Walking Ability
by Harold Rubin
Your co-editors have always practiced what we preach in connection with the healthful affects of walking. We have found it to be quite relaxing mentally as well as having physical benefits. We do not believe that you have to be a "speed" walker to derive benefits from walking. Do it at your own pace and you will derive benefits from having done it. The Journal of Nature recently reported on an experiment done at the University of Illinois on 124 sedentary men and women in the 60 to 75 age range.
The study's result indicated that an "invigorating" walk sharpened both memory and judgment in the experimental group. At the same time it was determined that anaerobic exercises (stretching and weight lifting) did not produce similar cognitive results.
The 124 sedentary men and women were randomly assigned either a walking or anaerobic regimen over a 6-month period of time. The walk took about 1 hour to complete. The study's lead author was Dr. Arthur Kramer, a cognitive neurologist. Tests were administered on the participant's ability to plan, establish schedules, make and remember choices, and rapidly reconsider them if circumstances warranted. According to neurologists the brain's frontal and prefrontal lobes control these brain functions. Dr. Kramer asserted that "These areas of the brain decline the earliest with aging". In "task switching" tests the walkers had about a 25% improvement in their results. The tests consisted of being shown alternating letters and numbers and being asked to quickly determine between vowels and consonants and between odd and even numbers.
The word "hemiplegia" indicates a stroke illness with emphasis on motor deficit involving loss of locomotion. Attention is then focused on this motor deficit, without reference to the examination of equilibrium. According to Mohr in Topics in Neurology, 1990 (pp. 1-11),"stability and intact equilibrium are essential for unassisted walking, even if there is residual weakness in one leg". Stephenson, writing in the journal called Physiotherapy, 1993;79:699-704, points out the importance of retraining the midline orientation rather than teaching the intact side to compensate for the paralyzed limbs. A number of researchers at the Shaare Zadek Medical Center in Jerusalem took up this idea and explored how early observation on equilibrium might provide a prognostic and diagnostic guide to the stroke patient's potential recovery of mobility.
They define equilibrium "as the ability of the body to maintain its center of gravity within its support base or to restore it to its support base if displaced from it". They felt that sitting equilibrium reflects the state of equilibrium reflexes "even before significant return of power to the leg allows assessment of standing and walking". They also knew that active rehabilitation is likely to be effective during a period of six months after onset of the stroke.
They state "Attempts to predict functional recovery from stroke can only be approximate, as they depend on physiopathological factors in the brain, the background pathology of the patient, and the emotional makeup. An approximate guide of prognosis can help, however, in planning treatment and future life-style. (Emphasis added by this author.)
"Improvement after a cerebral insult occurs because of two processes: 'intrinsic' or spontaneous neurological remission and 'extrinsic' or functional improvement that is dependent on motor learning and neuroplasticity. Since posture is fundamental to stability as well as movement, attention to midline orientation is one of the principles of rehabilitation from the earliest stages. Learning and reinforcing techniques are the instruments of rehabilitation, and, therefore, daily practice in posture should form part of the routine management of stroke patients…Attending physicians and nurses should familiarize themselves with some of these simple techniques of measurement and treatment of equilibrium, because the process of conditioning, if carried out intensively enough during the first few weeks, may reveal innate potential for recovery and make the management of stroke patients a more fulfilling experience for staff". (See: Feigin l., Sharon B., Czackes B., Rosin AJ. (1996) Sitting Equilibrium 2 Weeks after a Stroke Can Predict the Walking Ability after 6 Months. Gerontology: 42:348-353.)
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "HOW TO SELECT A NURSING HOME".
By Harold Rubin, MS, ABD, CRC, Guest Lecturer
Updated August 8, 1999
http://www.therubins.com
To e-mail: RehabStrat@aol.com or rubin@brainlink.com