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NEUROLOGICAL CONDITIONS
Working with neurological conditions
Low levels of physical activity are often found in people with neurological conditions and a high level of secondary conditions associated with inactivity. However the available evidence suggests that people with neurological conditions are no different from the general population in their response to exercise and the
benefits that may accrue (1), writes Helen Dawes. resistance to movement and can make moving and exercise harder. Exercise does not make these symptoms worse and may help to reduce both. Medication, such as Parkinson’s medication or muscle relaxants, may be extremely important in reducing spasticity and rigidity in some individuals. Fitness professionals should discuss whether the client takes any such medication and how they best time this at profiling. Flexibility training may help to manage muscle spasticity and rigidity and should be planned within a profile. Importantly underlying weakness and poor functional muscle movement may be present in muscles that have spasticity and rigidity and so functional strength training is still implicated.
peripheral and speech muscles. All these components respond well to training in people with neurological conditions. For certain rare muscular conditions eccentric training may not be indicated and appropriate and safe training should be confirmed with the neurologist or physiotherapist in charge of their medical care prior to starting their training.
l Apraxia: This is the loss of motor planning and movement, characterised by a loss of ability to execute or carry out learned purposeful movements even though the individual may be motivated and physically able to perform them. The individual may have strong and coordinated limbs but may no longer recognise and remember what a particular tool, such as a bike, is for or how to use it. They may have difficulty in planning activities such as dressing hence getting dressed in the wrong order putting on trousers before pants or have difficulty working out how to get on and off gym equipment.
l Altered muscle strength: There may be altered muscle strength, speed, power and increased fatigue in core,
l Altered movement: Altered movement skill may be present due to both neural and muscular changes and hence individuals may have an increased energy cost when performing movements such as walking, cycling or running. Whilst the level of difficulty will vary, any individuals who present with uncoordinated and seemingly effortful movement may be working harder than someone without a neurological condition. For example, when cycling on an ergometer or walking on a treadmill at the same resistance level or speed some individuals may be working twice as hard as expected. Monitoring heart rate and perceived exertion will help to establish the level
of effort; the individual may not be as ‘unfit’ as you think!
l Sensory changes: Sensory changes such as reduced skin sensation, body position and movement awareness are relatively common symptoms. This should be considered as an important part of the profile to establish and consider when planning training programmes. Individuals may have greater difficulty with free weights, but if exercises can be safely performed clients may really benefit from them.
l Autonomic dysfunction: Although less common some individuals may have altered and attenuated blood pressure and heart rate responses to movement and activity. When dealing with individuals who complain of feeling strange or dizzy when changing position, autonomic dysfunction should be considered and it is worth keeping an eye on heart rate responses during exercise.
l Variability: Performance, health and
Exercise programmes that contain flexibility, endurance, skills, coordination and strength training and combined training programmes can benefit mobility, health and wellbeing in people with neurological conditions
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