Nerve and Muscle Retraining Exercises
For anyone with limited abilities and/or mobility

Contributing Author: Jean Campbell

Before I started these exercises, I had no energy and was constantly tired. My left leg would lock up on me without warning, refusing to move for several minutes. My left arm and hand would do likewise and remain that way sometimes for hours. I was unable to speak a coherent sentence and stammered whenever I tried. Bladder control was nonexistent. My penmanship was terrible. I was prone to double vision and vertigo, floating dots or blank spaces in front of my eyes. Balance was foreign to me. I would shake so hard, I could barely use my walker. My short term memory was extremely poor.

When I finally started wearing a transdermal patch called Prokarintm, I slowly but surely started having the energy to experiment with these exercises. I am now able to walk for miles and have no more spasticity in either my left arm or leg. I speak a coherent sentence and actually carry on a conversation. I can usually sleep through the night or get up only once instead of four to six times a night. These are just a few improvements that have given me a quality of life I would never have if I hadn't started using the patch. I truly believe if I hadn't started on it, I would now be living my life in a wheelchair.

To begin, I want you to think back to when you were a baby, or when you watch the babies of friends or relatives. You couldn't walk right away, true?
You also didn't have a vocabulary at that time. You tended to “think” in pictures and would send those pictures from your brain down to your arms, legs, hands, knees and elbows. For example, when you were a little baby and your mom put you on a blanket in the middle of the floor, you had to figure out how to turn over from your back to your stomach. Once you managed to get onto your tummy, you happened to see a toy a long distance away from your present vantage point. You wanted to go check that thing out, but how were you going to get there? You sent pictures of that toy to your limbs expressing a desire to go and pick it up.

Your limbs don't have a vocabulary either. If they did, they would probably have laughed and told your brain, “Right. So what do you want us to do about it, and in which lifetime?”

Your brain kept sending the same picture to your limbs with more and more determination, which is called VISUALIZATION, and eventually your limbs started working together and accidentally started moving forward. This got your brain really excited, and it started sending that picture faster and bigger than ever. What you were doing at that time, even though you didn't know it was, you were stretching out your dendrites, those little finger like projections at the end of your nerves, that send and receive messages to and from your brain. These nerve endings have not forgotten the lessons they learned so many years ago, but they have shrunk up into tight little balls from lack of use. So what we basically have to do is send them back to school and retrain them.

One of the first things I want you to do is get a picture in your mind of wiggling your toes - first on one foot, then the other, and eventually both feet.
Send that picture down to your toes and try to make them wiggle. Many of you can already do this, but it will give you the idea of how to visualize and send messages along the neuronal pathways to your limbs and actually see them respond to visual commands from your brain. Do this and all exercises to follow at least 10-15 repetitions two or three times a day.

Now you want to change that mental picture and see your toes tapping on the floor. Do first one foot and then the other, then both.

Next, see yourself making circles out and then circles in with your feet, both separately and together. This is a range of motion exercise. As your body begins to respond to each of these lessons, incorporate them into the previous exercises so that you eventually have a vast repertoire of easy exercises to do at least two or three times a day.

Now that you have your feet beginning to pay attention I want you to start sending a picture of pressing first one foot on the floor as if you were going to take a step. Press. Hold. And relax. Then do the same with the other foot. What you are actually doing when you do this exercise is reminding your feet and legs they are weight-bearing objects. So when you advance to more adventurous tricks, they won't panic when you eventually stand up, and are able to support yourself starting with a walker.

So, are you ready for some more hard work? You can also work on some exercises while lying in bed at night. Think back to when you were driving your car. You put your foot down on the accelerator. Then you wanted to lift that foot up and put it on the brake. This is basically the same exercise you did in the previous step but in a different position. Don't forget your left foot. It has to exercise too. You can also use both feet together and turn them to the right and then the left while you are lying down or sitting up.

One more thing, while you are sitting, try to straighten first one leg, then the other. In other words, stretch your leg out at the knee and then return it to the floor.

