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Pilates for Parkinson’s Disease With Focus on Muscle Rigidity and Postural Instability Rhenana Grimes March 4,2017 Costa Mesa; Aptos, CA, 2016

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Page 1: Pilates for Parkinson's Disease - Pilates Equipment · Pelvic Tilt/Curl – started with just pelvic tilts/rocking Spine Twist Supine – I held her legs for control and worked our

PilatesforParkinson’sDiseaseWithFocusonMuscleRigidityandPosturalInstability

RhenanaGrimesMarch4,2017

CostaMesa;Aptos,CA,2016

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Abstract

Parkinson’sDiseaseisaprogressivediseasethatresultsfromalossofbraincellsthatcontrolmovement,andaffectshowyoumove,actandfeel.Itisreportedthatapproximatelysixtythousandcasesarediagnosedeachyear.Thestagescanbebrokendownintostages;earlystage(littleassistance/manageable),moderatestage(needsassistance/lifestylechanges),andadvancedstage(difficulttomanage/endoflife).Somesymptomsinclude,tremors(uncontrollableshaking),rigidity(musclestiffness),gaitshuffling,posturalinstability,bradykinesia(slowedmovements),freezing(muscleswon’tmove),difficultyswallowing,depression,andpain.AlthoughthereisnoknowncureforParkinson’sDisease,managementofitssymptomscanincreasethequalityoflifethroughoutthelifespanoftheillness.Medicationisoneofthetreatments,butproperdietandexerciseareofgreatimportanceinthedaytodayregimeofapersonwithParkinson’s.Pilates,inparticularisknownforitsmind-bodyconnection,makingitavitalinhelpingwithanxietyanddepression,aswellas,strengtheningandstretchingtheweakenedmusclescausedbyParkinson’s.

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TableofContents

TitlePage1Abstract2Diagrams&Photos4-5CaseStudy6ProgramAssessment7Weeks1-3Workout8-9Weeks4-10Workout10-11

Conclusion12

Bibliography13

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DiagramsofPosturalInstabilityandRigidity

CorrectedStanceGoalClients“Normal”Stance

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RightShoulder“hiked”CorrectedPosition

UseofLongBoxforcomfortDuetomusclestiffness

UprightFootWorkUsefulforbalance&Control.Feetdon’tflexAndtoescurl

LegPressStandingusuallyassistedwithagoalofdoingunassisted,verychallenging

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CaseStudy

Myclient,Joellaisa53-year-oldfemalewhowasdiagnosedwithParkinson’sDiseasetwoyearsago.Itisbelievedthatshehashadthediseaseforover6yearsbuthadbeenmisdiagnosed.Bynowhersymptomsareinthemoderatestagesandseemtobequicklyprogressing.Joelladoestakeamildmedicationandhasdramaticallychangedherdiettoaccommodateherdisease.Uponherresearchofotheravailabletreatments,JoellasoughtoutPilatesasawayofcopingwithdaytodaylife.Hersymptomsincludelegshuffling,musclerigidity,imbalance,slowedmovement,pain,depression,tremors,slowedspeechanddifficultyswallowing.Joellahasworkedanofficejobforover20years,whereshesitsandtypesthemajorityoftheworkday.Itisespeciallydifficultforhertogetupanddownfromsittingorlyingpositions.Movementingeneralisdifficultforherandtherealizationofherillnesshascauseddepression.ShewasrecentlyabletobetakenoffworkduetoherprogressingsymptomsandwiththisschedulewillbeabletocometoPilatesmoreregularly.Otherwise,thisprogramisbasedonaonceaweekattendance.Joellahopestoslowtheprogressionofhersymptomsbystrengtheningtheweakandrigidmuscleswithweightresistance.Anothergoalistoworkonherbalancetopreventfallsandinjury.Shealsoneedstobeabletogetupanddownfromsittingandlyingpositionsasthesetasksarebecomingmoreofachallengeforher.Joellastatesshe“needstoworkonleftside/rightsideexercises”becauseonesideofherbodyisweakerthantheother.Themind-bodyconnectionisalsoagreatneedforJoella,inordertoexerciseherbrainaswell,inhopestoridherofanxietyanddepression.

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BASIConditioningProgram

Uponarrivalofherfirstvisit,Joellawasinagreatdealofpain,stiffnessandwaswalkingveryslowly.Iknewitwouldbechallengingtogetherdownonthereformer,sowestartedontheCadillacandworkedourwaytothereformer.Theinitial3workoutswereonly30-45minutes,asJoellawaslackingendurance.Igaveherafewstretchesandexercisestopracticeathometobuildenduranceandstrengthinbetweenvisits.Byweek4,shewasabletocompletethehourworkout.

