band and, with straight arms, lift the band upward. Make sure you keep your shoulder blades down and thumbs up. Straight Arm Front Arm Raise Purpose: Targets the front part of the shoulder (anterior deltoid). Instructions: Stand with the middle of the band under your feet. Grasp the ends of the band and lift upward with your arms straight and palms facing down. Hold and slowly return. Scapula Stabilisers Exercise Purpose: Strengthens the muscles around the scapula and shoulder joint. Instructions: With a theraband tied around your elbows, rest on the wall at 90 degrees (shoulder height) and slowly contract your back and shoulder muscles while pushing into the wall. Hold and slowly release. Core Trunk Rotations Purpose: Strengthens core and back stabilizing muscles. Instructions: Stand or sit with your legs hip-width apart. Begin with one end of the theraband securely attached and hold onto the opposite end with your arms straight. Slowly rotate across your body away from the direction of the theraband. Once reaching the other side and the theraband is across your body, hold and slowly return. Straight Arm Pull Downs Purpose: Strengthens core and lower back. Instructions: Standing or sitting with legs hip-width apart to allow a firm base of support, begin with the theraband tied in the middle securely above your head. Starting with straight arms, reach up and grasp the two ends, pulling down with straight arms until they touch your thighs. Hold and slowly return. Legs Hip Flexion Purpose: Strengthens the hip flexors (iliopsoas). Instructions: With one end of the theraband securely attached, stand with your legs hip-width apart and the theraband attached to one of your ankles. Slowly pull your leg forward until it is in line with the other leg. Hold and return. Keep your back straight and avoid leaning or bending over. Ankle Plantar Flexion Purpose: Strengthens the muscles of the calf including the gastrocnemius and soleus. Instructions: Sitting in a chair or lying upright on a flat surface, wrap the middle of the band around your foot. Grasp the two ends of the theraband at your waist. Holding your hands static, slowly push your foot down into the band. Hold and return. Ankle Dorsi Flexion Purpose: Strengthens the muscles on the front of the leg (tibialis anterior). Instructions: With one side of the theraband securely attached, create a loop at the opposite end and place around the top of your foot. Lift the foot attached to the theraband toward your body. Hold and slowly return. Repeat for the other side. Hip Abduction Purpose: Strengthens the hip abductors. Instructions: With one end of the band securely attached to a stationary object on floor-level height and the other to your ankle, stand with the non-attached leg to attachment side-on. Slowly move your leg outward, away from your body. Hold and slowly return. Avoid leaning or bending your back. Repeat for the other side. Hip Adduction Purpose: Strengthens the hip adductor muscles and muscles around the groin. Instructions: With one end of the band securely attached at floor-level height and the other to one of your ankles, stand side-on with the attached leg facing the anchor point. Transfer your weight onto the unsecured leg and slowly bring your other leg towards your body. Hold and return. Crab Walks Purpose: Strengthens the muscles of the hips and knees. Instructions: Tie a theraband around both of your knees and stand with your legs shoulder-width apart bending down in sumo-squat position. Maintaining this position, slowly step sideways against the band while keeping your back straight. Take a couple of steps and return to standing position. Repeat in the opposite direction. Side-lying Abduction (clams) Purpose: Strengthens the gluteal muscles (glute meds). Instructions: Tie the theraband around both your knees while lying on your side with knees bent. Slowly lift the outside leg away from the other while squeezing your gluteal muscles. Hold and slowly return. Repeat for the other side. Now I’ve read this, what do I do now? Speak to an Exercise Physiologist to discuss your exercise plan. They may be able to tailor the exercise program to your needs and address strategies to help you improve your health and wellbeing.
