questions regarding a client with spina bifida

[clo]

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Hey all, I'm hoping to get some input from some of you regarding this client I just started working with. Hopefully come of you remember me, i've posted here before because I'm looking to transition in physical therapy from personal training which I've been doing for over 10 years now.

Back to my client. she's 47 years old and has what she says doctors have called a unique case of spina bifida because she is only affected from the waist down. she has no bladder/bowel or hydro encepholitis issues.

she was walking unassisted 6 years ago but developed an infection in her heal which required surgery than rehab. At that point she became discouraged and up until this point relied on her wheel chair.

She has numbness from her ankles down but can tell the difference between hot/cold and can feel pressure when someone is messing with her feet.

she is overweight but HIGHLY motivated to start working out again. She can move around without her chair, but is not capable of walking long distances yet.

So I've worked with her for 3 sessions now and we've been using a combo of weight machines and bands for her legs. We've been using light weight but I've found she has VERY weak hamstrings and adductors and strong abductors and quads. To help her balance issues we've also been working on her just standing up from her chair. she's able to do 10 reps of this.

My question: What should I be avoiding with her? I'm assuming there should be NO twisting of any kind because of her condition. what else?

 

[DPT ATC]

you are not a licensed PT? if not, you should probably refer this person to a licensed PT. sounds like you might be a little out of your league. i'm not trying to be insulting, but there is a reason that PTs have so much more schooling compared to personal trainers. it is to deal with situations like this.

 

[pwrtrainer]

you are not a licensed PT? if not, you should probably refer this person to a licensed PT. sounds like you might be a little out of your league. i'm not trying to be insulting, but there is a reason that PTs have so much more schooling compared to personal trainers. it is to deal with situations like this.

I agree that he should seek out a pt, especially since pathology is a huge part of what is taught, but I disagree that the pt should totally take over. If she has an all clear to exercise from the physician and has been to a pt to determine her limits, then clo is likely the next step. Most pt's I have met have as much expertise in the field of general fitness as a mens health subscriber. We just don't get taught this, especially not to the level of a 10 year vet trainer.

BUT...He should consult her healthcare provider and state his intentions coupled with her goals to see if he/she agrees that his actions will do no harm. Esp. since she has obvious neurological issues. If she is cleared, a PT may be overkill. Maybe she just wants 12-20 sessions to help keep her motivated and get a start, or someone to talk to during her time that doesn't refer to her as a patient.

clo...I would personally not ask on a student forum, but rather talk to her physician. If that is impossible, then find a PT near you that can help you out, and take the time to learn as much as you can about her condition before you act. If you are in fact unable to help her, be honest and tell her that. I know this economy sucks and every client is tough to keep, but if she gets hurt, not even the greatest informed consent in the world can cover you for a breach in your scope of expertise. And PT school in the future would be out.

 

[MinnDasota]

I agree that he should seek out a pt, especially since pathology is a huge part of what is taught, but I disagree that the pt should totally take over. If she has an all clear to exercise from the physician and has been to a pt to determine her limits, then clo is likely the next step. Most pt's I have met have as much expertise in the field of general fitness as a mens health subscriber. We just don't get taught this, especially not to the level of a 10 year vet trainer.

BUT...He should consult her healthcare provider and state his intentions coupled with her goals to see if he/she agrees that his actions will do no harm. Esp. since she has obvious neurological issues. If she is cleared, a PT may be overkill. Maybe she just wants 12-20 sessions to help keep her motivated and get a start, or someone to talk to during her time that doesn't refer to her as a patient.

clo...I would personally not ask on a student forum, but rather talk to her physician. If that is impossible, then find a PT near you that can help you out, and take the time to learn as much as you can about her condition before you act. If you are in fact unable to help her, be honest and tell her that. I know this economy sucks and every client is tough to keep, but if she gets hurt, not even the greatest informed consent in the world can cover you for a breach in your scope of expertise. And PT school in the future would be out.

I agree. Would be best to see a PT for a screen first. If already cleared for exercise by MD, then have a PT give you recommendations and then personalize with your training. Based on your description, it would be hard to give you recommendations on a forum without seeing the client in person. You might want to contact the PT that worked with your client to get a better history and recommendations.