ASSESSMENTIcouldgathermuchinformationfromsimplylookingatastraightforwardstanceoftheclient.Withaweakerleftside,itcasedJoellatobearmuchofherweightonherrightsidecausinghertobetenseonthisside.BecauseJoellawasunabletodoarolldownfromastandingpositionduetoherimbalance,IhadhersitfirstontheCadillacwithherfeetagainstthepolesfacingthePTBarasinthe(FBI)SittingForwardexercise.IthenhadherholdthePTBarwithalightspringandrolldownwhilecueinghertodrawinherabdominals,roundinghertrunkintoaCcurvetoemulatearolldown.IkneeledbehindherontheCadillacinordertoassessthecurvatureofherspineinforwardmotion.Shecouldnotbendtoofaratfirst,butitwasenoughformetogetsomegoodinformation.IconcludedthatJoellawas“hiking”herrightshoulderup.Thismadesenseduetotheleftweakerside.Shewascompensatingbysqueezingmoreontheright.Icuedhertorelaxherrightshoulderandputmyhandsonhertohelpherfeelwherecentralalignmentwas.Shestatedthatitfeltlikeshewasthenleaningtotheside,andalthoughshewasn’t,itwasagoodindicatorofhowlongshehadbeenusingthisunbalancedformation.Withtheremindercues,shewouldthenrepeatthemove4-5timeseachtimetryingtostretchahairdeeper.Iwasvery“handson”inthefirstfewweekstoaidintheexecutionofthemovements.MovementsweresmallasJoellabecameawareandfamiliarwithmusclesandmusclegroupsandhowtoengagethem.

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Weeks1-3Workout

Warmup:FundamentalMat(onCadillacforplatform/easieraccessthanfloor)PelvicTilt/Curl–startedwithjustpelvictilts/rockingSpineTwistSupine–IheldherlegsforcontrolandworkedourwayuptosmallunassistedmovementChestLiftChestLiftw/Rotation-Detailedcueinghelpedtofindandengagethesemusclesthathadbeenunused.*Focusonabdominalawareness&control/pelviclumbarstabilization/breathingfromdiaphragmFootWork:WundaChairClienthasdifficultygettingupanddownsoIchosethechairtokeepupright.ParallelHeels–Duringbilateralexercises,Icuedtodistributeweightevenly,pressingfrombothsidesParallelToesOpenVHeelsOpenVToesSingleLegHeels–Singlelegwasespeciallygoodforleft/rightstrengtheningSingleLegToes*Focusonhamstrings/foot&anklecontrol/trunkstabilization/bilateral&unilateralmusclecontrolAbdominalWork:FundamentalMat(onCadillacforplatform)HundredPrep–Babystepsarebetterthancompromisingform.Ihadherreallyfocusonthemovewithbreathandhowtouseabsratherthanpullingfromneck.*Focusondeepeningtheawarenessofabdominalmuscles/layeringabdominalmusclegroups/usingabsnotneckHipWork:StrapWork,Reformer(withassistance)Frog–Focustokeepheelstogetherwasamind-bodyconnectionCirclesDown–cueingnottorockpelvisandformovementtocomefromhipsCirclesUp–clienthaspainandstiffnessinhipssothiswashelpfultowardgainingmobilityOpenings–Goodforstrengtheningadductors*Focusonhipadductors/abductors/pelvicstabilization

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SpinalarticulationandStretches:Reformer(improvised)Bothfeetinstrapslyingsupineasafollowupfromhipwork,legstogether,straightenbothlegstoperpendicularposition(asmuchaspossible),stretchinghamstringsthenslightlyloweringlegs.Thenrockinglegsbackuptoperpendicular.Thiswasarealisticandeffectivespinalandhamstringstretchconnectingbreathtobody.*Focusonbreathingthruthestretch

FullBodyIntegration:FundamentalReformerBottomLift–Footbardown/feetonplatform-Iwaspleasantlysurprisedtoseethefocusanduseofmusclegroups*Focusonspinalarticulation/hamstrings/absArmWork:FundamentalReformer,ArmsSupineSeriesExtension–UsedalightweightontheseduetorigidityandtremorsinhandsAdductionUpCirclesDownCirclesTriceps*Focusonshouldermobility/coordinationThiswasaboutthetimewhereInoticedanythingmuchpassedthiswouldnotbebeneficialwiththeleveloffatigueJoellawasexperiencingasshehadnotexercisedinquitesometime.Theactofgettingupfromthereformerconsistedofitsownformsoffullbodyintegration,legworkandlateralflexion.Thenew-foundawarenessofherabdominalmuscleswasimmediatelynoticeableandputtouseassheworkedherwayupfromthereformer.Ifinishedthesessionwithsomestandingmovementasfollows:CoolDownInterlacedhandsbehindbackNeckmovementfromsidetoside/fronttoback–especiallygoodforpersonswithParkinson’sShouldershrugs/rollsSidereach/lateralflexion*Focusonbreathingfromdiaphragm/bilateral&unilateralmovement

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Weeks4-10Workout

SittingForwardormyversionofa”SittingRolldown”onCadillac(asdescribedinassessmentabove)hasbeenthepreferredstarttoeachsession.Ihavenowaddedaspringforresistance.

