ok another question from your favorite PT student :)

when, once upon a very long time ago [so it seems] when I was active in sports…I liked it. It makes sense.

Most PT I experience may use some aspects, but most are geared towards pilates and very lo-impact kinds of stuff.
Thing is, once you hurt as we tend to do, lose muscle tone and strength as we do, getting started is a very well…hurtful thing, that takes a lot out of us to JUST BEGIN to do it.

I’ve done PT on animals, using the Feldenkrais and Alexander techniques and since animals can’t complain…beauty is, is it does. Creatures like it all. The thing to be careful about with those who have sensory neuropathies is that, well, some of those damaged or healing nerves are HYPER….you cannot de-sensitize them at this point, only get them accustomed gently to new sensations. To ‘overachieve’ would/could possibly lead to hypertensions or neuralgias…tho I’ve not found any documentations medicall to this, some posters all over complain of this. Being truly sensitive to what the person/patient needs, says ‘IS GOOD’ or NOT is key in how you direct your therapies. Now, keep in mind, I’m not a doc…I’m only a patient, but I have seen the good and not so that some PT’ers do. That you are aware and are trying to be sensitive is well, ACES in my book!
Feldenkrais? If my insurance could cover it? I’d be there in a flash!

I know that everyone will give their own personality to their workouts but formal training should be followed for each and every level of therapy that is given to a client. You are not looking for cardio for the GBS person. You are there to make sure they learn to hold that foot in a particual position to get the maximum out of that movement. That arm or leg should not be twisted and the back should be in proper posture. All these things are the duty of the PT person to avoid injury to the person being helped. The GBS person does not need a routine that is going to wear them out. They need guidence in moving and maintaining proper position of each movement. Yoga and many of the other methods of exercise should be done by a trained person with formal training in that area. Many of them are 4 to 6 year courses. I would not do any of those movements with out a certification of formal training.

For Example: moving in the water you never step and cross one leg over across the center of your body if you have had a hip replacement. There are certain movements that a patient with knee replacements can not do. This is also to avoid injury. Each person is so different and the routines have to be so refined to meet their needs. Just to touch a person with GBS you might put your hand under their ankle/heel and they will hit the roof because you have touched a place where the nerve is close to the surface and tender to touch. The pain is extreme and brings on instant tears! You have to be very careful with the fragile GBS patient. They have muscle soreness, nerve pain, possible nerve damage not to mention tendons and ligaments that are severely tight that it might take months before those conditions change. You have to be able to work around all those things and continue to get them active without using up all their energy they will need for the rest of the day. They don’t suffer from being tired. They don’t suffer from being exhausted. They suffer from fatigue that takes days to overcome being over worked. Very fragile balance! Be very careful when you design your own methods for these things. Liability from a specific method that injures a client can set you up for a huge law suit. Not to mention your boss being very upset with you. All my OT and PT and other things were overseen by my Rehab Doctor. It was my job to report how I was feeling to her. The PT worked on only areas that she wrote out a prescription for.

I strongly agree with Kit. She has a way with words!:) Short and sweet with all therapies-not because of personality but because the gbs patient is more or less a damaged bundle of nerves that needs a tender hand to unravel and get to a workable position in life. No marathon training, weight training, cardio improvement or anything like that, its the movement, position and posture that counts. Always keep the reps short, should start with 5 to 10 only or 2 mins to 4 mins max, always allow for rest breaks and be aware of the fatigue level. Remember some patients can’t tell when/if they are tired until its too late.

Maria once you start to work with people you will find just how slowly the GBS patient is compared to other types of injuries. Usually their insurance coverage will run out before big progress is made. They will have to wait for their policy renewal date to come around before they can continue with therapy. For the place to start with treatment the GBS person will not be able to do much more than move each muscle group. Repetetion will wear out your GBS person. Even if you are manipulated the persons body for them. Until the signal gets correctly to the nerve you will be doing just basic movements for each area they are having problems with. You will not be even considering Pilates or Tai Chi as much as you will be doing movement using bands and putty and other aids. Then you move up to the balance or stability balls and light weights and movement in the water…remembering that just a slight uncontroled twist can injure the GBS patient. Later bring in the machines to keep the movement correct and the tension and weight stable. For the most part you are showing the patient the correct way to move and that they can move those parts. Until the body functions come back like the functions in the pelvis and feeling comes back they will not be able to feel they are moving correctly. So bridges and tilts and all those advanced things will be quit a challenge for the GBS person to make motion flow. Slow dance moves like the simple Waltz or Cha Cha will be a big challenge for the GBS person. Just holding the positions in Yoga will be a very big challenge for the GBS person. Not to mention getting up and down the steps and walking in everyday life, being able to stand at the sink to wash the dishes or stand at the check out line at the grocery store.

