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Neurophysiotherapy news

Meet the PT: Rowan Morgan-Ruffley



In the first article for our new Meet the PT Series, we hear from Rowan Morgan-Ruffley, adaptive personal trainer and owner of RMR Rehabilitation.

Hi Rowan. How would you describe the impact and importance of your work in the lives of neuro-rehab clients?

Exercise and fitness is very much an important role in the rehabilitation of clients who have suffered injury, or had long spells of time in hospital, or even after their hospital stay.

Amongst other things, reduced mobility can cause people to lose muscle mass, which helps people to burn calories. This then slows a person’s Metabolic rate.

To add to this, if you’re in a wheelchair or your mobility is initially affected, this can alter your calorie requirements.

We tend to see clients once they have completed their initial rehabilitation with a physiotherapist.

As a personal trainer, we may then support the physio with their routines.

We provide the client with strength and conditioning exercises or follow a routine that has been set up by the physio themselves.

This normally entails receptive exercises to help with the clients neuroplasticity.

For clients that are more mobile or further along in the rehabilitation we may support strength and conditioning of areas that have been weakened by their injury, or support the client to lose weight, gain weight, increase fitness, improve balance or core stability.

Are there any standout elements of your approach that are perhaps unusual or set you apart from the general ‘norm’?

There is certainly a grey area between a personal trainer and physiotherapist with regards to exercise and rehabilitation.

My aim over the last 10 years has been to try to bridge that gap through good communication and an eagerness to work together for the benefit of the client.

It is important that a personal trainer has the right qualifications and experience to work within the clinical setting.

There are qualifications a PT can do to widen their knowledge and understanding for working with clients with neurological conditions.

But like learning to drive, you only really truly learn once you have passed your test and are out in the traffic on your own.

PTs can learn the theory. The hard bit can be putting it into practice and working out how to adapt training methods to support their clients.

This is where working alongside physiotherapists and other professionals can help.

Fitness and personal trainers working with disabled individuals is not new in the fitness industry.

So I wonder why more people have not thought about integrating personal trainers in their rehabilitation.

It could possibly be due to the fact that a personal trainer is seen as a person who works you hard to the point you drop and cannot do any more, or that a personal trainer is to support people mainly to tone, build muscle, increase fitness or lose weight.

Although this can be true, there are also a lot of PTs out there who have the knowledge and understanding to support individuals around their condition and limitations.

Some trainers also know when to advise clients when to stop due to neuro fatigue and that if they do it too much, it could affect their day-to-day activities in the days post-exercise.

To keep our trainers at RMR Rehabilitation up to date with their training, we also put on monthly webinars presented by physiotherapists, case managers, OTs and nutritionists.

Recent webinars have covered been on topics such as nutrition after trauma, cerebral palsy, amputee and spinal injury rehabilitation and how personal trainers should write reports in connection with case manager guidelines.

These webinars help us connect more with the rehabilitation sector and understand what is expected from us from a learning point of view, building a reputation as professional personal trainers in the medical-legal world.

Can you please provide an example of a patient case which typifies the importance of the interventions you deliver?

One of my first clients was ex-military and had suffered an ABI as a result of a road traffic accident.

When I started working with him, he had already been working with a physiotherapist who he had made great progress with.

The physiotherapist felt that the man was at a stage where he would benefit from the support of a personal trainer.

The physiotherapist and case manager asked if I could help the client to increase cardiovascular fitness and strength and conditioning.

Although the client had been very fit and motivated in the past, he was struggling to engage in activities outside of the house and was also reluctant to get out of his wheelchair.

The client was able to walk with a walking aid but lacked confidence in his weaker left leg.

I put together some exercises to help increase strength and balance in his lower limbs. These exercises also involved shifting weight from one side to the other.

Over time, along with increasing walking distance, the client became more confident and in the end, donated his wheelchair to a charity.

The work I did with this was in tandem with the physio’s work. I was able to do the repetitive exercises while the physio concentrated more on their treatment and rehabilitation.

My role also involved motivating the client to leave the house and engage in different activities. We tried swimming, cycling, walking and eventually going to the gym.  This was a gradual process but one that I had time to build up to.

The client went on to do a 5km walk for charity and is still training with one of our trainers at RMR Rehabilitation.