Warmup:FundamentalMat(onCadillacforplatform)PelvicCurl–helpfulwithbalancewhenrollingallthewayupSpineTwistSupine–noassistanceChestLiftChestLiftw/Rotation–goodforleft/rightsidestrengthening*Focusonabdominalawareness&control/pelviclumbarstabilization/breathingfromdiaphragmFootWork:ReformerParallelHeels–performingthesefeetexercisesaregoodforstrength,balanceandshufflinggaitParallelToesVToes–mindbodyconnectiontokeepheelstogetherOpenVHeelsOpenVToesCalfRaises–greatstrengtheningforcalvesalsoheldheelsunderforastretchonlastreptohelpwithstiffnessandrigidityPrancesSingleLegHeelsSingleLegToes*Focusonhamstrings/foot&anklecontrol/trunkstabilization/bilateral&unilateralmusclecontrolAbdominalWork:Fundamental,ReformerHundredPrep(w/ostrapsweeks4-6;withstrapsweeks7-10)Hundred(w/ostrapsweeks4-6;withstrapsweeks7-10)*Focusondeepeningtheawarenessofabdominalmuscles/layeringabdominalmusclegroups/usingabsnotneck

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HipWork:StrapWork,Reformer(w/oassistance)FrogCirclesDownCirclesUpOpenings*Focusonhipadductors/abductors/pelvicstabilizationStretches:Fundamental,ReformerSomedaysIhaveherstretchwithfeetinstrapsasdescribedaboveinweeks1-3.OtherdaysIhaveherpracticeStandingLungeOnly(omittingpart2ofthestretch;dorsiflexfootonfloor)*Focusonbalancethroughoutthemove/hamstring&hipflexorstretchFullBodyIntegration:Fundamental,ReformerIntroductiontoLongSpinew/orolluporwithslightbeginningofrollup*FocusonAbdominals/Hamstrings/controlArmWork:Intermediate,Reformer,ArmsSitting(sittingonlongboxwhichiseasiertogetup/downfromandwithlightersprings)ChestExpansion–thisiswhereIsawtherightshoulder“hiked”andtheleantowardtheleftside.Afterafewweeks,clienthadmadethecorrectionsw/obeingcuedBiceps–allarmexercisesaidinpreventionofarmtremorsprogressingRhomboidsHugATreeSalute*Focusonshouldermobility/shoulder&elbowextensorstrength/trunkstabilizationLegWork:Fundamental,WundaLegPressStanding–thisisespeciallyhelpfulformuchneededbalance*Focusonbalance&controlofhipandkneeextensorsLateralFlexion/Rotation:ReformerorPoleMermaid(withmodifiedlegpositioningduetolackofflexibility;feetinfrontsittingposition)Polesittingonball;Reachingupandoverwithaslighttwist*FocusonlateralflexorstretchBackExtension:Fundamental,CadillacProne1*Focusonbackextensorstrength11

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ConclusionOnherfirstvisit,myclientJoellacouldbarelywalkintothestudioduetohermusclestiffness,shuffledgaitandpainfromParkinson’sDisease.Shehadnotexercisedonaregularbasisandworkedadeskjob,whichdidn’thelpmatters.Ihadtobeverystrategicinherplanandstayedonthesafesidethefirstfewvisits.BytheendofthefirstvisitshestatedthatmuchofherpainhadsubsidedandinstantlyfellinlovewithPilates.Ishowedherhowshecoulddosomestretchesfromherbeduponwakinginthemorningstohelpwithhermusclestiffness.Shecouldnotwaittoreturntoclass.Onedayabout5weeksintoherprogram,Joellawasleavingthestudio,andhadfallenoutsideaftertrippingonanunevensurface.Shewascallingmeonmycellphone,stillontheground,statingsheneededhelpgettingup.AsIranoutside,Isawherinthedistanceandallofasudden,shespranguptoherfeet.Isawherfacialexpression,andshesawmine,bothcompletelysurprised!Shesaidshecouldhearmyvoiceremindingher“Useyourabs”.Itwasaproudmomentforusboth.OneoftheBASIPilatesprincipals,Awareness,hadmadethemind-bodyconnectioninher,allowinghertodosomethingincredible…getupfromoffthegroundbyherself!Hernewfoundskillshadnotonlyhelpedhergetup,butrestoredhopeandconfidencewithinher.Shesincehascontinuedtoimprovethewayshemoves,thinksandfeelsaddingabetterqualitytoherlife.SheisnowoffworkandattendingPilatestwiceaweek.Shetellseveryonehowithaschangedherlife.

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Bibliography

BookMichele Tagliati, MD; Gary N Guten, MD, MA; Jo Horne, MA; PARKINSON’S DISEASE FORDUMMIES,Hoboken,NJWileyPublishingInc.2007WebsitesMayoclinic.org1998-2017MayoFoundationforMedicalEducationhttp://www.mayoclinic.org/diseases-conditions/parkinsons-disease/basics/definition/con-200284882017NationalParkinsonFoundationhttp://www.parkinson.org/understanding-parkinsons

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