Communication is the Cord to Creating a Health Care "Symphony"

 By: Stephanie Doke, MA, LPTA, CPT

Mind...body and spirit reside in one location but can one profession really treat all these entities?  Life is becoming more complex and so are our patients making it significantly important now then in the past to utilize all of our resources in the community for treating our patients and/or clients.  But, the only way to create awareness of other available health care professionals to assist in treating the patient as a whole is through communication.  Communication is the cord to creating a health care symphony and balancing the patient in mind...body...and spirit.

Recently, I took a basic Pilates reformer class and learned a lot.  I was reluctant in taking this basic class because I am a trained dancer and therapist who felt like I did not need to start at the beginning.  But, to my surprise even with a higher sense of body awareness I felt I possessed, I realized I knew very little about my body.  Then, I began to think about a patient I had been treating who was an above the knee amputee (AKA).  In the clinic I had been working on her gait deficits in the parallel bars but felt I could be doing more with her.  She was so weak in her core muscles and I knew this was where most of her functional movement was going to have to come from but she had no awareness of this deficit.  So, I decided to ask my Pilates instructor if she had ever worked with amputees before, she responded favorably and was more than willing to share ideas to help me assist my AKA patient.  This communication continues between me, the therapist and the Pilates instructor to address the unique needs of this AKA patient who has shown significant improvement.

There was another instance in working with a CVA patient when I felt the patient's total needs were not being met in the traditional clinic setting so, I spoke with a PTA colleague who did Watsu water therapy.  My knowledge of Watsu was very limited, so we set up an appointment where the patient and I both attended the treatment session.  My PTA colleague afterwards demonstrated some other techniques on me and once again I was amazed.  So, another cord to creating a sound symphony of the body was found by using this holistic technique that did not just treat the physical impairment, but encompassed the entire body. 

Pilates Potential

Pilates creates a mind-body workout by incorporating breathing techniques with movement which creates fluidity allowing the body to be more efficient.  This fluidity of movement increases body awareness by concentrating on correct spinal and pelvic alignment and the breathing component can help in reducing stress, which most of our patients present when in the clinic.  The basic principal technique founded by Joseph Pilates was to teach exercises that would develop a strong core, which consist of the deep muscles closest to the spine, and would be beneficial to any diagnosis.  The trunk, pelvis and shoulder girdle should be integrated in teaching control of the core for functional purposes.  Pilates is said to evenly train the whole body creating a balance and conditions the body allowing patients to enjoy their daily activities.  Pilates can train several muscles at once retraining the body to be more efficient and safer, which is exactly what is needed for an AKA patient. 1

There are six principals in Pilates which are centering, concentration, control, precision, breath and flow.  Centering concept is that all movement radiates from a strong, and stable but flexible center.  This is a challenge to the AKA patient because their concentration is usually on that amputated lower extremity, not on their center or core.  Concentration is to be present in the moment and on the task at hand.  Can you imagine being an above the knee amputee amputation and only focusing on the "now"?  It would be difficult; I think not to be worrying about how you are going to do all those daily activities that need to be done.  The other aspect is while training for concentration it is important to do the repetition of the exercise with quality not quantity.  This is functional because if the patient learns to concentrate on the task at hand like stepping off a curb it will happen more efficiently than loosing focus and thinking about getting into the car before stepping off the curb.  The counterpart to concentration is to maintain control and proper alignment during an entire exercise engaging the mind to the efforts of the body making the movement more fluid.  Precision is the end result of concentration, control, centering, and practice resulting in an understanding of proper alignment.  Breathing is the connecting link to mind and body drawing our wandering minds back to the task at hand.  Pilates uses breath with movement to increase our awareness of what we are doing, along with increasing the flow of oxygen to our tissues.  My AKA patient carries a posture of holding her breath and always has her shoulders up into her ears needing cueing to relax and breathe, which is a principal of Pilates.  A sense of flow and rhythm is done in all Pilate's movements which decreases stress on the joints.  In a global sense it integrates fluid, smooth movement patterns into our daily activities.  Most importantly Pilates can be modified for any skill level providing a safe but challenging environment. 2

Watsu Wonder

Watsu is performed in warm water combining elements of stretching, dance, massage, joint mobilizations and shiatsu.  The receiver is supported by being cradled, rocked and stretched in a nurturing, supportive environment.  Watsu can do many things that traditional land therapy cannot, but it goes unrecognized as a missed note in the health care symphony.  The benefits include warm water to support the muscles and spine, joints and muscles can be manipulated gently, and each person's experience is unique to what their bodies need at that time.  Many patients report a blissful feeling of letting go. 3 Watsu is unlike traditional massage because it gives a patient the opportunity if desired to go beyond the physical.  When the body relaxes to the weightlessness and warmth of Watsu the chatter in one's mind tends to cease.  The fundamental essence of one's being is left after the mind and body are quiet.