You said “I am just trying to get an idea of where to start a PT treatment for a GBS.” In a nutshell…..Slowly at the very basic beginning. At the begining you are working with some one that is paralized. Yoga and Feldenkrais Method is too fast and required some strenght to make the continuous motion needed in the Feldenkrais Method. Remember also there is many methods or versions of Yoga. So those for the beginning GBS person are too advanced also. The beginner will have to coordinate breathing, motion and control for each required motion. Doing maybe just 3 or 4 movements might wear out the beginner. Remember it is just an effort for them to chew to finish breakfast. Brushing their teeth might take minutes like combing their hair my require them to take a break in the middle of just combing not even styling their hair. It is very hard to put into words what or where in the whole scheme you mean by the “beginning”. I agree that some of the conventional methods leave out many needs for people. Remember with the GBS person it is the message that goes thru the nerves that you have to wait for the connection to take the right route. You are not dealing with the brain not knowing how to do somethings like in an infant or stroke patient. Our brains remember what it was like to do those things. Remembering is frustrating because it is like being locked or tied in our bodies. Some of it is mental to think things through, but for the most part it is moving and waiting for the nerves to get the signals to the correct part of the muscle to make them move.

To describle that feeling is hard. I can lay there and think as much as I can that there is movement. I can lay there and visualize as much as I can that there is movement. Until there is movement in that area it does not work so manipulation seems to turn on an area. That pointer finger is motionless and I stare at it. Nothing! I stare at it and command it to move. Nothing! My OT picks it up and lets it fall and I don’t feel it hit the table top. She says to move it! We try and try and go back and forth. Just that thinking tires me out. I try and try….no progress that day. That same day the Speech therapist comes in and works with me to learn to swallow my saliva and the muscles are still too weak! I am exhausted and frustrated. In my dreams I am normal and can dance and sing….now I can barely make a noise. My eyes were not able to blink to give a yes or no answer. I am in this body and I want out! Rolling me over to my side for a bath and changing the bed is too much for me. I am not able to speak to tell you that I am hurting. There is no expression in my eyes to beable to convey to you that your fingers touching my body hurts. In an severe case of GBS these are the things you are dealing with in the beginning. So saying “beginning takes me back pretty far where with others their beginning might mean they have use of thery body from the waist up and can speak and watch tv and hold a book to read. Many of us were not able to do that! When does therapy start? From the first sign of the illness reversing. Moving the patient so they don’t get bed sores is moving those muscles, although the aids and nurses don’t realize how good it feels to move but how painful it can be also just to be touched. The massage you get from being given a bath makes your day! You are able to tell the places that are starting to regain feeling. Sound makes your whole body shake or rattle and your eyes might wobble. Just being able to close your eye lids would be such a relief so the room does not look like an earthquake is shaking the room.

I think you are going to be a good therapist because you seem to care and are doing research. Time will tell as you gain experience! Good luck with that. Keep the good questions coming! I just hope I have explained this so it makes sense.

Maria with time you will get more experience and begin to see what each patient needs and how you have to be creative. One thing might not work as well at first, but by making another area stronger to support those other areas that need worked later on. For example as the wrist gets stronger than the fingers can do more. If the back is weak the abs and hips have to be strong to give support. It is correct the whole system has to become stronger. Someone mentioned that they had to scoot and crawl to get around. Being able to do that is more of a work out that you realize. It took me many months of Rehab just to be able to do those things. I was taught backwards in a sense. I was not taught to crawl and then stand. I was taught to get myself sitting on the edge of the bed and then stand with the aid of the walker. It was much later that I was able to crawl to play with me dogs and get the ball from under the furniture. I could know kneel down to get down there I did not have the strenght, but I was able to walk to get myself to the kitchen or bathroom and then back to bed or the recliner or chair or couch which at first I was not able to use because it was too low to the floor and I could not get out of it! I also was able to come home because I had people that promised to take care of me and my needs even if they did not live therre they were as close as a phone call and had the key to get into the house for an emergency. I hated to leave the door open because the dogs did not like people just walking into the house without me going to the door as we did in the past routines.

The nurse and OT and PT come to the house and were dismissed as their jobs ended. They worked very hard to get me where I could do things for myself and not have to have daily help. They took me for walks in the neighborhood to visit a neighbor a block away! She had knee surgery and I actually went up there to check on her one day with the therapist! OT was sorta the stuff type and did everything by the book…..but we were not reading the same book! I was always thinking about the future and wanted to know what to expect! I actually was able to tell him what I wanted to be able to do right away and what he wanted was not of interest for me today and we would do that tomorrow. I had to have the solution to my daily problems before I could worry about being able to accomplish things that I had help with for now! He would get way ahead of PT and in my household it just was not realistic for me doing things that were on a different floor and I was not traveling up and down to do laundry right now. I needed help with the can opener or turning the door knob or turning my hand over to accept a pill or change from some one. My rehab people were very good about being adaptable to my daily needs, whims and dreams. They were intouch with each other and all them reported back to my rehab doctor. I also made monthly visits to her and that was the biggest goal was to get me able to get in a higher vehicle to travel. Once I was able to travel then I could eliminate the people coming to the house and get PT and OT at a facility near my home. There the OT person was very adaptable and listened to what I was saying. In PT I got herded thru their schedule of events and they left out many areas where I needed help. I was struggling in some areas. Then I started to demand and be my own advocate. (I learned that from this site.) You have to be able to communicate and boy did I open up the lines of communication. PT would suggest something and if I was not comfortable with that route I expressed my concern if they did not listen to my request to make sure I was not hurried past something I felt I was not ready to move on from….I stood firm and talked to their boss, the rehab doctor. They would say that was not on the sheet of instructions for them to do, I had it put on the sheet of instructions for them to do. I had me to worry about! I have to add I was not nasty and did all this with humor so it did not look like I was stepping on anyones toes! To this day I give my OT person a “high five” when I see him and his family at the local store. We know it is showing how far I have come from not being able to lift my arm from my side to now being able to give a high five that creates some noise!

