Exercise for CIDP - IG Living

1 22 August-September 2010 IG Living !Anyone who has experienced local anesthesia or hashad an arm or leg fall asleep knows how frustratingloss of feeling and/or impaired control of a bodypart can be, even for a short while. Our brains have aninherent desire to know the status of our body parts at alltimes. When something is preventing or interferingwith the signals that travel through our nervous systemto and from our brain, it can have a dramatic effect on ourbehavior and our ability to function. Think about the last time that you were given a shot ofNovocain before having dental work performed. Can youremember what you probably began doing even beforeyou left the office? You might have run your tongue alongthe side of your mouth that was numb; rubbed, pinchedor tapped your face; or even gently bit your cheek to seehow hard you could squeeze before feeling The impulse comes from our brains as they try tofigure out what s going on and to regain control of thesituation.

2 But, drawing a comparison between a trip to thedentist and the symptoms experienced by someone withchronic inflammatory demyelinating polyneuropathy(CIDP) is by no means a fair association. However, it mayhelp those who have never suffered from a neuropathy tohave some concept of what is experienced day after dayby someone who Is CIDP?CIDP, commonly considered the chronic equivalent of asimilar condition named Guillain-Barr syndrome, is a diseaseof the peripheral nervous system that is caused by anabnormal immune response that mounts an attack onmyelin (a fatty covering that protects nerve fibers andallows for a signal to be relayed quickly). As a result of thelost myelin, the affected nerves respond weakly or not atall to stimuli, resulting in progressive muscle weakness,fatigue, loss of deep tendon reflexes and atypical nervesensations (tingling, burning, numbness and/or pain).

3 Symptoms are usually symmetrical and frequently causedifficulties with walking and the coordination of othermovements. The autonomic nervous system also may beIndividuals with CIDPcan improve function andmobility by engaging in appropriateexercises for the upper and lower Matthew David Hansen, DPT, MPT, BSPTSE xercise forCIDP23 August-September 2010 IG Living !involved, leading to complaints of dizziness when changingpositions, heart symptoms and trouble with bowel andbladder function. In most patients, the course of CIDP is slowly progressive;however, it is not uncommon for periods of recovery, lastingweeks to months, to occur between relapses. Although thereis currently no known cure for CIDP, symptoms can be treatedvia corticosteroids to reduce inflammation, plasmapherisisto remove harmful antibodies from the blood, intravenousimmune globulin (IVIG), immunosuppressant drugs (in somesevere cases) and Exercise .

4 Early medical treatment is importantto confine nerve damage to the myelin sheath and to preventharm to the axons (nerve fibers) Exercise Can HelpAppropriate Exercise is a vital part of any CIDP interventionplan because of its potential to improve strength andendurance, thereby minimizing muscle shrinkage andimproving function and mobility. Understanding some ofthe recommendations that have emerged from scientificresearch for those exercising with a peripheral neuropathycan help to establish a proper , patients should always visit with their medical doctorbefore beginning an Exercise regimen. This is an importantprinciple for any population; however, it is even more essentialfor those with a peripheral neuropathy, because the wrongexercise parameters can actually make a bad situationworse rather than better.

5 The possibility of the autonomicnervous system being involved also means that the bodymay not respond to Exercise in a typical manner. Second, patients shouldn t overdo it! The damage causedby CIDP to myelin, and the possible damage to axons, resultsin the body s ability to recruit fewer muscle fibers to performa task. Consequently, those muscle fibers that are engagedare at greater risk of being overworked. Some soreness afterexercise may be expected, but it should dissipate within 12to 48 hours. If pain persists, is exaggerated or is coupled bya loss in strength, the patient likely did too much. Submaximal Exercise is frequently recommended forperipheral and/or a properly trainedphysical therapist can help patients find the exerciseprescription (frequency, intensity, time and type of activity,known as the principle) that is currently right forthem.

