Recently two of my older adult participants have raised the same querrie. Both are males in their 60's with cerebral palsy (spastic athetosis, whole body affected), very intelligent and independent and aware of their bodies, and both have been participating in CE over past several years. Both gentlemen have noticed increased spasm / athetoid movement in their dominant arm -- to the point of affecting their ability to carry out tasks they normally can do, or throwing them off balance and causing falls. Has anyone come across this with older adults with cp or with other similarly presenting conditions? Does anyone have any idea as to what the cause -- and more importantly any solutions? One has already tried an increase in medication to manage spasticity as per dr's suggestion but it only provided very short term relief. Any thoughts or shared experiences would be much appreciated.
Lisa Gombinsky, Senior Conductive Educator, Adult Resource Program, The Spastic Centre NSW, Australia
Lisa, it is an interesting
Lisa, it is an interesting experience you have. As you ceartainly know athetoid CP caused by the damage of the cerebellum or most likely the basal ganglia. The normal ageing process affects both strucures resalting changes in the muscle tone, posture and coordination. If there is no other apparent reason I would put my bet onto it. Of course this is just a tought, there is no scientific evidence to support this idea but in case of a typically developing or ageing -:) individual, the changes in the mid brain (where the basel ganglia is located) can affect movement. Interesting topic for a research...
Gabor
Increasing, and decreasing
Increasing, and decreasing athetoid movements.
I have worked with one particular Athetoid young man since he was a very young child.
Though out each stage of his development the athetoid movements of his body have increased or decreased . Especially difficult times where the times when enormous spurts of growth took place that altered the way he could use his muscles and also changed the strength he had in them.
Puberty of course brought with it changes in hormone levels as well as more growth spurts, all very visibly affecting the intensity of the changing movements in all of his muscles.
Sometimes his speech improved enormously when the athetoid movements, not only in his face, but in his whole body decreased. Sometimes he was extremely difficult to understand at others as clear as a bell.
Sometimes we feared operations would be needed on his lower limbs to enable him to keep walking independently, but the fears where gone when the legs starting doing what he wanted again. He learnt how to work with the different movements until they changed once again.
Another change came when he developed epilepsy. His whole body become weaker, we think as a result of his daily medication. On days after an epileptic fit the over movements in his body increase. He has to learn new solutions for these days too.
Our solutions? Conductive upbringing. Finding the right thing to do at the right time.
I am sure Garbor is right it is the aging process. We see these changes happening from the moment a child is born, in each stage of development and aging. Our clients have to come to terms with the way the body is changing, how it is moving and they must continuously find new solutions to everyday problems.
These clients need several "tricks" up their sleeves to solve each problem as not everyday is the same and the tricks don’t always work.
Hi All -- Firstly, thank you
Hi All --
Firstly, thank you Gabor and Susie -- your comments are appreciated, and certainly along my lines of thought. Funny -- in this little microcosm that is the CE community, over the years it has always been you two that have been at the other end of the internet responding to my questions and comments professionally and helpfully -- thank you -- working on my own is that much easier knowing that there are people out there that I can turn to when necessary.
I could be pulling at straws, but especially with regards to normal aging and changes to basal ganglia... I'm wondering if there is a link to what happens with people aging with athetoid CP and people with Parkinson's Disease that is progressing beyond being easily medically managed. If, as the Parkinson's progresses and the affected parts of the people with PD's brains deteriorate further, the amount of dopamine needed to create movement is elevated to a point of disabling diskinesias, is it possible that with 'normal aging' the basal ganglia and other affected areas of the person with athetoid CP's brain become less able to respond to the dopamine or other chemical messengers causing an increase in unwanted movement? Just a thought.
By the way -- with one of the gentlemen in my original question, we have worked out some pretty awesome visualizations that have allowed for much smoother and fluent movement, and he is now building them into activities at home. The other gentleman's new movements are still very sudden and unpredictable, and we are still working on finding a trick that helps him manage with them
Thanks again -- best wishes --
Lisa Gombinsky, Senior Conductive Educator, Adult Resource Program, The Spastic Centre NSW, Australia
Dear Lisa When you first
Dear Lisa
When you first posted this question I tried to get in touch with a very experienced conductor friend of mine to discuss this subject with her. I have at last reached her and I will list some of the things we have come up with.
One of her suggestions was that it is a metabolical problem.
She suggests that perhaps the receptors are not working as they were earlier on in life. This all fits in to the ideas that have already been posted.
We wondered when these changes take place. Is it at a specific time of the day? After a specific activity? Are they influenced by any emotional and environmental changes to the clients life.
Does the client take medicine, eg. muscle relaxants or tranquilisers? Maybe with increasing age the dosage needs changing.
Are the clients developing rheumatism? 60 is the age when this could begin to develop.
It is also possible that the earlier positions that were used to fix limbs and prevent over movements just don't work anymore. Reasons could be contractures, weakening in muscles, pain.
It is worth investigating what the pulse of the client is especially in the time just before the symptoms arise. A record would have to be kept over a longer period of time.
I hope the results of my chat with my conductor friend help you Lisa. The whole discussion has certainly helped me especially with the client I am presently working with. Thanks to both of you too.
Susie
My daughter has a recessive
My daughter has a recessive genetic condition called Joubert syndrome that affects the cerebellar vermis. Delayed motor development with all coordinated movement is a major factor of this syndrome. My dtr who is 5 yrs 11 mos has previously had hand and arm movements in the air that seemed to be "self stimulating". Recently, her movements look very athetoid including her head, neck and torso. This only occurs when she is sitting not performing an activity. The movements stop with intentional movement and she regains coordinated control when doing an activity such as feeding herself. It seems that the suggestion is that maybe the changing of the basal ganglia with growing may be the cause of this. Any other ideas how this might be occurring in a disorder other than cerebral palsy