Neurologic Disorders

Among  the  most  frequently  occurring  neurologic diseases  in  Europe  and  North  America  are  multiple  sclerosis,  Parkinson’s  disease,  cerebrovascular  diseases,  brain  and  spinal  cord  trauma,  and chronic  headache.  These  neurologic  disorders  are also  the  most  relevant  for  treatment  with  sport therapy,  a  motion-therapeutic  method  that  compensates and regenerates disturbed bodily, mental, and social functions; prevents secondary damage; and promotes health-oriented behavior. Sport therapy  is  rooted  in  a  biopsychological  approach  to the  human  organism.  The  methods  of  sport  and movement therapy are based on medical, exercise, educational,  psychological,  and  sociotherapeutic principles.

Historically, the therapy of neurologic disorders was limited by the common view that brain development is confined to childhood and that the adult brain  has  lost  the  capacity  to  develop.  Recently, however, the observation of plasticity in the adult brain has shed new light on the potential for sport and exercise in the therapy of neurologic disorders. It is now recognized that not only the strength of synaptic transmission but also the size and activation pattern of cortical networks are activity dependent.  These  findings  provide  a  scientific  basis  to elaborate the therapeutic use of sports and exercise in the treatment of neurologic disorders.

This  entry  provides  an  overview  of  the  most relevant  neurologic  disorders  that  are  currently treated with sport and movement therapy. For each disorder,  first  the  medical  basics  are  described, and  then  the  specific  methods  used  in  sport  and movement therapy.

Multiple Sclerosis

Multiple sclerosis is a demyelinative disease characterized  by  an  autoimmune  destruction  of  the myelin  sheaths  of  nerve  fibers.  Genetic,  environmental,  and  psychosocial  factors  have  been  identified  as  etiologically  relevant.  The  time  course and location(s) of the demyelinization process are highly  variable  both  inter and  intraindividually. Thus, patients display a variety of symptoms such as blurred vision or loss of sight, motor weakness, numbness  and  tingling,  vertigo,  facial  pain,  coordination  deficits  including  the  speech  and  ocular muscles,  fatigue,  impaired  control  of  the  bladder, and depression. The course of the disease is unpredictable and can be relapsing–remitting or primarily  progressive.  Women  are  affected  three  times more often than men. The onset of the disease is typically between 20 and 40 years of age.

The fatigue symptom is an important factor to be  considered  when  planning  sports  therapy  for multiple sclerosis patients. The lacking economy of movement in this patient group may have different causes.  Important  factors  are  muscular  hypertonus,  coordination  deficits,  and  fatigue.  All  three factors may lead to a decreased quality of coordination and thus lead to an additional expenditure of  energy  and  strength.  Sensory  loss  can  lead  to qualitative and quantitative changes in the subjective body image and this should be considered in the context of sports and exercise therapy. The fact that  mental  health  can  be  influenced  as  well  by physical activity (PA), especially in groups, makes this an important approach in sports therapy with multiple  sclerosis  patients.  Since  the  localization of inflammatory foci in the central nervous system and the course and severity of the disease differ, in practice  heterogeneous  groups  are  built.  This  has to  be  considered  when  organizing  a  group.  The division of a wheelchair group and also a walking group could be useful. In addition, the intensity of training should be dosed individually and be modified sufficiently for patients with varying levels of performance.  An  acute  episode  is  a  contraindication for participation in a sports therapy group.

Parkinson’s Disease

Parkinson’s  disease  is  a  degenerative  illness  characterized  by  a  loss  of  neurons  and  a  depletion of  dopamine.  The  lack  of  this  neurotransmitter results  in  alterations  of  posture  and  movement. Core  symptoms  are  a  resting  tremor,  a  reduction and  retardation  of  body  and  facial  movement, stiffness, postural instability with gait disturbance, loss of dexterity, and a soft and monotonous voice. Further  symptoms  are  depression  and  vegetative symptoms,  such  as  the  dysregulation  of  blood pressure (BP), body temperature, and bladder control. The prevalence of this disease increases with age from 1% to 2% of the population over the age of 65 years to 3% over the age of 80.

