Thursday, February 25, 2016

The Importance of Recovery in Cerebral Palsy

In the race to achieve developmental milestones, promote dynamic movement, and improve overall function, I have found that the "larger picture" is sometimes clouded if not lost completely.  By this I mean that the human organism operates (oscillates) within what I like to call a specific Biophysical Continuum.  In other words, we are not simply "ON" all the fact, we exist within specific "states" of activation.  By activation, I refer to what is the predominant systemic / biomechanical system operating at any given time. 

This perspective is an attempt to provide some clarity on the human organism (person) as a whole...or as a "Supersystem" that is something more than just the sum of separate individual systems.  Rather, it is an exponentially complex and inter/intradependent piece of evolution and engineering.  In effect, it is likely beyond our current capabilities to truly comprehend...which is why the Biophysical Continuum is a valuable tool in navigating the journey through neurodevelopmental challenges. 

Biophysical Continuum

 As shown in the graphic above, we can effectively separate a full day into 3 formal "states":

1. Activation
2. Relaxation
3. Recovery

Being a continuum, there is no explicit "point" at which one state becomes another...rather that we "slide" seamlessly from one state to another, and at many times during the day, we exists in a state that can be a hybrid "blend" of either activation / relaxation and relaxation / recovery. 

Activation can be formally identified as "exercise and movement".  To be precise, it is manifest by HIGH levels of muscular, neurological, and mental resources.  There is a higher rate of catabolic activity which contributes to increased levels of metabolic build-up (lactic acid, etc...) which is toxic to the body and needs to be flushed, and there is a greater stress on biomechanical architecture and neurological resources (concentration).  Relaxation can be misleading, however within the context of this post, I refer to it as those mental and physical activities that take place during the course of the day.  In other words, the "routine" that takes place when we are not either sleeping or exercising.  In this phase, the mental / neurological / physical requirements are well within tolerable limits...mainly because they are likely to be habits that have become somewhat "automatic" and are essentially done within any real conscious effort or concern.  More importantly, systemic function is essentially at a "net zero" level...meaning that there is a sufficient amount of "input" to satisfy the required "output".  Recovery is most accurately defined as "sleep" (and in many cases, meditation as well).  It is during this phase that our systemic "oscillation" (respiration, digestion, lymphatic system, microcirculation) plays a primary role while the neuromuscular "engine" reverts to a primitive and formal "off" state.  This is THE state at which our evolutionary development and "operation" are hard at work.  We slip from any voluntary / conscious influence and are essentially operating on the autonomic / involuntary / primitive level. 

This is where we formally enter into our most valuable self-healing, self-regulating, and recovery phase.

If we assign a generic amount of time during a 24-hour day, we are presented with a breakdown that approaches something like the graphic above.  If we assume an average amount of sleep that centers around 8 hours (a lot for some and too little for others, but you get my meaning), an average of 30-60 minutes of what could be considered as "exercise / movement" based activity, and the remaining 15 hours manifested as "daily activity"...we are left with a "colour-code" that looks like that.  In essence, this is an example of an environment that is sustainable.

If we consider the realities in CP (and all neurodevelopmental disorders, in fact) we get a vastly different picture.  Disorders of movement and posture require extremely high levels of muscular activation (even to accomplish those tasks that we generally consider "easy") as well as high levels or mental resources.  To be precise, many if not most of what we normally classify within the context of "daily activity", falls into the category of "athletic exercise" in the individual with CP. 

The ultimate outcome is an environment that stresses ALL systemic and biomechanical resources...the result of which are those common challenges we see with alarming and consistent regularity:

-low bone density
-digestive distress
-muscle wasting
-immune system dysfunction
-altered respiratory mechanics
-low circulating oxygen
-hormonal imbalances
-etc, etc...

All of this taking place under the influence of (in most cases) irregular and/or insufficient sleep patterns.

The "bottom line" is that the mechanical and systemic equivalent in a healthy individual is something akin to exercising 14 hours a day, sleeping about 4 hours a night, and leaving approximately 6 hours to accomplish everything else we would attribute to daily function (eat, shower, leisure, study, work).  When placed within THIS context, the stress on the CP body becomes more is an enormous challenge to a growing organism

The body does not have adequate time to engage in the process of self-healing and self-regulation...meaning that recovery is insufficient and incomplete.

In summary, my primary message is intended to reflect the following:

ANY strategy that contributes to relaxation and enhanced sleep potential is a valuable and VITAL component to all rehabilitation plans.  Although all of the efforts to improve movement, balance, coordination, fine motor skill, etc...are critically important, they also ADD to the biomechanical, systemic, and neurological daily requirement.  Therefore, a careful and focused effort to potentiate the "rest and recovery" of an individual with CP will result in a Biophysical Continuum that is more harmonious and consistent with a sustainable supersystem.

In essence, the "investment into recovery" pays HUGE dividends within the realm of movement and dynamic function.  A system that is rested, fresh, and fluid will perform significantly better...which ultimately results in a better rate of progress.  More importantly, it "raises the ceiling" of potential and greatly enhances the prognosis and opportunity for a best-case scenario.


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