As you are able to watch the others support and manipulate the persons body into standing from sitting. Watching where they put their hand and feet to give support and how they will step thru a walker to use their limb as support for a weak knee that will not lock so that that person can take a few steps will amaze you. Our accomplishments will be your accomplishments daily. I had OT and PT work with me in the one unit of the hospital until I could get off the trache. To watch them work as a team on a person was amazing. It gave me so much respect for what they do. It is a gift we give to each other without mentioning that bond. To this day I admire them and keep in touch with nurses and aids and send them message with new patience they have that I know. We still can laugh at the way it was and hug toward the way it will become. You have to be creative or it would be boring. People usually hate to exercise anyways so you have to make it so they enjoy it. You have to make it customized to their needs so they can see progress, not so you can turn the page to the next chapter in your book. You also have to be firm to say: “No, you are doing it the wrong way!” or “You are not doing it the way I showed you.” “If you just go thru the motions and don’t try you are not going to do well.”
“You have to concentate!” “You did it because I challenged you and you did into have faith in yourself.” I got my share of criticism! It made me work harder. It does that when they say in order to go home you have to do this or that and list the goals. To drive they listed the qualifications and I added some of my own. Better to be safe than sorry!

As far as facial exercises besides the ones mentioned are:

1. Pretending to blow out birthday cake candles. That also increased lung function. But also works those facial muscles.

2. Fill up those cheeks like you were going to play the Bugle. Squats in the pool so your head gets covered not just your shoulders….that again worked on lung capasity and strenght. It is more fun when they serve as double duty. This also helps you to hold your breath for in the shower. You would be surprized how the GBS patient wants to blow out when water hits their face.

3. Pretend to kiss by kissing the air 25 times as fast as you can. Again breathing control exercise too! BIG KISSES with the sound and all! I do this while the dog tries to figure me out, so people don’t think I have lost it!

4. Putting your bottom lip over your bottom teeth and saying MUM, MUM, MUM as many times as you can. It helps with the neck muscles and swallowing and strenghtens the jaw like chewing gum does. Also helps with the tiny muscles around the lips that give you wrinkles.

5. Eye lid lifts and Eye brown lifts combined with hard squinting and rolling the eyes. Following with your eyes the outline of a house and draw in all the windows and doors. Also following the ceiling tiles and making Z patterns from one corner to the other also help. Warn people you are exercising and not getting an attitude! Oh don’t forget the side to side movement too! Ofcourse, all of this is done slowly or you will pass out or atleast get dizzy!

[B]All this and I don’t think I really answered your question! OH DEAR![/B]

Nice thing about the message boards is someone is there to add to what you said or didn’t say! Private Messages you miss out on that important input! You can see I am either very talkative or as I wish to think I am exercising my fingers by typing!

Once I was traveling weekly to rehab twice or three times a week…..my insurance paid for 20 visits a year so the rehab facility did not have alot of time to work with me before I had to quit coming or pay for visits myself. I had to wait for that time to expire and the new coverage to pick up where we left off. That is the only complaint that I had with my insurance plan. I do not know what I would have done if I was not seeing steady changes or improvements. I just accepted it and went to a fitness club and continued to work on what I was taught and shown to get stronger. It was more diversitified than most and was started and supported by our local hospital. There was many things there I could do and many more I was not able to participate in yet. I did use their pool alot and some of the machines and the slow paced classes in and out of the water for people with handicaps and Arthritis that did not have so much pounding on the joints as the aerobics and pilates and step classes. I went into the beginning bands and weigh classes too. That kept me fighting gravity and just not pool work. MOST people do not have that advantage like I did! Insurance runs out so does their progress. I agree with the don’t use it-loose it theory. This might be my shortest post ever! Do I get an award? 😀 But you are not going to hurry up progress in the GBS either. My progress stayed a little infront of my insurance coverage! I am glad my rehab people kept track of my coverage and visit for me. I have heard of others that did not do that for their patients and run up large medical bills. OK finger exercises/typing is done for the day! Have a good weekend!

PS you can only start to specialize when you have learned it all and then can funnel that knowledge down to only one group! Since all of our needs are different we need someone that usings all methods in some way to get us to a point of being sucessful. There is no black and white here. It is those grey areas that keep you on your toes and challenge your job so you can not get burned out! If something is not working you have to be able to change gears quickly so your student does not give up! Insurances are a pain! They don’t see the slow progress and will give the GBS people stress all the time. One of the things that will really do us in, quickly.