We’ve all seen the billboard on our morning commute, the pamphlet in a doctor’s waiting room, or the poster in a hospital elevator. Strokes can be treated if you act F.A.S.T- Facial drooping, arm weakness, slurred speech, time to call 911. However, this only skims the surface of the diverse impairments post-stroke that may linger in the next few months to years of someone’s life.
One day in the long-term acute care hospital, I met a patient whose past medical history included a stroke and severe ataxia limiting her ability to move around safely. Ataxia is caused when our nervous system is unable to control and coordinate voluntary muscle movements. For this patient, that meant not being able to stand up from the edge of the bed without two people preventing her body from throwing her backwards. No matter how many times we practiced, changed verbal cues, or changed tactile cues, the results remained relatively the same.
Eager to make a change, I decided to simplify the movement and incorporate Pilates knowing the latest research has been positive in this population, though limited in quantity and number of subjects. I found that simulating “the frog” from leg springs on the Pilates tower gave us the greatest results. The patient remained lying in bed while I tied two TheraBands to the head board, the same way Joseph Pilates was rumored to attach springs to the beds of sick individuals during World War I. With the legs each looped in a separate band, we focused on pushing equally against resistance to a 45-degree angle using the squeeze of the legs together as both a strategy and biofeedback to achieve control. It was an added bonus that this required the patient to also stabilize the trunk with the abdominals. I anticipated having to repeat this exercise over several sessions before seeing any significant carry over. However, the patient amazed me, her husband, and herself when the first stand following the exercise had so much control she needed minimal assistance from just one person. Using the bands daily, in PT and individually, she continued to make huge strides in her recovery preparing her for 3 hours of therapy a day when transferred to an acute rehabilitation facility.
In addition to replicating Pilates exercises, I realized these movements also reflect the work of Professor Heinrich Sebastian Frenkel who developed a series of symmetrical and asymmetrical, smooth, and rhythmic movements to reduce ataxia. I am now considering reimagining all the Frenkel exercises to be performed with Pilates equipment or principles, specifically mimicking the Pilates tower and chair, with future patients.
Although I have trialed this on only one patient so far, the research supports my theory and experience. In 2014 Shea et. Al. determined Pilates improved balance, lower extremity strength, and quality of life post-stroke. Posture and gait speed remained the same, but what I found most interesting (and relative to my experience) is that the most significant changes far surpassing the minimal clinically important difference were on the BERG and 5x Sit to Stand! In 2016, Lim et. Al looked deeper into the effects of Pilates on Balance post-stroke while Roh Et. Al researched how Pilates improved walking post-stroke using 3D motion analysis. Pilates was found to significantly improve sway and velocity in all directions with static and dynamic balance, stride length, gait velocity, and knee and hip ROM. Lastly, and just last year, Yun et. Al. found using Pilates post-stroke shows significant improvements in physical, social, and psychological domains improving the overall quality of life.
To wrap it up, I'm jumping on my soap box. Pilates is often associated with fit, healthy, women in the gym. Please don’t fall into this rabbit hole! I am hoping this post encourages both Pilates and medical professionals to challenge themselves to incorporate these methods into settings and populations you may have not thought were possible, including acute care and patients recovering from a stroke.
REFERENCES
Lim, H. S., Kim, Y. L., & Lee, S. M. (2016). The effects of Pilates exercise training on static and dynamic balance in chronic stroke patients: a randomized controlled trial. Journal of physical therapy science, 28(6), 1819-1824.
Roh, S., Gil, H. J., & Yoon, S. (2016). Effects of 8 weeks of mat-based Pilates exercise on gait in chronic stroke patients. Journal of physical therapy science, 28(9), 2615-2619.
Shea, S., & Moriello, G. (2014). Feasibility and outcomes of a classical Pilates program on lower extremity strength, posture, balance, gait, and quality of life in someone with impairments due to a stroke. Journal of bodywork and movement therapies, 18(3), 332-360.
Yun, S. M., Park, S. K., & Lim, H. S. (2017). Influence of pilates training on the quality of life of chronic stroke patients. Journal of physical therapy science, 29(10), 1830-1835.
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