The early use of therapeutic movement measures in Parkinson’s disease is an important supplement to medical therapy. To overcome the reduction of body  movement  (freezing  phenomenon),  optical, acoustic (music), and tactile stimuli may help initiate  the  movement.  Repetitive  training  of  corrective  support  reactions  can  bring  a  positive  effect on  stability  and  contribute  to  prevent  falling.  A dosed  run  treadmill  training  (duration  method) can influence the course rhythm and stride length positively. If patients suffer from orthostatic hypotension, this can be improved by targeted cardiac training. Important elements of sports and exercise therapy  are,  for  example,  practicing  an  upright gait with long steps and contralateral movement of the arms and practicing the changing of direction. These  measures  are  supported  for  example  by  a functional everyday life-oriented training.

Cerebrovascular Diseases

Stroke,  which  is  a  sudden  focal  neurologic  syndrome,  is  the  most  frequent  manifestation  of  a cerebrovascular  disease.  Stroke  is  mainly  caused by  a  lack  of  blood  supply  (ischemia)  or  by  cerebral  hemorrhage.  The  occlusion  of  a  major  cerebral artery often results from an embolus, typically from  the  heart.  Small  vessels  are  affected  by  diabetes mellitus, high BP, or cigarette smoking. The symptoms  strongly  depend  on  which  artery  is occluded.  Frequent  symptoms  are  a  paresis  and numbness  of  one  half  of  the  body;  impairments in language, praxis (conceptualization and execution of movements), spatial cognition or attention; a  visual  field  defect,  vertigo,  or  diplopia.  Similar symptoms are found in cerebral hemorrhage. The latter, however, is often accompanied by an acute and severe headache.

In  sports  and  exercise  therapy  with  stroke patients, improving of strength and coordination, promoting  local  and  general  dynamic  endurance, and  training  of  sensorimotor  function  and  perception build the focus in addition to the general objective  and  content  of  movement  therapy.  If spasticity (muscular hypertonus) develops in paralyzed limbs, a regular PA can help to reduce it temporarily  and  to  develop  strategies  to  counteract spastic  patterns.  Beyond  a  well-dosed  motor  skill training,  coping  with  cognitive  tasks  is  also  part of  the  individual  sports  and  exercise  therapy.  In summary, suitable exercises for stroke patients are disciplines with manageable coordinative requirements  that  promote  aerobic  endurance.  These objectives can be realized by the active stay in the water, provided that the patient’s ability was tested and secondary diseases are excluded. In the water, a commodification of cardiovascular function can be  achieved  and  the  water  density  facilitates  the movements.  A  practical  example  is  aqua-jogging or aqua-walking.

Brain and Spinal Cord Trauma

About half of brain trauma cases are due to traffic  accidents  and  about  one  quarter  each  to  falls and  accidents  during  sports,  leisure,  and  work. If  present,  the  duration  of  the  loss  of  consciousness  is  prognostically  relevant.  A  wide  range  of symptoms  may  occur  and  persist  depending  on the  location  of  the  lesion,  including  more  subtle symptoms  such  as  nervous  instability.  The  incidence of brain trauma is highest between the ages of 15 and 24, as well as above the age of 75. Men are twice more likely to suffer brain trauma than women are.

About half of all spinal cord trauma cases are due to traffic accidents; one fifth are due to accidents at work. The higher the lesion is in the spinal cord, the more extensive are the resulting impairments. Lesions at the level of the neck result in a paresis  and  a  loss  of  sensibility  of  the  arms  and legs,  an  impairment  in  the  control  of  bladder,  as well as disturbances in the regulation of vegetative functions  such  as  BP,  heart  rate  (HR),  and  body temperature  regulation.  Lesions  at  lower  levels result in a paresis and sensory loss of the legs and an  impairment  in  the  control  of  bladder.  Sixtyone percent of spinal cord traumas occur between the  ages  of  16  and  30,  with  a  male-to-female ratio of 5:1.

