Wednesday, August 28, 2013

Why consistency is so important, the truth behind the reason your not seeing improvements

As a trainer and a therapist it is not uncommon to provide "homework" to  patients or clients, part of what we do as trainers or therapists is to educate the trainee on exercise, diet, form and technique of movement, etc.... Our goal is to initially have the trainee adopt our program to maintain when not being supervised.

The reason for this is so that the client develops consistent diet, exercise or movement patterns with the instruction that was provided. The repeated performance of an exercise or an activity reinforces it in your brain so eventually it becomes more of a natural movement or activity.

Once that has been accomplished the progression can be implemented during training or treatment sessions.

Despite popular belief, there is no quick fix to improve health or recover from injury, there is no safe magic pill to drop 30lbs in 2 weeks or build 30lbs of muscle in the same time period.

What there is though, is tried and true and has been performed for years by many. It's consistent hard work.

Think about it... Michael Phelps did not become one of the greatest Olympians ever by practicing inconsistently did he? No, he practiced consistently to achieve his goals.

As babies when learning to walk many falls take place, probably 10 or more a day, does that stop them from trying? No, they are consistent in practicing their walking until they achieve it.

The same can be said for your exercise routine, are you getting the most out of your current exercise program? Are you exercising consistently 2-3 times a week or are you going hard and then fizzling out?

The majority of people will work really hard for 2 weeks, expect to see major differences in strength, weight, performance and when they don't they get frustrated, become inconsistent, or quit altogether.

I want to stress how important consistency is, not just for exercise and diet, but in life. Some of the most successful people in this world failed at some point in something, yet they still managed to find success.

The reason for this is that they were consistent in their performance, they did not let in or give up.

So I encourage you to do the same, if it's a diet or an exercise program to lose weight, improve function, or just to overall improve your health.

Stay consistent and I promise you will see the rewards of your efforts.

Keep Fighting and Never give up!


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Thursday, August 22, 2013

3 Easy and effective exercises to improve your posture

Hey Team,

I thought I would touch on something that I feel I talk about on the daily with clients and patients...Posture.

In this day and age of computers and smart phones, more and more everywhere you look you are bound to see someone with rounded shoulders and forward head like this

or like this

So much of our daily activities require us to work with our arms out in front of us like typing, driving, or writing. Over time we begin to slump which rounds our shoulders and places our head in a forward position, the longer we stay in this position our postural muscles become weaker and chest muscles become tighter rounding our shoulders more.

Over time we may begin to develop shoulder pain, neck pain, or even headaches as a direct result of this muscle imbalance.

Well I have a cure for's not in a pill or magic potion though, it's actually good ol consistent work on your part to correct the issue.

3 easy and effective exercises that you can do anywhere to begin to correct this muscle imbalance and start improving your postural awareness.

1. Doorway Stretch- This is a very effective stretch to decrease the tightness in your pecs, do it daily.

Position yourself in a doorway from a wheelchair position or standing, put your hands on the frame of the door as pictured and lean into the doorway until a comfortable stretch is felt.

Hold for 30 seconds and repeat 3 times.

2.  Scapular Retractions

From a seated or standing position, position your arms 90 degrees at your side. Squeeze your shoulder blades together, sticking your chest out and return to start position.
Perform 3 sets of 10 repetitions each with a 2-3 second hold on the squeeze.
3. Scapular Wall Slides

This one is definitely not as easy as it looks.....
Position yourself against a wall, pull your wheelchair so that it is completely against the wall.
Place your head, shoulders, and bottom against the wall. Now position your arms in a W position as pictured.
Keeping all of the above points of contact (head, shoulders, and bottom) as well as the back of your hands on the wall as you slide from a W position to a Y position.
Perform3-5 sets of 10 repetitions.

As mentioned earlier, the above exercises are extremely effective in decreasing tightness and improving postural awareness, it won't happen with just 2 times or even 5 times of performance. This is something that you have to be consistent with in order to begin to see the effects shine through.
Think about it, your at your work desk for 8 hours of the day on the computer...that's 8 hours of forward rounded posture, just 4 times of completing the above exercises is not going to cut it.
Be consistent, do it daily. They are quick and easy and can be done anywhere, start improving your posture today.
Try them out right now and tell me what you think, and yes that handsome devil in the first pic is me doing my doorway stretch in case you were wondering.
That's all for now,
Keep Fighting, Never Give Up!
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Sunday, August 18, 2013

Benefits of health and fitness for the disabled

Hey Team,

Doing some reading today and gathering some research and other articles that focus on positive outcomes following activity or exercise performance.