 

[clo]

no offense taken and this is definitely not out of my league. If she were coming to me for rehab than it would be. she is coming to me to lose weight and and stronger and wants to get rid of her wheel chair. she is capable of walking but very short distances.

she has been given the go ahead to exercise so seeing a DPT is not necessary. at this point what she needs and has is a VERY experienced personal trainer that knows more than most rep counters do in a gym.

However I do like the advise of seeking a therapist for additional input on where she is now and what we should be focusing on.

My goal is to get her out of her wheel chair and walking again like she was before her heal surgery 6 years ago. And while I know every precaution that should be taken I'll suggest she consult with a DPT as well. Alot of good can come from that in many ways.

Good suggestion, thanks.

 

[DPT ATC]

i didn't mean that she should only be seen by PT, sorry if that's how it came across. it would be great for the client to work with both PT and a personal trainer. what i meant is that if she has been primarily using a WC and only walking short distances there are things that PT can assess in addition to a strengthening program which she can do with a personal trainer. PT should assess her balance and safety, make sure she doesn't need an assistive device, assess home setup and safety, etc...

 

[clo]

i understand. While I've got a very good understanding of how the body works and how to recognize muscular imbalances etc..... I agree that getting a baseline assessment from a therapist would be most helpful.

in fact i'd feel more comfortable is she did see someone just to cover the few grey areas I'm not too sure about.

 

[pwrtrainer]

...

 

[clo]

Thanks! it's fun throwing out the work "proprioception" to some trainers and asking them to explain it. pretty funny.

on a side note I've got my transcripts from school on the way over to a couple schools here in Maryland. I want to go in and talk to them about their PTA programs.

 

[DPT ATC]

i agree. it is obvious that you take your profession seriously and care about your clients.

on a side note, i'm curious if most personal trainers have personal liability insurance? or are they covered by an employer? like i said, just curious. thanks.

 

[pwrtrainer]

i agree. it is obvious that you take your profession seriously and care about your clients.

on a side note, i'm curious if most personal trainers have personal liability insurance? or are they covered by an employer? like i said, just curious. thanks.

If in a gym, we are told that we are covered, but alot of the time the coverage doesn't encompass training. At my last position we were covered under the owners umbrella policy. If I were a contractor I would have ironclad insurance, especially since it is relatively cheap. The problem is that even though trainers hurt their clients all the time, the clients are either bullied by the gym into believing the gym was not at fault, or the client simply doesn't read their contract to know who is at fault when. I have always felt that no waiver can protect you from neglect. If a personal trainer is doing a prone plank with a client that has known low back pathologies, they are playing with fire. If they do it and load a weight plate on their back, they are in neglect and are seriously risking their clients health. My favorite was the 70 year old male client a co-worker had standing SINGLE legged on a BOSU trainer turned upside down.....while texting. He moved on to become the director. The bar for qualified people in that feild is set very low with a few outliers like clo who aren't even in the same class, yet when people refer to treiners, they are typically talking about the texting type.

 

[clo]

I couldn't agree more.

As for insurance, if you are an independent you need your own insurance. Now for a brief period before I had started my current job I had my own PT business and worked for a franchise. She paid me a hourly rate to do 1 free session with her clients which in turn covered me under her insurance policy.

But the first step I took outside her doors to do any training in the parking lot, etc... I was on my own.

I'm in a corp position now; a wellness coordinator. it's fun and rewarding but need more challenge which is why i'm looking into the PTA program.

I will say that I can't stand the direction corp gyms have taken. It's all about the $$ amount and not about the person. Last corp gym I worked for had a training company come in and take over the PT there and one of there guys prided himself on making clients pass out and used that as a tool to get them to sign up. Why? $$$$$

I quit and swore I'd never go back.

 

[clo]

UPDATE:

just spoke with my client this morning. she's going to go back to the PT to get some input, etc....

 

[superCOTA]

Interesting read.
Did she suddenly give out when fatigued?
Were there orthotics to prevent the ankles from giving out?
Hopefully this person doesn't have too many stairs into their abode.

 

[clo]

Interesting read.
Did she suddenly give out when fatigued?
Were there orthotics to prevent the ankles from giving out?
Hopefully this person doesn't have too many stairs into their abode.

No
yes
dunno.

I've not taken her to fatigue yet. we've come close but I don't feel it's necessary in order for her to get a good workout. Yet.