To stretch or not to stretch- consider this for people with Cerebral Palsy
It is likely that everyone has heard the importance of stretching, and how it can be of benefit in maintaining range of motion, improving function and preventing injury. This sounds like it would be the case for the Cerebral Palsy (CP) population- particularly as a main characteristic of CP is muscle hyper-resistance (high resistance to stretch) ; this is alongside reduced muscle length and increased joint stiffness….but apparently, this may not be the case. A recent review by Kalkman et al (2020) suggests that there are little to no improvements on muscle function from stretching protocols used in children with CP. But why is this the case? Differences in muscle & tendon properties in CP clients Studies have shown that there are differences in the muscles and tendons of children with CP when compared to typically developing children. Including: - Shorter muscle length and longer tendon lengths - Shorter muscle fascicles (bundles of muscle fibres) - Limited potential for active shortening - Reduced force generation capacity - Changes in muscle and tendon growth factors Due to these changes, as well as changes in the joint stiffness and the way in which the musculotendinous unit (MTU) responds to stretching, it potentially may not be helpful in increasing muscle length or improving range of motion. Kalkman et al (2020) propose that one reason that stretching (passive, serial casting or Ankle-foot orthoses) may be ineffective, is that the majority of these interventions do not sufficiently stimulate a stretch in the muscle- they primarily target the tendon part of the MTU (i.e. the tendon is what “sees” most of the stretch applied). Imagine you are pulling at a cord tied to something. The part of the cord closest to you is made of elastic, and then the part tied up is made of rope. If you try and pull the rope away from what it is tied to, the elastic part of the cord is going to stretch out a lot easier and quicker than the rope part. This is similar to what is happening in the muscle-tendon unit in someone with CP- the tendon is the elastic, and the muscle is the rope….The tendon is the thing that is seeing the most of the stretch. Although some interventions can improve range of motion of the whole MTU, changes in actual muscle length seems to have very minimal (if any) contribution to these changes. The tendon stretch, the impact of passive structures, and increased stretch tolerance seem to have the most influence on any changes seen in range of motion. Perhaps these interventions are not able to achieve improvements in function, as they do not target the actual “muscle” part of the MTU well enough, which is the component that would potentially result in functional changes. So what can we do to improve the effectiveness of stretching in CP populations? Some ideas from research Botulinum Toxin- A and stretching: Botox injections can reduce the amount of resistance in the muscle, which allows it to receive more of a stretch when it is applied. Electrical stimulation and stretching- Stimulating the muscle/s that does the opposite action of the one you are trying to stretch (i.e. stimulating the muscles that straighten the knee) can help to create a relaxation response in the muscle/s you want to stretch (I.e. the muscles that bend the knee). This means you may be able to achieve a greater stretch in the muscle. “Eccentric fascicle loading” (i.e.“active stretches”)- Loading of the muscle whilst it is in a lengthened position can help to increase the stretch. Methods such as backward downhill treadmill training have been shown to promote walking and mobility measures. Stretching can be helpful to prevent worsening of contractures (which are frequently seen in the CP population), however as a stand-alone treatment, they do not promote muscle length improvements, or improve function in those with CP. Further research is required to determine the most effective way to improve muscle length and function, however it appears that stretching alone is not an effective intervention. Reference: Kalkman BM, Bar-On L, O’Brien TD and Maganaris CN (2020) Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome? Front. Physiol. 11:131. doi: 10.3389/fphys.2020.00131
What everyone ought to know about Nutrition and Spinal Cord Injury
Spinal Cord Injuries and Nutrition How to live and eat well with a spinal cord injury? For someone who has suffered a spinal cord injury the body undergoes a tremendous amount of physical and mental trauma. Not only does it suffer these effects it also goes through significant changes to the underlying cell structure leading to changes in the regulation of hormones, and the way the body utilizes food intake. This article presents key topics that are represented in the novel Eat well, Live Well with Spinal Cord Injury. Eat well, live well with Spinal Cord Injury is a highly educational book by two nutritionist Kylie James and Joanne E Smith who have both have suffered spinal cord injuries themselves. It presents a unique insight to some of the challenges people with spinal cord injury face after their injury and how to