The intention of sports and exercise therapy is to  stabilize,  compensate,  and  improve  the  functions affected by the brain damage. This resource oriented  therapy  involves  the  improvement  of coordination,  since  a  common  symptom  in  brain trauma  is  residual  ataxia.  The  stand–gait  coordination  and  eye–limb  coordination  can  be  trained by simple and complex motor actions. The development  of  compensation  strategies,  increasing overall  capacity  and  improving  the  strength  of the  locomotor  apparatus  should  be  further  goals in  exercise  therapy  with  brain  injury  patients. Improving  the  quality  of  the  motor  task  can  be achieved by regular practice.

The  aim  of  exercise  therapy  concerning  motor skills  of  paraplegic  patients  includes  the  compensation  of  muscle  function  in  particular  of  the upper extremities. Sports therapy with tetraparetic patients often uses hand biking to prevent cardiovascular  diseases.  The  maximum  oxygen  uptake and  aerobic  capacity  can  be  improved  by  circuit training (interval method), for example, to economize  the  cardiovascular  capacity.  Other  focal points  of  sports  therapy  with  paraplegic  patients are the training of sitting balance, weight-bearing exercises,  and  the  rehearsal  of  everyday  movements in order to obtain and provide the greatest possible  independence  of  auxiliary  persons  and material.  In  addition  to  its  therapeutic  function, sports  therapy  has  a  major  psychosocial  significance  for  paraplegic  patients,  bringing  into  play the elementary skills and abilities that demonstrate to  wheelchair  users  the  activities  necessary  for practice and provide them with sufficient competence to deal with everyday situations. As a sport, for  example,  wheelchair  basketball,  wheelchair rugby,  or  table  tennis  could  be  considered.  The changing  game  situations  require  quick  decisions and  accurate  movements.  This  leads  to  increased concentration  of  mental  and  physical  abilities and  contributes  to  the  improvement  of  balance. In addition to the previously mentioned examples, there are also many opportunities for athletes with disabilities to participate with people without disabilities (integrative sport).

Headache

Of the various types of headache, tension headache and migraine are epidemiologically most relevant.  Chronic  tension  headache  has  no  structural correlate.  Pain  from  chronic  tension  headaches is  usually  bilateral,  sometimes  with  a  frontal  or occipital accent. The pain is most often described as dull, with tightness or pressure. The intensity of the pain is mild to moderate and reportedly does not interfere with daily activities. Sports and exercise  may  diminish  an  ongoing  tension  headache. Approximately  2%  to  3%  of  the  population  suffers from chronic tension headache, with men and women being equally affected.

Migraine  headache  is  thought  to  be  the  consequence  of  disturbances  of  the  trigeminal  system.  The  genetic  disposition  is  well  established. Migraine  headaches  take  the  form  of  attacks that may last from 4 to 72 hours. In most of the patients, the headache is unilateral and pulsatile in character. The intensity is moderate to severe and increases with exercise. The headache is accompanied by nausea; vomiting; and sensitivity to light, noise, and smell. The headache attack may be preceded by a temporary focal neurologic deficit, the aura, which can manifest as a disturbance of vision consisting of flashes of light, formations of zigzag lines,  or  an  enlarging  blind  spot;  focal  numbness or  weakness;  or  mild  disturbances  of  language production.  The  aura  lasts  from  5  to  20  minutes and ends with the onset of the headache. Incidence is  twice  as  high  in  women  as  it  is  in  men,  with respective population-based rates of 14% and 7%. Migraine  episodes  typically  begin  in  adolescence or in early adult life.

The  aim  of  sports  therapy  in  headache  is  to improve  the  subjective  well-being  of  patients. Cardiovascular  endurance  training  can  reduce migraine  and  tension  headache  symptoms.  It is   required   to   increase   the   cardiopulmonary performance—that is, the exercise intensity should be in the range of 60% to 75% of maximum HR and  be  regularly  (two  to  three  times  per  week) performed  with  an  effective  training  time  of  30 minutes  per  session.  In  line  with  sports  therapy, also  endurance  sports,  especially  jogging,  has  a relaxing effect on headache patients (reduction of stress level).

References:

  1. Ropper, A. H., & Brown, R. H. (2005). Adams and Victor’s principles of neurology (8th ed.). New York: McGraw-Hill.
  2. Wilmore, J. H., Costill, D. L., & Kenney, L. (2011). Physiology of sport and exercise (5th ed.). Champaign, IL: Human Kinetics.

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