Maintaining and Improving Mobility

Posted - June 2007 in Living with HSP - Management & Treatment News

Maintaining and Improving Mobility with Ataxia

“Dancing with Ataxia”

by Tom Clouse, M.D.

adapted from content on: http://www.walkingwithataxia.com/
Tom Clouse is a medical doctor and has ataxia.

LET’S BEGIN

There are many subtle things we do, or allow our bodies to do, many of which we’re aware of but shrug off due to our growing ataxia.  Remain aware of these things – it’s a tough thing to do and it will take time.  The process will get easier as you progress however, and it begins with you making the commitment to be fully aware and take control of your movements.

TO MOVE, TO WALK

I have different exercises which I regularly do to help me walk and dance.  The most important thing for us to do is to strengthen our legs and our ‘core’ to keep us stable.  Most of us can use more exercise and will greatly benefit from being more fit overall.  You don’t have to go out and become a body builder, just trim down a bit and build up what you already have.  The concept is simple.  You need to strengthen your foundation to better support your body.  Strengthen your legs and your balance will begin to improve. 

EXERCISES

1. Sitting and Standing

  • Sit on a solid chair like you would find at a dining table.  No wheels allowed and it needs to be stable. 
  • Sit with your back straight, eyes up and forward with your feet flat on the floor (shoes on). 
  • Come forward in the chair so you can feel some weight evenly distributed on the balls and heels of your feet.  I’ll refer to this as planting your feet.  Get to know this as your comfort zone.
  • Next you’re going to stand, keeping your weight evenly distributed over the balls and heels of your feet.  Practice this until you can stand without your weight shifting on your feet.  You’ll have to maintain the correct posture and body alignment to accomplish this.  Find where yours is.
  • Use the same concept when sitting – what is the correct posture and body alignment to keep my weight evenly distributed over the whole foot? 

When you have figured out how to maintain your weight distribution on your feet both sitting and standing, there will come a revelation.  "I’m not swaying as much when I stand up."  That’s the point!

Further, as you progress with this exercise, use less and less of the chair, your cane or other support devices to assist you.  You need to find the support within yourself the best you can.  This is known as ‘core strength’ – the object of the very popular Pilates exercise movement.  These basic sitting and standing exercises will help provide that strength AND you’ll need to work on strengthening the muscles in your legs as well, especially the big muscles on the front of the thigh. 

If your legs are weak don’t expect too much until you strengthen them.  Further, take those assistive devices away only when you feel comfortable and safe.  You’ll know when the time is right.

2. Leg Muscles

  • While standing, turn your attention inwards and become aware of every move you’re making and how you’re doing it.  Look for and find your inner control and center.
  • Your "center" will be found with you standing with your weight evenly distributed on both feet – that is, the same amount of weight on the left foot as on the right foot.
  • Plant them on the floor with your weight evenly distributed over the balls and heels of each foot as well.
  • Now, slowly shift a small portion of your weight from one foot to the other keeping both feet planted on the floor.  Increase the amount of weight you shift as you gain some confidence.
  • Here is a key!  Bend your knees a little.  We move like the Tin Man in need of oiling.  Loosen up with your knees and bend a little. Feels more stable and secure doesn’t it?  When you feel more confident, bend your knees a little more with the weight transfer.
  • Also, try keeping both feet planted while bending your knees as you move straight up and down from a mini-squat to fully upright and back down again as you bend your knees.  Start with slow movements and slight bending of the knees at first.  Increase the bending and speed slightly as you get the knack of it.

Practice this and lock it in your memory.  It will be your new foundation to build on.  There’s much more but this will get you started.  I’m betting you will be standing with much less sway the first day you grasp the concept.  Then you’ll be ready to re-learn how to walk with the same result.

A FEW TIPS FOR WALKING

  • Keep the foot pointed straight ahead.  Don’t let your toes turn in, it sets you up for being off balance with the next step. 
  • Feel the big toe and ball of the foot on the ground with each step.  Try to stay off the outsides of your feet/shoes as this causes you to teeter in that direction.
  • Keep the weight balanced evenly over the whole foot – ball and heel:
    • Try not to rest your weight on the balls of your feet because invariably we end up on our toes and then try to take the next step with our nose.
    • Do not stand on your heels as we have all "learned" to do.  It makes you more unsteady and a puff of wind can knock you over backwards.
  • Your knees come with a hinge, so use it.  Have some bend in the knees, but not too much at first.  We get stiff in our stance trying not to fall.  However, that sets us up for the fall as we start to sway like a tree in the wind.
  • Pick your head up and look straight ahead. Try to keep your eyes off the floor.

Stay aware of and practice these things.  You’ll thank yourself later.

GO WALKING

Go walking for exercise and push yourself.  I’m not taking about ambling around the block, moseying around the neighbourhood, or strolling through the mall!  I’m talking about the type of walking where you work up a sweat and start to pant like your dog.  