lead a healthy lifestyle following an injury. I feel that I get sicker easier than other? How come? Following a spinal cord injury, the body undergoes changes which can ultimately leave the person more susceptible to infections. Factors contributing to this include: - Immune system suppression - Paralyzed/weakened abdominal, intercostal and diaphragm muscles; which are essential in being able to clear airways. - Decreased activation of lymphatic system as a result of decreased mobility. Lymphatic fluid is reliant on muscular contractions to move. - Increase exposure to potential pathogens from touching wheelchair rims. - Higher dependence on others for personal care, exposure from other people’s illnesses. - High levels of stress, which can decrease immune function and increase constant cortisol release. - Increased risk of secondary health complications such as pressure sores, low bone mineral density, arthritis, type 2 diabetes. Why have I gained weight since my injury? Weight gain is one of the most common secondary health complications for those with a spinal cord injury. 65% of people with SCI are overweight a third of the population are obese. Some of the factors that contribute to weight gain after a SCI include: - Changes in body composition; higher proportion of fat mass and muscle wastage. - Lower resting metabolic rate - Some medications can contribute to weight gain - Reduced physical activity - Poor diets - Mismatched caloric intake to expenditure - Higher risk of nutrient deficiencies such as chromium which is important for blood sugar balance can often be depleted can lead to weight gain. - Changes in economic status - Hormonal changes, drop in testosterone, increase in estrogen à contributes to weight gain. - Chronic low grade inflammation has been associated with depression, pain, weight gain, compromised immunity. - Glucose intolerance and poor carbohydrate metabolism which can lead to insulin resistance and type 2 diabetes. What are some of the risks associated with increases in weight gain? - Increases in weight can decrease immune function. - Increase stress on nerves and joints - Decreased circulation - Increased inflammation and pain - Fatigue - Compromised bowel and bladder routine - Poor sleep - Depression - Increased risk of pressure sores due to skin folds - High blood pressure - Insulin resistance and type 2 diabetes - Fatty liver - Hormone imbalances - Difficulty breathing - Increased risk of blood clotting - Reduced life expectancy. How much food should I be eating? Caloric intake in determined by our energy expenditure. Generally, those who have suffered a spinal cord injury have a lower energy expenditure due to increased time being spent sedentary and reduced demand from their muscles. In order to maintain a healthy weight our caloric intake needs to match up with that of our energy expenditure. Kylie James and Joanne E Smith demonstrated some simple calculations which have been modified for that of a person with a spinal cord injury. I’ve gained some weight what do I do? Best thing to do is consult an expert nutritionist or dietician who can come up with a meal plan that is sustainable and something that you are able to stick to. Some hints to get you started on the right track: - Reduced caloric intake - Consume the appropriate portion sizes - Balance sugar levels - Restrict fruit intake to 0-1 fruits per day - Restrict grain intake to 0-1 servings per day - Set realistic weight loss goals around 0.5-1lbs per week. How do I get healthy calories in my diet that can help decrease inflammation? Almost everyone struggles to get the right type of calories into our bodies and to give our bodies the best chances of fighting infection if we were to get sick. Some foods to help with systemic inflammation include: I’ve heard my metabolism has slowed down since my injury; how do I increase this? Metabolism is a process by which your body converts what you eat and drink into energy (mayo clinic). Thermogenic foods have been shown to help stimulate metabolism these can include but not limited to whole foods (not processed foods), hot peppers, cayenne pepper, salsa, green tea, apple/apple cider vinegar, brussels sprouts/broccoli, celery. There are some supplements which can assist with improving inflammation within the body. Please consult your doctor prior to taking any as there can be interactions between supplements and medications you might be taking. - Chromium helps to improve insulin sensitivity. - Omega 3 is a natural anti-inflammatory agent Now I’ve read this, what do I do now? Please seek medical advice before undergoing any diet/ lifestyle changes. Never change medications without seek medical advice prior. Speaking to your local nutritionist or dietician can also help set you up with a dietary plan. Remember diet is one important factor in improving your overall health and exercise and diet go hand in hand. Speak to your local Accredited Exercise Physiologist on how you can get moving. The NDIS can also assist you in seeking professional advice from a dietician or Accredited Exercise Physiologist. Speak to your plan manager on how to get access to this type of funding.