Watsu practitioners can learn a variety of techniques and levels but regardless the Watsu experience has a profound effect on the receiver.  The warm water softens the tissue, soothes the mind, floating alters the perception of gravity and time creating a sense of lightness.  If the patient is instructed to follow the rhythm of movement with breath it creates a sense of ease which allows the patient to feel understood. 4

From a traditional and conventional standpoint in regards to physical therapy and Watsu these are the benefits in dealing with neurological needs like the CVA patient previously mentioned.  Watsu helps to decrease hypertonicity including spacticity and rigidity.  The hypertonicity is addressed by gentle and rhythmic rocking, along with repeated trunk rotation and elongation which aids in decreasing abnormal muscle tone in neurological patients.  From a standard physiological view this is why I sought out an alternative for my CVA patient because of his rigidity in the affected lower extremity, especially his ankle.  Later, I realized Watsu could possibly help him deal with the anxiety and stress he had about falling.  He had previously fallen and dislocated his right shoulder which was dysfunctional at the time.  This increased his anxiety because he had expressed a concern that if he fell again he would not be able to catch himself.  So, Watsu gave him a nurturing and supportive environment that addressed physiological deficits along with allowing a more peaceful mind, once again the mind-body connection working together .5

Communication is the Cord

Each discipline in the health care symphony is important, but communication between each unique discipline creates harmony for all those concerned.  When listening to a musical symphony we can appreciate each individual instrument with its distinct sound.  But, when all the instruments play together it touches us magically on a higher level.  We label our patients as an above the knee amputation (AKA), cerebral vascular accident (CVA), and a total knee replacement (TKR), but they are more than a physical impairment.  We can address the patient's total needs through other health care professionals which have grown over the years if we open ourselves up to communication and utilizing community resources.

References

1.  (2008). Balanced Body Pilates Inc.  Retrieved February 18, 2008 from

www.pilates.com/BBAPP/V/about/pilates-benefits.html

2.  (2008). Balanced body University.  Retrieved February 18, 2008 from

http://bbu.pilates.com/instructor-training/what-is-pilates.html

3.  (2008). Aquatic Bodywork Association New Zealand.  Retrieved February 20,

2008 from http://www.watsu.org.nz/

4.  Yavelow, Andrew. (1999). Finding Yourself in warm water; the spiritual

possibilities of Watsu.  Retrieved February 20, 2008 from

http://www.waba.edu/watsu/Watsu%20and%20Spirituality.html

5.  Schoedinger, Peggy. (n.d). Benefits of Watsu For People With Orthopedic,

Neurologic and Rheumatologic Special Needs.  Retrieved February

20, 2008 from http://aspen.forest.net/waba/watsu/Watsu%20Special%25Needs.html

Enter the parking lot on Zumba class days at Body Dynamics and you will hear the music right away- you will also have a hard time finding a place to park!

Want to tone up, slim down and have some fun?  Zumba is aerobics at an all-new level- making it truly like going to a party.  Observing this class while filming and photographing Yona and her best friend and fellow Zumba Master, Kesha- the energy in the room was incredible.  There is no way you can call this just exercise.  It is one big dance party!

Yona Whittinghill came to America from Albania 7 years ago to attend college in Boston at Clark University.   Just two years after coming to America she moved to Florida and is working on her Marketing Degree at the University of South Florida.Yona completed the Zumba Master Class taught by creator Beto Paris in Miami, Florida. Yona and Kesha are certified Zumba instructors.  (Yona in photo- left)

HISTORY

Celebrity fitness trainer, "Beto" Perez, stumbled upon the concept of Latin inspired fitness in his native country of Colombia (South America) in the mid 1990's. One day, he walked into his class and realized that he had forgotten his aerobics music, and his only option was to grab whatever tapes he had in his car. Beto’s tapes were comprised of the songs that he loved, the traditional Latin salsa and merengue music with which he had been raised. But it was a challenge to improvise a whole class on the spot using non-traditional aerobics music. Beto rose to the challenge and from this last-minute improvisation was born a revolutionary fitness program – Zumba! The class soon became the most popular class at his fitness facility.

Read more….  http://www.zumba.com/about.cfm

Zumba combines high energy and rousing music with exclusive moves that allow the Zumba participants to dance away their concerns and the inches from their waist.  Zumba is a fun workout and is great for the body as well as the mind.

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