Reimagining POTS rehabilitation: a functional neurology perspective
Prescribing exercise for moderate to severe POTS patients can be notoriously challenging. Patients with POTS may have significant exercise intolerance and may experience post-exertional malaise that compromises their results to exercise.
While there is little empirical evidence to support it, chiropractic neurologists have observed that patients with POTS may have metabolic fragility from energy mismatch that causes their brains to have poor capacity for stimulation.
That means that taking a walk may be too metabolically demanding and can make a POTS patient worse?
So how do we reconcile the need for exercise to improve metabolic and mitochondrial health with the poor tolerance?
The answer is that exercise doesn’t have to look like traditional exercise.
Maybe a patient can’t exercise upright but can do exercise in a recumbent position..
Maybe a patient can have a provider move their limbs for them and generate a tolerable amount of neuronal activation?
Maybe a patient can tolerate small doses of ocular or vestibular exercises before they can walk?
Our job is to find the level of neural activation a patient can tolerate so that we can find a place to start and progress.
With enough time and control of other factors like inflammation, a patient with POTS may be able to leverage plasticity to change their autonomic nervous system to create tolerance for their environment.
#neuroplasticity #neuroscience #dysautonomia
5 окт 2023