6 Low-impact exercises like walking, swimming, ridinga recumbent bike or performing open-chain arm andleg exercises (without bearing weight through the extremity)might also be good alternatives to high-impact activitieslike running or jumping. Third, patients need to be aware of their physical that put them at undue risk of falling or otherphysical injury should be avoided. And, they shouldn thesitate to ask someone to help, or at least accompany,them during their workouts. Fourth, muscle strengthening and aerobic conditioningare important. Science has demonstrated that strengthexercise programs can improve muscle force in patientswith peripheral ,3,4 However, it also has beenshown that aerobic conditioning is important in combatingfatigue and other impairments, particularly in the laterstages of ,3,4 And last, patients should wait until a muscle can workagainst gravity before stressing it against additional , under normal circumstances, myelin and peripheralnerve fibers can regenerate, with muscle control graduallyreturning as it does.

7 However, with CIDP, residual damage isnot uncommon and recoveries can take some time. Therefore,it is important to progress exercises in a systematic way inorder to avoid overstressing muscles and the Appropriate Level of ExerciseThose experiencing an immunological disease exacerbationprobably find it difficult to imagine themselves biggest hindrance may not be the weakness they areexperiencing, but instead, the popular misconception thatexercising means performing a workout la Jane Fonda,Appropriate Exercise is avital part of any CIDP intervention plan becauseof its potential to improvestrength and endurance,thereby minimizing muscleshrinkage and improvingfunction and 2010 IG Living !Billy Blanks or even Richard Simmons. The reality is thatthere are multiple levels of Exercise difficulty, each asachievable and as genuine a workout for those to whomthey are prescribed as a typical Exercise video would be fora fully able-bodied recreational athlete.

8 For CIDP patients,the following Exercise progression levels can be used forparticular exercises, but which level is appropriate willdepend upon what the patient is ready for. Passive Exercise :Gentle movement of the body (usuallythe limbs) is performed by a properly trained individual,without effort on the patient s part. Passive movement canbe beneficial for maintaining or improving blood circulationand range of motion. Thinking about the movement andtrying to assist may also help to re-establish nerve connectionsin cases where actual damage has occurred to the nerveand regeneration is under Exercise : Assistance is still required fromanother person, but the patient is able to participate inmovement to some degree. Actual activation of the muscle(s)is occurring; however, it is still not strong enough to movethe limb Exercise (gravity eliminated): Independent movementis possible in a gravity eliminated position, but notagainst gravity.

9 For example, a patient may be able to lifttheir knee toward their chest (hip flexion) while lying ontheir side in bed (gravity eliminated position), but notwhile standing (against gravity). Active Exercise (gravity reduced): Movement is possibleagainst some gravity, but not against its full pull. To usethe same example of hip flexion, a patient may be able tobring a knee toward their chest while lying on their back(gravity reduced), but not while standing (against gravity). Active Exercise (against gravity): Movement is possible inall planes (including standing for hip flexion), but withoutadditional resistance. Resistive Exercise : The highest level of progression, butalso the most variable level, limited only by the potentialof the conditioned human body to produce may take the form of weights, resistive bands,household items, one s own body weight, and Upper-Extremity ExercisesThere are several upper- and lower-extremity exercises forsome of the most important gross motor (large muscle)actions performed by the body.

10 The figures in this articleprovideoneexampleof the progression levels for each exercises also can be performed while patients arelying on their back, stomach, sides, sitting and standing. Lower-extremity lower-extremity exercisespredominantly involve the hip, knee and ankle. Hip flexion(Figures 1-4) is the action performed when lifting the leg towalk forward or step up onto something. In addition to hipflexion, two other hip actions extension and abduction are fundamental to an individual s ability to walk andmaintain balance. Figure orPassive Hip FlexionFigure Hip Flexionwhile lying on your side(Gravity Eliminated)Figure Hip Flexion(Gravity Reduced)Figure Hip Flexion(Against Gravity)25 August-September 2010 IG Living !Hip extension (Figure 5) is the motion that helps to pullthe leg back and propel the body forward after taking astep.