A multidisciplinary team approach to rehabilitation has the patient at its centre. Surrounding that patient is a team whose respective roles and expertise combine to fulfil the best possible rehab outcome.
When people think ‘rehab’ they tend to think ‘physio’ and there is a clear and defined role for these skills. Another key player in the multidisciplinary team contributing to successful rehabilitation from spinal cord injury is the Accredited Exercise Physiologist.
Accredited Exercise Physiologists (AEPs) are recognised allied health professionals who specialise in clinical exercise interventions for a broad range of pathological populations; individuals who may be at risk of developing, or have existing, medical conditions and injuries. AEPs are equipped with the knowledge, skills and competencies to design, deliver and evaluate safe and effective exercise programmes. Their aim is to prevent or manage acute, sub-acute or chronic disease or injury and assist in restoring one’s optimal physical health or wellness.
Matching each client’s needs
Here at Neurokinex we have a team of AEPs whose respective skills and expertise are matched to clients’ needs. While no two clients will present with the same challenges, a few commonalities exist which can be addressed by one or more approaches.
An example of this is our work to improve the capacity for exercise for one of our C7 AISA clients, Lucy, who typically needs to wear an abdominal binder to maintain her intra-abdominal pressure when doing cardiovascular training. Our expert team has devised and delivers interval training for Lucy that she is doing without her abdominal binder. Her programme includes completing tasks both standing and sitting to help Lucy improve her tolerance and stamina to exercise. As a result, she is relying less and less on external equipment for her independence.
Quality of life
Neurological injuries and illnesses such as spinal cord injury can have long-term impacts on the health and wellbeing of the individuals affected. The role of exercise within their rehabilitation plays a large part in helping improve their quality of life. Within the team approach, the exercise physiologist can design a tailored, specialised programme to assist the individual with any physical activity goals that they have. With neurological conditions such as spinal cord injury, the physiological demands and function of the body can change/be altered. Knowing how this impacts something such as energy output through exercise is how an AEP can design exercise programmes and educate those living with a neurological condition.
Cardiovascular fitness vs neurological level
An important factor considered by AEPs in their exercise prescription and rehabilitation approaches, is how their cardiovascular fitness can be significantly affected at a neurological level, complete versus incomplete injury and the extent of their injuries. Individuals with an incomplete injury, in particular those who are able to walk, can respond to exercise in a similar way to able-bodied people. Those with a complete injury at the cervical or upper thoracic levels (T1 – T4) will have a significantly different response to exercise. This is due to a new reliance on upper limb exercise, paralysis in their lower limbs and a loss of supraspinal sympathetic nervous control. Tetraplegia and High Paraplegia from an SCI is associated with dysfunction of the sympathetic nervous system because of this loss of supraspinal control which, in turn, can have a significant impact on the cardiovascular responses during exercise. An example of this is the ability for the body to redirect blood from essential organs to exercising muscles using the supraspinal nervous control. In individuals with a spinal cord injury, this may not occur adequately and can result in exercise-induced hypotension (low blood pressure).
Safe and effective
Safe and effective exercise prescription for individuals with neurological conditions including SCI requires careful consideration of the neurological level and the implications/effects of the exercise types chosen. The knowledge and skill base that our exercise physiologists bring to the team at Neurokinex gives us the edge in delivering and designing bespoke rehabilitation programmes to not only address their rehabilitation goals but to ensure that they are improving their physical fitness in a safe way.
