This question was posted to our LinkedIn Group. Can anyone help her?

I have a new client, a young woman (30's) who had a stroke 18 months ago in the final weeks of her pregnancy. She is just now being released from PT, and still has significant unilateral weakness.

I've done some research on the web, and I see a lot of posts and articles about the benefits of pilates in working with stroke victims, but I can't find any protocols. I'm assuming bi-lateral closed chain movements to start with, then as strength builds, moving to open chain and/or unilateral. However, I would certainly apprecaite any guidelines that anyone could provide.

thanks!

(Hi Marilyn, I ran out of editing time at LinkedIn so have given my fuller post here)

In my past life I worked as a Speech Pathologist with stroke patients, and they are all quite different in terms of muscular weaknesses, balance, memory capacity, etc. So of course, the way you treat her could be very different to a previous stroke patient, hence the lack of protocols. Can I suggest you keep a record of what you do, and post it onto a website for future Instructors that will benefit from your experience, that way we can get some protocols based on what you have learned and share the knowledge.

Stroke recovery can be very slow, she will probably not progress as quickly as other clients and you may find you need a structured, routine approach to her sessions, not just adding new repertoire each time. She may get confused and frustrated with herself so you will need to be patient and set realistic small increment targets for her. Get some advice from the PT on this as she/he will be experienced dealing with this lady.

Questions to PT-
Is her comprehension all Ok, does she understand the instructions you give her?
Does she remember things from one session to the next, can she retain information?
Is she safe with walking around a busy studio, is her vision such that she can see clearly or does she have blind spots, same for hearing?
How is her emotional state?
Is she ready for balance work, what are her physical strengths and weaknesses?

Based on the answers to these questions, I would suggest you stick to a regular routine for a while, and add new things over time. Agree to the goals of the Pilates, so as to not set up unrealistic expectations.

Anyway for now, I would look at being as functional as you can, with an 18 month old I guess she has a lot of physical demands, so enquire about her routine so you can get an idea of what she most needs to do, and what she is aiming for. Bilateral work sounds a good start, it's so hard to know without seeing her. I would include well supervised balance work if she is ready for that, and co contraction whole body movements will be relevant, that is, use arms at the same time as legs are working to help stimulate the brain in a familiar movement pattern. Core strength in seated may be of much greater use than supine. It may be that getting up and down off the reformer or floor, is too big a challenge for her so be prepared to adapt on the spot. We Pilates teachers are good at that!

She may not be able to lie on the affected side and keep her alignment, depending on how weak she is. Focus on building up her strengths for 'a positive movement experience', in the words of Brent Anderson.

I will stop typing now as I could go on forever, feel free to contact me directly Marilyn as you progress, I would love to hear how you are doing and what you are learning. Good luck, it's really exciting to be able to apply our skills and this wonderful technique to help someone like her.

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