Do the walking regardless of whatever else you do.  Why?  You need the practice!  Vary the speed and your posture to find what works the best for you.  Fight yourself to walk as fast as you safely can and still stay on the sidewalk or within some imaginary lines on the road.  Walk farther and farther each time until you’re doing 3-5 miles at a time.  It’s going to
take most of you quite awhile to get to that distance.  Rest when you need it, but gradually push yourself to do more.  Within a short time you will start to notice an improvement in your balance and walking abilities.

MORE EXERCISES

3. Strengthening the Legs

Here is a simple exercise which you can do to help strengthen your legs without the need of special equipment.  You are going to use your own body weight and something to hold on to so you don’t fall.  You can do this in your house or anywhere for that matter.

  • Find an area with a smooth wall.  You will need something to hang on to on at least one side of you for support.  The first few times I used a tall filing cabinet for support.  What ever you choose, make sure you can’t push it away, or pull it onto yourself if you start to fall.
  • Backup to the wall until your heels are approximately 6 inches away from the baseboard and keep them approximately a shoulder width apart from each other.  And use your support! 
  • Now put your butt, shoulders and the back of your head against the wall.
  • While bending your knees lower yourself as far down as you can go towards the floor, then stand back up.  While you are going up and down keep your butt, shoulders and head against the wall, and keep the weight evenly distributed over both feet.  When you are against the wall you will naturally transfer your weight onto the balls of your feet as your heel rises off the floor.
  • Repeat this until your legs get tired, then take a break.  Repeat this basic exercise daily or even twice a day until you can go all the way down and back up without having to use the support to keep you from falling.
  • When you can safely, and remember I said safely, step away from the wall and repeat the same exercise without any support.  You may find that you are having some difficulty with your feet side-by-side.  If you are, then simply move one foot forward and try it again.  Use your arms like the wings of an airplane to help you balance.  This may take you a little while to do but it is possible.
  • Keep this tidbit in mind when you first step back against the wall.  Your feet need to be planted on the floor before you start the squat.  When I say that your foot is planted on the floor I mean that your weight is evenly distributed on your heels and the balls of your feet.  For those of us with a cerebellar problem this is very important. 
  • When you step away from the wall and try this exercise without support make sure that you begin, and continue throughout the up and down, maintaining your weight evenly distributed on both planted feet.  If you can do this and maintain your planted feet, you will find it easier to walk properly. 

So what is walking properly?

Now that you have learned the strengthening exercises against a wall and understand how to keep your feet planted on the ground, let’s talk about transferring your weight.

4. Transferring your Weight

  • Standing away from a wall just as I described above, bend your knees just a little bit.  Try to keep your butt, shoulders and head in the same line that you did against the wall if you can.  If not, stand as it feels comfortable to you, BUT keep your feet planted on floor!
  • Now I want you to think of some music that you like that has a nice beat to it.  In fact, play some music if possible while you’re doing this.
  • Move back and forth from one side to the other, from one foot to the other, little by little.  Each time transfer just a part of your weight onto your right foot, then onto you’re left foot, then back and forth from one foot to the other.  Keep doing this without bouncing up and down, keep your feet planted on the floor and keep your knees slightly bent.
  • As you get the hang of it start to transfer a little bit more weight as you continue.  Now we’re going to do the same thing with your feet in a different position.  Take one normal step forward with one foot and plant both feet.  The only way you can do this is to have your body centered over both feet.  Now do the same rocking exercise forward and backward as you did when your feet were side by a side.  What you are doing is learning to transfer your weight from one foot to the other without losing your balance.
  • A word of caution!  Do not transfer your weight entirely onto the ball of your forward foot yet.  If you do, it is very easy for you to continue moving onto your toes and then onto your nose!   Also, do not transfer your entire weight onto your heel!  The back of your head will thank you for keeping it safe.  Keep your feet planted for the most part. 

Practice all the exercises I’ve just given you and they will help you more than you can imagine.  Let’s move on to the next part of this transferring of your weight with walking.

WALKING PRACTICE

Those of us with cerebellar problems tend to shuffle walk, then stop and rest with most of our weight on our heels.  This puts us in an awkward position. 

  • The proper way is, with each step forward, the first part of your foot to strike the ground will be your heel. To get ready for this first step, one foot must be free to move, that is, it must have no weight on it.
  • Bend your knees slightly, transfer your body weight to one foot and step forward with the other foot. 
  • Make sure your heel hits the floor first.
  • As the ball of your forward foot hits the floor, your body weight should be evenly distributed on both planted feet.
  • Continue to walk forward and simply repeat this same process. 

This is a basis which everything else is built upon.

Keep at what I’ve just given you and you will walk better.  There is no doubt in my mind because this is what helped me, and in part allows me to dance, and I’ve seen it help many other people.  You will find that your normal sway back and forth is decreased and you feel more stable.  And that is the point!  It won’t be easy.  It’s going to take some time.  And the result will be worth it.  I guarantee it.
 
Good luck…. Tom

"Do not follow where the path may lead.  Go instead where there is no path
and leave a trail." 
Ralph Waldo Emerson