neurological rehab

Feel, Feel, Feel! Creating Change through Attention to Sensation

John* (*name changed to preserve privacy) fell while at work and suffered a fifth cervical vertebrae (C5) compression fracture and was diagnosed with incomplete quadriplegia. Spinal nerves carry messages to the muscles for movement and each of the muscles in our body has a corresponding nerve innervation at the level of the spinal cord. When this pathway is disrupted in spinal cord injury, the muscles that receive their signals from below the level of injury can’t receive the signal to move, preventing the muscle from firing. In incomplete spinal cord injury, not all of the nerve fibers have been severed and the person has the potential for regaining motor function (each person in his specific circumstances to an individual degree).

When John was referred to me for occupational therapy he demonstrated emerging movement in both upper extremities. John was able to demonstrate movement at the elbow, wrist and some movement in the fingers. John was experiencing movement below his level of injury (finger and thumb movement is at the eighth cervical level, C8 to the first thoracic level, T1). Although John could flex his fingers in making a fist, and extend his fingers to open his hand, he could not grasp objects functionally because he could not integrate his thumb into his grasp (think about picking up a cup to take a drink!). John wanted to be able to use his cell phone, drink from a cup, get himself dressed, golf, return to work and everything that was important to him in his life.

Every time that John would try to grasp using the full function of his hand, he would move his thumb slightly and then his thumb would stick tight to his palm as the rest of his arm would lock up, co-contracting every muscle in his arm at the same time in full effort. John’s body was trying to compensate for what he was unable to do with the use of other muscles. In one session we were able to make changes through attention to sensation and this is how we did it:

John closed his eyes. I asked him to focus 100% of his attention on the sensation of his hand supported on the table. I had him move the thumb, just in the very small range he had before the aggressive co-contraction of the rest of his arm and FEEL it! We did this a few times and each time when he would start to move into the range where co-contraction occurred, STOP! He felt the sensation of the movement without the co-contractions and then he felt the sensation with the co-contractions. He could then differentiate the two very different attempts to move the thumb. Finally, I had him coordinate his movement with his breath: inhale the thumb out and exhale, grasp. Through ruthless attention on the sensation that each movement created, and calming, reorganizing the nervous system with breath, John was able to move his thumb through the full range necessary to grasp and release.

Attention Matters!

If you want to make change in the body, especially after neurological injury, take the time to concentrate on your sensations and use that knowledge to create change. Focusing mental attention stimulates neurons to produce strong connections between them. New or stronger neural connections rapidly respond. In addition, pranayama or deep breathing (diaphragmatic or “belly” breathing) can help set the stage for producing neuronal connections by calming and organizing the nervous system. So check it out in your own experience: Can you create change through attention to sensation?

Pre Natal and Post Natal

Prenatal Yoga: What to expect

When you are expecting, prenatal yoga can help you stay fit, prepare your body for labor and promote your baby’s health. Prenatal yoga offers a dynamic approach to affect your fitness level as well as your mental health.
Here are a few things you can expect from a prenatal yoga class:

[h2]Breathing or Pranayama:[/h2] Expect guided breathing techniques that encourage attention and focus on the sensation of the breath. Deep breathing techniques with focused awareness ensure an abundant supply of oxygen for you and your baby.  Prenatal yoga breathing techniques may also help you manage shortness of breath and endurance during pregnancy and work through contractions during labor.

[h2]Postures (Asanas) and physical movement:[/h2]  Step-by-step instruction for physical exercise ensures that you can safely increase your strength, flexibility, balance and muscular endurance during your pregnancy.  Prenatal yoga exercises can help your body prepare for childbirth and promote a speedy return of your pre-pregnancy body by tapping into muscle memory.  Props (blankets, blocks or straps) may be used to provide support and comfort.  Exercises are coordinated with the movement of the breath to promote a connection between mind and body.  The level of exercise and types of movements will depend on where you are in your pregnancy. Be sure to let your instructor know if you have any specific pain or concerns before you begin.

[h2]Guided focus or intention:[/h2] Because the mind and body are deeply connected, we can decrease stress and anxiety, and cure the prenatal blues by focusing on this relationship through a guided meditation technique, intention or focus.  You will likely be encouraged to use mindfulness strategies or maintain your attention on a specific sensation in the body or your breath and notice what mental tendencies (thoughts) arise while in class.  You might be asked to experiment with your mental habits and reactions to become more aware of how they affect your mood or change sensation in the body.   Yoga techniques can help to create fulfillment in each moment despite what the external circumstances may be.