Jennifer Millar, a physical therapist, and Kiersten Riggs share simple exercises to support balance, coordination, and strength in Friedreich’s ataxia (FA).
Transcript
I’m Jennifer. I’m a physical therapist with the Johns Hopkins Ataxia Center. And I’m really excited to talk with Kiersten today about exercise for people living with FA. We’re going to show you guys a few exercises.
Jennifer: The first one we’re going to talk about is a way to challenge your inner ear, which is your vestibular system.
Your vestibular system is basically a human gyroscope that allows you to sense head movement and generate an eye movement to see clearly when you’re walking. This can be an issue sometimes with FA. So this is a good system to challenge.
And we’ll show you a basic exercise that you can do starting in sitting, although we’re starting in standing. Basically you’re going to be looking at a single point, and you’re going to focus on that point, preferably a letter or a word.
You’re going to keep your eyes locked on that letter or word, and you’re going to turn your head slowly, not too far, and continuously back and forth, starting at maybe 30 seconds or whatever you can do without feeling nauseous or dizzy. And you gradually will work up to maybe a half, to a minute or so.
And you would do this side to side and then eventually do this up and down.
So this is training the vestibular ocular reflex. We call this a gaze stability exercise. And you could do this any time, anywhere. If you’re sitting in between TV commercials, or when you’re doing balance exercises, you can incorporate this vestibular ocular reflex or gaze stability exercise.
All right. Very good.
And a way to make this harder is to do this with a closer target or with a farther target, or feet just a little bit closer together, just moving the feet maybe 1 inch at a time. Not too much of a change. And you’ll notice just that incremental change in the base of support makes the exercise that much harder.
Excellent.
Preferably this is done in the safety of a corner of a room where you have a wall on either side of you, behind you. Safety is absolutely important, and part of motor learning is kind of figuring out and exploring what is your limits of stability. So being in a corner or some object is available to catch you is a good way to practice this at home.
Next we’re going to do an exercise that’s really fun on your hands and knees to work on movement coordination, but also core strength.
So we’re going to get down here together and we’re going to start with our hands apart — hands together and knees apart. And we’re moving one in the right hand and the left leg in sync. And then we’re moving the left hand and right leg in sync. And we’re going to keep going.
So hands apart, knees together, then hands together, knees apart. And keep going. One more.
And now we’re going to switch directions. We’re going to go back. We’re going to move the right hand, left knee in sync and then left hand, right knee. “Keep going.” Hands together, knees apart, and hands apart, knees together. And again you’re trying to move in sync. So this is working on motor control, motor coordination, core strengthening, all in one exercise.
And then if you really want to be advanced, you can pick up your knees.
Don’t worry about doing Kiersten.
And do the same thing with its hands and toes. Something to work towards eventually.
All right. You can also do crawling forward and back.
Kiersten: You get the floor on this then.
Jennifer: OK.
So it’s just basically crawling. Don’t overthink it. But it’s the idea is to move and touch the floor in sync. And eventually you can do hands and toes if you really want to go nuts. OK. Good. OK.
So now we’re going to do some variations of the bird dog. So the first thing we’re going to just do is arm elevation only. We’re going to just pick one arm up, hold for a few seconds, lower, and then switch. And then you could just start here and then master that.
And then the next progression would be keeping your arm still, but move your legs. So bring one leg back and you don’t have to go far or fast. Hold for a few seconds, lower, and then switch.
And pretend you have a coffee cup on the small of your back and you don’t want it to spill, so you’re just kind of keeping good posture as best you can. And again, we’re aiming for slow and small movement, not fast or big movement. And breathing diagrammatically.
And then the progression is arm and opposite leg. And again, all you have to do is just clear your hand and leg from the floor and then lower and switch. So we’re not aiming for big movement, slow and soft, and really just picking your hand or leg up just an inch or two off the floor is enough to challenge your balance.
Yeah. Good.
And then it’s just kind of finding a way that works. And if it’s too much to do both arm and leg, just back up and do one or the other.
And then the progression is to do rocking. First you’re going to rock back. And then when we rock forward, we’re going to pick one arm up and then bring your arm down and rock back and then come forward and bring the other arm up.
Yep. And then keep going.
So you would do that for whatever time you’re able to do, maybe work up to a minute or so. Again, repeating things over and over once you’ve found a way that works is key for motor learning. So, that’s why we try to do several repetitions once you kind of figure it out, a way to make it work.
All right. So after maybe a minute we’ll do legs only. So we’re going to rock back. And then when you rock forward you’re going to pick one leg up, hold for a few seconds, and then lower and then switch. And again we’re aiming for slow movement, small movement.
It’s really good. Super good.
Kiersten: Thank you.
Jennifer: Great posture. That’s great. Did you want to try arm and leg or no?
Kiersten: Yeah we can.
Jennifer: OK. So we’re going to do next is we’re going to go for the gusto. We’re going to rock back and then we come forward. We’ll do one arm up just an inch and the opposite leg and then lower and switch. Rock back. And we come forward. Just clear your hand and knee, you don’t have to go far. And then lower and switch.
Great. Excellent. And then lower. And we’ll do one more, and then we’ll be done.
The nice thing about this is you’re low to the ground. So if it’s not perfect, you’re not going to be hurting yourself because you’re low to the ground. So it’s part of learning and figuring it out. So yay.