Let's get a little more advanced now. For those of you with some degree of mobility, I want you to take a walker and sit down on the edge of your bed with the walker in front of you. If you are just getting out of a wheelchair, I don't want you to try this without someone there with you. I want you to VISUALIZE pushing yourself into a standing position by using the bed or even your knees, and grasp the walker. Give yourself a broad base of support, feet at shoulder width, see yourself feeling well balanced, and try to let go of the walker for two or three seconds. Do this in sets of 10 to 15 repetitions at least two or three times a day. The more you practice this step, the sooner you may find yourself being able to stand there for 15 - 20 seconds or longer. At this point you may want to try something else. Try to visualize balancing first on one foot, then the other. You may not be able to accomplish this at first, but with time, patience and practice, and a little bit of luck, it may happen.

Once you have some semblance of balance, let's see what we can do with it.
Put the walker one arm's length in front of you and let go, regain your balance and see yourself taking two or three tiny little baby steps to the walker. NO GIANT
STRIDES ALLOWED!!! In time you may get so good at this, you'll be picking up the walker and carrying it ahead of you for several steps. Once you have reached that point, you may want to start using a cane instead. Please use it until you gain confidence in your new, old abilities.

We will get back to your fancy footwork here in a little bit, but for now let's get some work done on your arms and hands. For those of you that are quadriplegic, I want you to get a picture in your mind of trying to press your little finger to your thumb. Think PRESS. HOLD and RELAX. Then your ring finger to your thumb, press, hold and relax. Middle finger to thumb - press, hold and relax. And finally, index finger to thumb, press, hold and relax. Do this exercise in sets of ten or fifteen AT LEAST two or three times a day. Try to picture your fingers doing what you are asking them to do. You can also verbalize the message. I know that long before I was on Prokarintm, I had to do that on a constant basis. However, it did seem to help get the message across. Once you start getting your fingers to obey those simple commands, you can add to it by trying to squeeze a soft exercise ball that will be easy to grip. As the muscles begin to strengthen, you will be able to do simple range of motion exercises with your hands and wrists. Also start doing stretching exercises. See yourself out in the orchard reaching for an especially delectable piece of fruit that is just out of your reach. Do all your exercises with both arms and hands. One may be stronger and more willing to cooperate, but you need to exercise both limbs equally. You may want to work on the weaker side a little bit harder.

Back to some more exercises. If you have little, or no muscle tone in either your arms or legs due to paralysis, visualize tightening your muscles, and then relaxing them. Try to do this at least ten to fifteen times per set, and two or three times a day if you can. The more frequently you try to do all the exercises I have in this little booklet, the quicker those nerves may try to remember that they aren't being asked to perform brain surgery, or do some kind of rocket science.

As you progress, try challenging those nerves and muscles with variations on the same theme. Keep those exercises slightly different from time to time in order to tease your dendrites into stretching out just a little bit more and perhaps exploring new pathways. By doing so, you may be strengthening muscles, nerves and even bones and gradually finding yourself doing things you used to do without a second thought.

Now, some of you may have difficulty with eye/hand coordination. Let's try stacking blocks or even light weight magazines on top of each other, as many as you can, and then reverse the process.

If you have difficulty with your cognition and have some short term memory problems, if you can, write down a list of three or four items, say the list out loud to yourself about ten times and then put it away. Five minutes later, try to duplicate that list. It may, in time, help your memory and cognition. Some other things you could do would be to work simple crossword puzzles, word search puzzles and gradually working up to medium and hard puzzles. Try to reason out simple logic problems and doing puzzles with simple exchanges of letters. As your confidence improves, add simple math problems and increase the difficulty as ability dictates.

Many of you may have speech problems but with practice in saying simple words and your vowels, repeating this procedure at least two or three times a day, you and your friends may be amazed as your voice strengthens and your speech improves. It may, in time become louder and more confident and you might notice you are no longer stuttering, or tripping all over your words, at which point you will probably want to practice, practice, practice. Go for it! Read children's books out loud. Have some fun and be creative.

For those of you with some degree of mobility, I want you to start walking one lap of your living room, that means a round trip, and do so without wall walking. Remember to do this two or three times a day. After about five days, I want you to increase it to two round trips. As you feel able to, increase the laps until you can do ten or more round trips twice a day. By this time you may have developed the confidence to venture outside and start walking first to and from the mailbox, and eventually down the block and back. Hopefully it won't take you too long to start venturing further and further. If you do so, just remember that you will have to be able to walk back the same distance you walked out.

Is your balance getting better now? Good! Are you brave enough to try walking heel to toe? This takes lots of practice and I would make sure you do it close to the kitchen counter at first, in case you need something to hang on to. If you actually accomplish this, take some deep breaths and relax. Once you get the hang of this one, everything else will feel like child's play.