An Adaptive Personal Trainer has a lot of roles.

We can provide motivation, advice and guidance around exercising safely and effectively.

We also support clients with different levels of mobility, with some of our clients using wheelchairs and others confined to their chairs at home.

Some are mobile and can get themselves to the gym. But one thing that links everyone together is that they all have the right to exercise.

It is just a case of breaking down the physical or psychological barriers they may be preventing them from being able to do so.

Even if we are supporting a client to maintain the mobility or independence they still have, this all works towards keeping them fitter, healthier and more active.

This in return hopefully helps to prevent secondary illnesses.

How do you approach new clients in terms of assessing their needs and planning their therapy journey?

From the very start of our client’s journey, we work alongside physiotherapists in order to offer the best form of support.

This can involve doing a joint session or handover with the physiotherapist involved.

We also request the physiotherapist’s most recent assessment or review to help us to identify which areas we need to work on.

After conducting our own assessment, we will set SMART goals (Specific, Measurable, Achievable, Relevant and Time-bound).

This helps us to ensure that our objectives are obtainable before we to try and set a time frame.

It is important to set both short and longer-term goals.

Short-term goals can take anything from three months to a year. These are important as a long-term goal can sometimes seem a long way off and it is good to have milestones you can tick off along the way.

Once we have put together a programme, we talk to the physio and client to make sure they are happy with our recommendations.

The physio may then review our sessions and progress on a monthly or quarterly basis depending on the level of injury/mobility and where they are in their rehabilitation journey.

Do you work closely with other members of multidisciplinary teams? 

Yes. 75 per cent of our clientele are medical-legal clients, so we regularly work as part of a multi-disciplinary team (MDT).

Our trainers communicate with case managers, physiotherapists, occupational therapists, psychologists, nutritionists and care staff.

How would you describe your approach to family members of your brain/spinal clients? 

We understand that family members have been through a lot after seeing their loved one’s go through life-changing injuries.

The clients themselves go through rehabilitation and adapting to their current situation, family members have to adapt and change, too. This can obviously cause a lot of stress and anxiety.

As a personal trainer, we work with the client and the family member to make sure our sessions are personal to the client.

During our consultation, we will ask the client and family members what they enjoy doing. Were they active before the accident? Did they participate in sport or go to the gym? These questions are important to get an understanding of the client’s history.

They also help family members feel comfortable that their loved one is being asked for their opinion.

Our approach is person-centred and involves input from the client and family members.

We also make sure to keep a good line of communication between ourselves, the client and family members. This has been shown to be very beneficial with our clients’ ongoing rehabilitation.

Is it important to involve them in your work?

We have always had a person-centred approach where we focus our support and rehabilitation around the needs of the client, their condition and their personality.

What works for one client may not work for another.

From the first consultation session, we ask our clients questions like: What they like to do? What are they worried about with regards to exercise? Are there any psychological or physical barriers that prevent you from exercising?

We listen to the clients’ answers which inform how we go about supporting them with their rehabilitation.

Our aim is to motivate and guide our clients to meet their goals.

Without the client’s willingness to participate, it makes it very hard for them to achieve their goals, which is why we need to tailor the sessions around the clients’ likes and interests, hence making sure we involve them every step of the way.

What does success look like in your therapy discipline?

Success can be measured in many different ways. You can measure how far the client has come in regards to both physical and psychological improvements.

Physical improvements can be easier to measure than psychological ones. They can also be closely linked, with achieving a physical goal having a psychological impact.

We measure an individual’s success by monitoring improvements in their strength, agility, balance and endurance.

This can differ between clients as all of them have different starting points.

Goals and targets will be set at the start and monitored and reviewed during the course of their rehabilitation.

Functional exercise is involved in a lot of our clients’ sessions as we look to train muscles movements our clients will use in everyday life.

Success can be anything from helping a client to improve strength to benefit their sit-to-stand to increasing the range of movement in their upper-limbs. This will help with tasks such as putting items into cupboards and opening doors.

Some clients will progress and meet their targets while others will maintain their current physical condition but improve their psychological wellbeing.

Success will look different for each client.

As long as we monitor their physical and psychological journey along the way, we will continue to support them in the best way we can.