Task: To swim front crawl
Individual: cognitively-intact, motor system ‘efficient’ (or so I thought), perception-this was a challenge!
Due to creaking knees, I recently decided to start swimming lessons. I had previously been taught how to swim at junior school, and this had involved being able to swim 1 length of the pool and pick a plastic brick up off the floor. Once that was achieved I was thrown out and the next cohort were in. As a result, I was confident in water but struggled to swim a length without being exhausted. On the background of this level of skill I embarked on adult swimming improvement lessons. My goal was to be able to swim a mile, in my eyes very achievable after a few lessons!
Lesson 1, the initial postural set: You need to be able to lie flat on the water to be efficient. Well this was easier said, than done. I assumed in my mind the perfect postural alignment and pushed off from the wall. I subsequently got a mouth full of water and went off at an angle, far from straight. The feedback from the swimming instructor was “do you know your head is not straight and 1 shoulder is higher than the other.” I was unaware of either, and so when I then adopted a ‘straighter’ posture it was perceptually very alien to me. With head aligned in relationship to my trunk my perception was that I was side flexing through my neck to the right. Once that was established I then had to maintain that position as I pushed of from the wall in a straight line. Yet another discovery was that my legs were not pushing off symmetrically. With practice this was improved but establishing an efficient posture and maintaining 2 symmetrical and active legs was challenging. What consolidated my improvements was not just the feedback from the instructor but being able to practice this on my own. I had to use it to improve it, be specific in what I practised and repeat the activity, all of which sounded very familiar.
Lesson 2, moving your arms and legs (together!): OK my position wasn’t perfect in the water but it was a lot better. Then came the kicking. Again my leg asymmetry came to the fore. 1 leg was in a straight position and the other was floating out to the side. Being aware of where my legs were as well as maintaining my posture was starting to get very tricky. It was also apparent that I was holding my legs in a very stiff position; ‘relax and feel how you can get movement through your feet’ were the comments. This was proving difficult, what was needed was an assistive device. Out came the flippers, now I could feel what my feet were meant to do. Having propulsion through my feet and moving through the water was a great feeling, success! Taking them off and going without was trickier but what helped was the feeling I had gained from using the flippers so there was some carryover into my performance. This was all well and good but now I had to move my arms as well. What was challenging was learning the pattern my arms had to move in and to be aware of what both were doing. The emphasis was to ensure your arms were as streamlined as possible i.e. in a straight-line pathway making your resistance less in the water and that they pulled at the right time, quite a challenge on top of postural control and leg kicking. One arm came around to the side in a circumducted pattern and both came across my body with too much flexion and adduction when pulling. This made me posturally less stable and I ended up rolling (yawing is the nautical term I think) in the water, which was very effortful and made me less efficient. Repetition, repetition and repetition, and it gradually improved. Initially I made changes in the session, I had changed my performance. Did it last to the next session, not at first. More repetition and I gradually started to achieve some more permanent changes - plasticity in action, now that was a relief!
Lesson 3; do not forget to breathe. You don’t say I had to breathe as well. My initial solution when learning these motor tasks was to hold my breath. Then I either had to stop to breathe, or alter my swimming technique drastically. The trick is to rotate your head in time with your arm swing and to alternate every 3 strokes to the left and right. Initially it was very difficult and resulted in a few mouthfuls of water. Time to break the task down. Initially I practised breath control while not swimming, going under and then out of the water, achieving regular easy breaths, that was the breathing part. Now on to the rotation, to the left and right. As I suspected, I was better rotating one way than the other. The key was to ensure I was in a straight line, 1 arm in front and 1 by my side and maintain orientation longitudinally through my body then the rotation was much easier and more efficient. Linking that to the breath control took time! The trick was to relax and never get out of breath in the first place rather than rushing my stroke technique to ensure I could take a breath. Initially this was possible for a few strokes, gradually with practice, and errors, I increased the distance to a length without getting out of breath. Once there I could then rehearse this on my own and gradually build the distance I could swim
Learning to swim, who said it was easy?! Did I get disheartened on the way? Yes, I did; frustrated that I couldn’t do it easily, I was not changing quickly enough and I was comparing myself to other people in the pool - they were doing better than me. And that all sounds very familiar to our patients struggles in their rehab sessions.
Have I achieved my goal yet? No I haven’t, but I can now to 4 lengths non-stop without getting out of breath, which is a lot better than when I started. Were my initial thoughts of how quickly I would develop and change over optimistic – probably, but I am motivated to crack on and get to that mile!
In the words of the instructor: When you first came, you had learned how not to drown, now you have started to learn how to swim!
If you would like to learn more about helping your patients achieve their goals through a sound knowledge of motor systems control and neuroplasticity then sign up to one of our BBTA courses and develop your skills! www.bbta.uk.org