Pilates and the Stroke Patient

By Teresa Wong, PT

According to the Centers for Disease Control and Prevention, every 40 seconds someone has a stroke in the United States. This equates to over 795,000 victims a year and 610,000 of these strokes are first occurrences.

In addition to these sobering statistics, the “face of stroke” is changing. According to the Joint Commission, “Strokes are getting younger and younger”, about 30% of strokes occur to those under 65 years of age; in other words, during their productive wage earning years. In a study performed six months after a stroke, they found that 30% of stroke survivors continued to need assistance to walk and 50% had some degree of paralysis on one side of their body. Another long-term follow-up study revealed that long-term stroke survivors, especially those with only one episode, had a good chance for full functional recovery.

The impact of a sudden disability can be devastating not just physically but emotionally, financially and socially as well. As a result, the rehabilitation programs for this patient population needs to be reexamined with strong emphasis on effectiveness and efficiency. In over 17 years of experience as a physical therapist working with neurological patients, I have found Pilates to be extremely powerful when incorporated into the rehabilitation program of stroke survivors. At Rehab Hospital of the Pacific, this is what we call Clinical Pilates.

6 Essential Pilates Components for Stroke Patients

These six essential principles of Pilates for stroke recovery are:

1. Centering
2. Control
3. Flow
4. Breath
5. Precision
6. Concentration

The emphasis should be on quality over quantity. Pilates exercises do not include a lot of repetitions for each move. Instead, doing each exercise fully, with precision, yields significant results in a much shorter time. With assistance from Pilates equipment such as the Reformer, these principles in integrated into each exercise resulting in a more effective and efficient exercise program to facilitate maximal recovery.

“Centering” After a Stroke

The most common physical dysfunction as a result of stroke is hemiplegia or the paralysis of one side of the body. During the initial rehab process, it is common to utilize compensatory patterns as quickly as possible in an effort to gain mobility and as a result, the patient’s awareness of their bodies is often altered.

With Clinical Pilates, the focus is continuously on centering and strengthening those deeper core postural muscles with an emphasis on control. With the guidance of the Reformer and a trained practitioner, the treatment becomes “self-correcting” and facilitates rewiring of the nervous system with minimal compensatory patterns through the encouragement of fluid movement patterns that emphasize control, stability and alignment all at the same time.

As a result, patients gain a better understanding of their bodies at this critical point in their recovery process. During the initial rehabilitation process, it becomes a powerful combination to integrate Pilates principles such as core strengthening and control into traditional therapeutic techniques such as gait and balance training to maximize functional recovery.

Breath and Alignment

Most stroke survivors intuitively hold their breath as they make the arduous journey to learn to move their bodies again. It is instinctive and almost universal when your body suddenly feels unfamiliar, weak and unstable. As a result, their physical recovery lacks efficiency as the body globally contracts its muscles and become easily fatigued from the constant contractions.

Pilates’ emphasis on controlled breathing with each movement not only boosts physical efficiency by decreasing unnecessary contractions but also facilitates proper alignment in posture and overall balance. In addition, the emphasis on elongation of each movement helps to open up the trunk and pelvic area allowing more range of motion resulting in more freedom of movement during dynamic activities.

With hemiplegia, there is a strong tendency to shift completely to the unaffected side, which only reinforces the weakness and poor motor control of the affected side. As a result, the asymmetry in the physical body becomes reinforced as opposed to moving towards correction. By using Pilates principles to facilitate proper breathing and alignment, comes improved balance and with improved balance, comes increased confidence.

Educating the Patient

As physical therapists, our job is to educate each of our patients on how best to heal their bodies after an injury to maximize their functional potential. This becomes a significant challenge when the nervous system has been damaged and proprioception, sensory input and motor function are all impaired. Additionally, in the stroke population, often there are cognitive impairments, and abnormal reflexive tone that is often not under voluntary control.

The utilization of the Reformer in the rehabilitation program facilitates this education process instinctively. Again, if done properly, Pilates is self-correcting, meaning the patient can see and feel their weakness, their asymmetries, and their abnormal motor patterns themselves. This increases their body awareness significantly and allows them to gain a deep understanding of their body and take a proactive approach in their rehabilitation process.

With the rapidly changing currents in healthcare, there is an emphasis on rehabilitation programs to focus on educating each patient to be responsible for their own recovery process, regardless of their diagnosis. Each patient needs to understand the recovery process can continue long after their formal rehabilitation programs ends and therefore, the better they understand their bodies and it’s strengths and deficits, the better equipped each patient will be to maximizing their own recovery.

Teresa Wong, PT has been a physical therapist for over 17 years. She has worked extensively with neurological patients of all ages, from infants to centenarians. She has published research in JOSPT and Archives of Physical Medicine and Rehabilitation on spasticity, gait and wound healing. She has also worked in a functional gait assessment laboratory utilizing surface and fine wire EMG, as well as kinematics to study dynamic gait patterns. Teresa came upon Pilates over 13 years ago in Los Angeles at Mari Winsor’s studio. Since then, she has continued to build upon the integration of Pilates principles into her physical therapy practice.

As seen in the Winter 2010 Balanced Body Pilates COREterly