It is common knowledge that there is a benefit to regular exercise for everyone, which is why any morning of the week you will see people running, riding bikes, or walking.

The benefits of a consistent exercise program are countless, but overall help to improve mind, body, and soul.

Following a disability there is an even greater reason to exercise, yes it is still important for mind, body, and soul, but there is plenty of consistent research that is proving that regular exercise can also improve function.

  • Activity based rehab- is a term that has become popular in the spinal cord injury, and while more research is needed to prove its effectiveness for all spinal cord injuries, there is some research that finds benefit for some.

I recently did a post on The first fully functional quadriplegic- check it out here--->


Take a look at this research article on Activity based therapies-

  • Walking program-I have stressed walking to many of my clients who are recovering from a stroke. There are countless studies on the benefits of a regular walking program for strength, muscle and cardiovascular endurance, as well as improving movement patterns, balance, and control.
Here are two articles that prove the benefits of walking for those recovering from a stroke and for seniors to improve or maintain strength and independence. Walking for Stroke

and Walking for older people

  • Group Fitness for kids with disabilities-Regular consistent exercise is just as important for children and may even be more beneficial Research article on fitness program for kids with disabilities

As more research is conducted and gathered, the same result will be proven over and over again for anyone with or without a disability....Consistent exercise will improve and benefit your Mind, Body, Soul, and Function.

So keep fighting and Never give up!

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Sunday, August 11, 2013

The Dedicated-True story of an adapive fitness clients progress with aggressive training

Hey Team,

I came across a progress report that I wrote for an adaptive fitness client who was recovering from multiple strokes that I worked with for over 6 years and thought I would share it for those that are interested.

This clients name has been switched to The Dedicated, it is a real account of our progress made together.

Take a look at our journey together, and see how an aggressive adaptive fitness program  and consistent hard work took The Dedicated from dependence in a tilt in space wheelchair, to walking with hand held support.

Devon Palermo Adaptive Exercise Progress Report

Client: The Dedicated

Disability: Multiple strokes, gait/coordination disturbance

Initial assessment for Adaptive exercise: March/2006

To whom it may concern;

The Dedicated was initially evaluated for an adaptive exercise program in March of 2006, at that time The Dedicated presented in a tilt in space wheelchair dependent for propulsion. The Dedicated was non-ambulatory, and required maximum assistance if not completely dependent for all transfers. In the home The Dedicated utilized the following: Hospital bed, standing frame, Wheelchair, and portable ramps for negotiation of steps in the home, as well as necessary aids for self grooming, The Dedicated also utilized the care and assist of a caregiver. The Dedicated was able to communicate with me verbally, but often required assistance from a caregiver when unable to express verbally what was wanting to be said.

Standing was assessed which required max assist-dependent effort with max assist for verbal cues. Sporadic volitional control of the lower extremities was demonstrated when weight bearing and The Dedicated could only stand for seconds at a time. The Dedicated expressed an intense fear of falling when standing supported. we tried weight bearing through the knees with upper extremity support through the elbows on a bed. Positioning required max assist-dependent with max assist verbal cueing. Just as with standing The Dedicated demonstrated sporadic volitional control with glute and lower extremity activation which prompted me to focus solely on weight bearing exercises to improve muscle control by overloading the central nervous system.

The Dedicated agreed to begin in home training 3x a week to work on strengthening the lower extremities and improving standing tolerance.

An exercise program was demonstrated to the caregiver to perform on days we could not meet for training. Exercise program consisted of Leg strengthening exercises that could be performed in the bed. These exercises required max assist for verbal cues to be performed properly secondary to The Dedicated having much difficulty with awareness of left versus right/ right versus left and the sporadic volitional control of the leg muscles.

After several months of working on weight bearing exercises in standing and on the knees and with the exercises performed while laying in bed, I began to note improvement in volitional control of the lower extremities. The Dedicated was now able to respond with muscle activation consistently with verbal cueing, though at times The Dedicated would confuse which lower extremity The Dedicated was attempting to control.
I decided to start implementing core balance and proprioception through the use of a physio ball. The Dedicated required max assist for set up, but was able to maintain balance while sitting on a physioball with moderate assist and moderate assist verbal cueing. I decided to continue with weight bearing exercises while including the newer core stability exercises.

As strength improved in the lower extremities, we were able to work on standing with close supervision after min to moderate assist going from sit-stand and with verbal cues for upright posture.Standing had exhibited tremendous improvement going from seconds to minutes. Soon we began to implement dynamic balance exercises, reaching across midline, standing with eyes closed, etc...

