Total Pageviews

Saturday, November 8, 2014

Neuromuscular Re-Education-- or "It's all about your butt!"

So, two weeks ago, Bob had his four week "re-certification" at Outpatient Rehab. He passed speech with flying colors, not so much PT...

Once again, he's caught in that "plateau" trap, the "no progress" or "slow progress" and "no functional improvement" crap and he's about to be booted out of the insurance-paid-for-therapy door....

This time, however, because Bob has a trust fund and we can afford to private pay for therapy, Bob's PT did some legwork and a found a highly recommended personal trainer at a local fitness studio who specializes in stroke and brain injury rehab.

Friday, we went to the fitness studio for a "free consultation" and "evaluation" with the personal trainer.

And I tell you, it was very different from the usual insurance-paid-for-therapy evaluation. In fact, the "therapy" is very different from anything we've run into at all the different rehab centers we have frequented in these past four years. This place practices the "BEST method" (stands for "Better Educated Strength Training") and the stroke rehab program concentrates on "neuromuscular re-education" and this therapist/personal trainer actually talked about things like "neuroplasticity" and "brain-to-muscle connectivity" and things I've really only read about -- up to now.

So, this sounds like pretty exciting stuff....

Our one hour evaluation consisted mostly of the trainer explaining the theory of "neuromuscular re-education" which is basically re-training the brain to take back control over the muscles, then taking Bob's history, and checking out Bob's range of motion. Then we got, what I will call for lack of a better term, "The Butt Lecture." Which went, something like this:

Your Butt is the largest muscle in your body.
As the largest muscle, your Butt is connected to and affects all other muscles in your body.
If your Butt is weak, your whole body will be weak!
If your Butt is weak, you will be unable to properly stand or walk!
A weak Butt will make you walk hunched over and unstable!
A weak Butt will cause your spine to twist!
And sitting on your Butt all day, weakens your Butt!!

Therefore, step 1 in the program will be to Strengthen 
Your Butt!!!

He then asked Bob to squeeze his butt cheeks together. I was really unsure if Bob could even do this -- in fact, I really don't remember any therapist ever asking him to do this -- but lo and behold, Bob did manage to do a butt squeeze, albeit a sort of wimpy squeeze.

This PT says Bob needs to work on his butt squeezes, and then he needs to work on being able to squeeze one butt cheek at a time, and alternate each side -- I'm thinking, huh? Can a person really do that? And you know, I tried it (right there in that therapy room), and tried it again (at home), and, um, am still trying this ---and heck, I don't think it's even possible! -- but then, I am no butt expert. Perhaps, my butt is weak, too!

The "evaluation" was coming to an end, and I asked what type of equipment they used. And the PT told me they would not be using equipment with Bob, at least not right away. That his first goals for Bob would be 1) butt strengthening and 2) re-training Bob's brain to control Bob's neck muscles so Bob could hold his head upright again.

Then, he told me that all the other therapists had been attacking Bob's neck problem all wrong. That those therapists had been, hands-on, stretching Bob's neck muscles for him and this was in no way training Bob's brain to hold his head upright and that could only be done by teaching Bob some methods to stretch his own neck...

So, after Bob's neck is straighter and his butt stronger, the therapist would then work on standing and taking steps.

And, he said, he would also like to see Bob move his right hand and arm. And I'm thinking, what?! Is that even possible? Four years post-stroke?

I mean, Bob's right arm/hand have been pretty much "dead" now for four years and every other therapist has given up on it, so I tell the guy this, and he tells me about one of their other clients, who also suffered a massive stroke, and three years ago he came to them in a wheelchair, unable to stand or walk, and all his previous therapists had told him that he would never walk again and today, he is walking with a cane...

So I called Bob's trustee and she's sending a check, and I signed Bob up for eight weeks of "neuromuscular re-education" therapy (2 times/weekly) and we'll see what happens....

Should be interesting.

Makes me sad, though, to know these types of therapies are out there, and available, but only to those who can afford it. Bob's eight weeks will cost $960, something we never could have paid for, before....

So, I'll share what we learn here!

Right now, everyone, Lesson #1:  Squeeze Those Butt Cheeks!!!! (and if anyone figures out how to squeeze one cheek at a time, let me know.... )


Sally said...

During the initial months of recovery PT, my husband, Sam was made to do as many pelvic and butt squeezes as he could manage. Your 'Butt' explanation makes sense now! :)
Love and good wishes from our corner of the world.

Anonymous said...

Interesting to say the least. Nope, couldn't squeeze one cheek at a time. Though "out of pocket", $960 for 16 sessions doesn't sound all that bad, it's so good Bob can begin that treatment using the trust fund. I sincerely hope he can make some progress through this therapist.

Hugs & prayers, Dan

Barbara Lambert said...

Very interesting! I'm wondering if this trainer is willing to do any long distance consulting. And if s/he could do it via Skype. Could you ask? And give me a contact if possible?

J.L. Murphey said...

Strange that PT emphasizes butt muscles after a hip replacement but not after a stroke. I remembered it after my stroke and did them.

The focus for hospital based is central core where private will take one set of muscles at a time. Your butt is also part of your central core. But by saying central core they focus on abdominal muscles first.

To squeeze one cheek, focus the back muscles on one side and then squeeze. But first you need to strengthen both to isolate one side.

There is a huge difference between private trainers and hospital based. 1) they are paid for results, and 2) they can focus on one area versus the body as a whole. Stick with the private pay as long as you can to get your old Bob back is my advice. I wish I had that option.

Rebecca Dutton said...

A new muscle routine always wakes up the body and mind. I like the idea of teaching Bob how to stretch his neck instead of waiting for a therapist to do it passively. Butt training is essential for standing up. If Bob can help during a transfer it will put less stress on your back.

Linda said...

It sounds really exciting for you and Bob. I was fortunate to do group aquatic therapy led jointly by a special trainer and my regular Physiotherapist. One day the trainer asked us to do butt squeezes. I was so shocked to find that only on check squeezed. Knew my leg wasn't doing much but the butt too?? Anyway it was not really that long once I started working on it before I got some improvement in my cheeks and that really helped my gait.

Anonymous said...

Thankyouthankyouthankyou!!!! That makes SO much sense, I,looked for, and found, a trainer that says he does "neuro-muscular re-education", and am waiting for a call back. This is exciting, isn't it. I do so hope it helps Bob.

Jenn said...

Do you have BUNS OF STEEL yet??????