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