Anyone for trying to relearn going up and down steps? I know the prospect of this feat was somewhat challenging the first few times I did it, but now I do it all the time. Start with getting a picture in your mind of what it was like in the past going up or down no more than one or two steps. Place a step or two that is approximately 4” to 6” in height next to a wall or the kitchen counter. See yourself picking up one foot while balancing on the other, and place that raised foot on the step in front of you. Now push that foot down, straighten the knee and bring the other foot up beside it. Then step back down the other side by bending the knee of the leg you plan to balance on, and at the same time let the opposite leg move down to the floor or step below you. With time, patience and practice, you may be able to do this with ease and lots of confidence.

One day while sitting in a car, I started wondering what it would be like to get in or out of a vehicle without having to assist my legs with my arms. I kept this picture in my mind, and at the next garage sale, I did it. Well, I kept practicing this because it was so bizarre and finally I told my mom. She couldn't believe it, so I showed her at the next two or three stops. She was astounded. So, in order to prepare for this feat yourself, practice sliding on and off the side of a chair whenever you think about it.

If you still feel unsure about the strength in your knees, stand next to the table or the kitchen sink and do deep knee bends. You can also stretch out your muscles by hanging on to the back of a chair and step back with first one foot, and then the other. Make these stretching exercises gentle at first so you don't traumatize your muscles.

When you get tired of doing all the leg work, your homework isn't finished yet. When you sit down to relax, I want you to visualize what your penmanship should look like. Start practicing writing a simple sentence like, “I will do more today then yesterday, and reach a little higher.” Write that sentence down ten times every day. Also a set of your numbers, 0 through 9 ten times everyday. You may be amazed at how quickly you will start writing clearly once again.

Many of you may have trouble with bladder control. Here are a couple of suggestions that have worked for me.

Many of you women may remember having to do Kegel exercises to hold back the urine at least until you made it into the bathroom and sat down, while you were pregnant. What you did at that time was tighten up the sphincter at the base of your bladder, and squeezed your leg muscles and buttocks together. As the baby practiced it's boxing and punting routines, you needed to do that exercise more and more. Try to get back into that routine again. It sure helped me.

Some of you may have trouble being aware of the urgency to go or have some difficulty when the time comes to completely empty your bladder. Consult your doctor about doing the Crede’s maneuver, which is placing your hands on the bladder which is approximately an inch below your navel, and pushing down on it.
If done properly, you should notice an increase in your output.

There are a couple of other exercises you can do also for your cardiovascular system and overall well being. If you have one, ride an exercise bike starting with about one or two minutes each time, and build it up to mileage. You can also do water aerobics which are a great way to exercise with gentle resistance while getting in a full workout for your entire body.

Now that you are feeling mobile and stronger, put on some music and either dance or exercise. Enjoy yourself. Hopefully you are on your way to a new, old you. Only better, right? Don't be afraid to dream up other exercises to stretch and strengthen your nerves and muscles. They will thank you for it by giving you even more energy than you may have had in a really long time.

When you've had enough and decide to go to bed and get some sleep, take some time out to finish off your exercises while lying on the bed. Lay on one side with your knee slightly bent and do 10 or 15 leg lifts with the top leg. You can also bring the knee of that leg up to your chest, lower it and then raise your leg straight up and slowly return to the starting position. That would be counted as one repetition. Guess how many you should try to do, and don't forget the other leg!

Do any of you have trouble with your vision? Mine has been slowly but surely improving. It was suggested by my ophthalmologist that I try to remember what something looked like. Then close one eye and try really hard to get that object into focus. Then repeat it with the other eye.

You have to have a positive attitude, and remember you can do anything if you set your mind to it. In a manner of speaking, when someone tells me something can't be done, I just tackle it with a smile and do it. If they say it's impossible, well that just takes a little longer.

It is really important to believe in yourself. When and if you start seeing signs of improvement, even if it's just as simple as a slight increase in energy, it will encourage you to reach for higher goals. Set yourself some short term goals that will easily be attainable with exercise, and keep the big picture in front of you. Don't get discouraged if you don't see results right away. The chances are very good that if you do these exercises routinely, you may be very surprised at just how much better you are doing and feeling. Good luck and Happy Exercising!