We all know exercise helps decrease your chances of developing heart disease and help keep your bones healthy and strong. But did you know it also helps fight infections? As the winter months are coming around its tempting to give up on your regular exercise routine but many know that now is the best time to be exercising. So why exercise? Exercise increases the delivery of blood around the body and thereby the delivery of white blood cells. Your white blood cells are one of the systems responsible for battling infection. Increased delivery enables these white blood cells to do their jobs better. It is also suggested that being physical active can reduce the incidence of communicable and non-communicable disease and assist in flushing bacteria out of the lungs and airways. Helpful tips during flu season: - Get enough sleep; your body will have the best chances of fighting an infection should it occur. - If you are feeling sick try and taper the intensity but get your body moving. - Before any workout – wash yours hands, before, during and after you work out to reduce the spread of germs Exercise can improve mood, give you energy and improve mental health outcomes. Speak to one of our Accredited Exercise Physiologist today to find out more.
Five Reasons Why Wheelchair Users Should Regularly Exercise
When you use a wheelchair as a means for mobility, physical activity and exercise may be one of those things on your to-do list where you can’t seem to find any time for. In this guide, there are a few important reasons why you should reconsider your exercise priorities and a few good tips on how you can fit it into your lifestyle. Reason #1 | Health & Well-being Maintaining optimal health and well-being is a vital component to improving our quality of life. It is common for wheelchair-users to decrease their physical activity and exercise levels due to a lack of their functional ability. Active lifestyle is critical for wheelchair-users to prevent injuries, optimize physical and mental wellness, and decrease the risk of development of other secondary illnesses. 30 minutes of moderate intensity exercise 5 x a week is recommended as a minimum as a guide for healthy adults. Tip A talk test is a great way to assess the intensity. If you can talk but not sing during an activity, it’s a great indicator you are working at a moderate intensity. “It is health that is real wealth and not pieces of gold and silver” - Mahatma Gandhi Reason #2 | Shoulder Management Shoulder complications are very common with wheelchair users. Common activities such as household chores, lifting overhead and even sleeping can aggravate shoulders leading to muscle impingements, rotator cuff tear and general capsule tightness. Appropriate and adequate management exercises can reduce the occurrence of shoulder pain and other complications by strengthen and stretching muscles surrounding the shoulder joint. Simple daily stretches and strengthening exercises can prevent the risk of overuse injury and improve the ability to perform activities of daily living. Tip When stretching, a slight discomfort is recommended, pain from overstretching can cause injuries. If you suspect you have an injury due to overstretching, please seek medical advice. “Even if you don’t have time for a big workout, stretching in the morning and night really changes your body” - Erin Heatherton Reason #3 | Prevention of Chronic Illness There are many chronic diseases associated with living a sedentary lifestyle. The risk of developing cardiovascular or metabolic diseases increase dramatically as we spend more of our day in sitting. This is especially true for wheelchair users. Structured aerobic and strength training incorporating large muscle groups is required to reduce these risk factors. Tip High intensity interval training is great way to incorporate both strength and aerobic exercises. “Physical activity - even if you don’t lose an ounce, you’ll live longer, feel healthier and be less likely to get cancer, heart disease, stroke and arthritis. It’s the closest thing we have to a wonder drug” - Tom Frieden Reason #4 | Functional Ability Independence is a key factor in maintaining a high quality of life. Strength and aerobic capacity is an indicator of functional independence for wheelchair users. Maintenance of strength and aerobic capacity ensures that wheelchair users are able to perform daily task such as transfers, self-care and mobility. Lack of function ability will result in dependence on carers and family members and reduce social participation. Tip If you don’t use it, you lose it. Regular exercise will protect your functional ability. “Independence is happiness” - Susan B. Anthony Reason #5 | Mental Health Regular exercise releases endorphins into your body which helps energizes and boost your mood. It also provides you will an overall sense of wellness increasing your self-esteem. There is also a strong correlation between inactivity and the adoption of unhealthy behaviours such as consumption of junk food. Tip A healthy body leads to a healthy mind. ”The reason I exercise is for the quality of life I enjoy” - Kenneth H. Cooper If you would like to learn more about exercises for wheelchair users, contact us!