With the improvements noted in standing, I decided to attempt walking with The Dedicated. This proved to be a VERY difficult task. Secondary to fear and lack of coordination with movement, walking ended up being a very maximum assist of 1, almost dependent. Verbal cues were expressed for upright standing, activation of muscles for standing, breathing, and lower extremity  advancement.

As we continued to push with the very difficult task of walking, slowly The Dedicated’ walking began to improve. Requiring less physical assist going from max/dependent to mod/max, and the verbal cues for advancement of the lower extremities decreased, though cues were still required for breathing, balance, and posture. Due to the improvements noted, The Dedicated requested to increase our visits. We would shift from 3x a week to 5 x a week sometimes with sessions lasting two hours depending on the day.

Through the first two years of working with The Dedicated privately, The Dedicated continued to attend physical therapy. The physical therapist and I conversed regularly on the improvements that were made in the home and would apply them to treatments in PT. The Dedicated was able to benefit from the use of the Lite gait and Lokomat while in PT. It is my belief that of all the tools presented for trial with treatment, the Lokomat made the most significant improvements by increasing confidence, decreasing fear of falling, and forcing an upright position in standing.

The Dedicated would go to PT for Lokomat training 3x a week for 20- 50 min ambulation sessions in addition to the home training. Lokomat use improved  coordination of the lower extremities with ambulation while not in the lokomat, it also improved endurance for walking while training. Another benefit of the use of Lokomat is that it positioned The Dedicated in an upright proper walking alignment by use of the exoskeleton, The Dedicated was unable to lean . Lokomat training continued well over the normal recommended amount of 12 sessions secondary to improvements.

Once discharged from physical therapy the focus at home became solely walking. We tried several assistive devices. (platform walker, standard walker, neck brace for positioning) Nothing seemed to benefit posture with walking, but we stayed consistent and kept pushing forward.

We began to increase our distances going from 25 ft 2x in the hallway of the home initially to over 400 ft in the hallways of the condominium lobby, to up and down stairs with mod assist and verbal cueing and finally  to over 1000 ft with standing rest breaks as needed.

The Dedicated soon requested trial of walking in the pool. I thought it a good opportunity to work on balance in standing using the buoyancy of the water. Due to the decreased muscle mass on the left leg, we had to use a water weight to decrease the buoyancy of the left leg. Pool ambulation and balance exercises in the water had now become a staple in our exercise sessions during the summer months over the course of 4 years. Ambulation on land after being in the pool did seem to improve requiring less verbal cues for movement and improved fluidity of leg movement.

Currently The Dedicated has been given an exercise program to complete with caregivers in addition to the walking exercise that is performed 3 x a week with me.

The home exercise program consists of standing balance, transitioning from sit-stand, dynamic balance exercises, and ube interval training x 40 minutes with rest breaks as needed.
Total of 6 years working with The Dedicated in aggressive adaptive training has yielded positive results that even surprised the doctors who followed the The Dedicated’ care.
The Dedicated has overcome many challenges, but worked very hard to do so.
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Keep Pushing, Never Give Up!

Sunday, August 4, 2013

Relentless Training- The First Fully Functional Quadraplegic

Hey Team,

In my last post I listed the top balance exercises that I recommend for those with disabilities looking to improve balance, stability, and control.

I spoke on how over stimulation of the Central Nervous System is in my belief a significant factor in improving mind muscle connection.

I strongly believe, and research does show that intensive physical training yields positive results for those recovering from disabilities.

I started to think about a man named Patrick Rummerfield, I remember in my early days working with Spinal Cord Injury patients hearing the stories about Patrick and how he was relentless in his training. The Stories about how he would have someone load cuff weights on his legs and set him up on a bike to cycle even though he was barely able to make a movement. How he would do this daily, and how eventually he was  able to move, then able to complete a full revolution on the bike, then stand, and ultimately walk.

I remember seeing him during a Spinal Cord Injury rally, and being inspired all over again, It is Patrick's Never Give Up attitude that motivates me to want to motivate anyone with or without a disability to improve themselves.... to improve myself.

He has a quote that says it all on his site “If you’re going through hell, keep going.” Sir Winston Churchill

That speaks volumes to me, and it should to everyone. Keep pushing, be relentless....Whatever the struggles, Whatever the disability, Whatever the difficulty stay consistent and push a little more every day!

Check out Patrick's site here:

Keep Fighting, Never Give Up!


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