Neurokinex specialises in Activity Based Rehabilitation and our approach is one that attracts a great deal of interest and intrigue. Firstly people ask ‘what is Activity Based Rehabilitation?’
You could describe it as the best recovery opportunity for people with a spinal cord injury which redefines possibility and defies convention. But, more accurately, Activity Based Rehabilitation (ABR) is a form of neurological rehabilitation devised to encourage functional recovery following spinal cord injury by utilising multiple strategies to encourage neuroplasticity within the nervous system.
Also known as Activity Based Therapy and commonly shortened to ABR or ABT, it is gradually gaining in popularity around the world, both because of the positive outcomes it achieves and the high levels of engagement from its participants.
Diverse and creative
The rehabilitation itself is diverse and creative, individualised to the needs of each participant, but common in its principles. Exercises and activities are set to a level that is both challenging and intensive for the participant, with high repetitions of each task undertaken. Wherever possible, the activities take place outside of the participant’s wheelchair, utilising equipment or physical assistance to work in supported weight-bearing positions. Electrical stimulation is an adjunct commonly used to enhance muscle recruitment, timing and feedback. The newer Wide Pulse Stimulation is favoured due to the indications that, alongside reflex muscle contractions, it also leads to excitatory ascending impulses within the central nervous system, thereby encouraging communication between the brain and injured areas of the body.
In common with more traditional forms of rehabilitation, Activity Based Rehabilitation favours holistic goal setting with participants, breaking down larger and more ambitious goals into smaller, bite-size pieces that can be checked off, helping track the progress being achieved. It is also evidence-based, underpinned by research and measured by outcomes recognised throughout the speciality of neurorehabilitation.
The optimal environment for Activity Based Rehabilitation is a fusion of a conventional neuro-rehabilitation gym containing plinths and parallel bars interspersed with the facilities of a commercial gym, kitted out with resistance equipment and weights. In this environment, the trainers, who have backgrounds in both health and sports performance – from Sports Scientists and Exercise Physiologists to Physiotherapists – can develop programmes which challenge fitness, strength and function in unison. Armed with an in-depth knowledge of neuroplasticity alongside skills in exercise programming and functional task acquisition, they train participants as they would an elite athlete, aided by equipment and techniques designed specifically for neurological rehabilitation.
Engagement is key
To get the best out of the training, participant engagement is key and all activities are completed one-to-one with a trainer who keeps the participant focused on the task, often setting goals or challenges to add an element of competition. The nature of Activity Based Rehabilitation necessitates a good relationship between trainer and participant as they work symbiotically through a series of exercises, in which the trainer will also play an active role. This differs greatly from much of the community-based rehabilitation currently provided in the UK, where a hands-off approach is taken. Unsurprisingly, a strong sense of camaraderie develops between trainer and participant which boosts morale and encourages a ‘can do’ attitude. This, in turn, reduces dependency and increases the likelihood of the participant embracing new opportunities.
Activity Based Rehabilitation is important in the early stages following injury or diagnosis to encourage the maximum functional recovery, but also has an important role to play in the chronic phases of neurological conditions. The risk of developing secondary complications after spinal cord injury, such as pressure sores, contractures, cardiovascular disease and diabetes, is high. To combat these, exercise and movement are vital, but regular gym facilities are often inadequately adapted for wheelchair users or unable to provide the necessary physical assistance for individuals to fully participate. Alongside these factors, it is important to recognise how difficult it is for anyone to train and stay motivated by themselves. Activity Based Rehabilitation in chronic injury allows participants to set health and fitness goals, get out of their wheelchairs to exercise in positions that are beneficial for their health and build strength and endurance that can have knock on benefits to their function even after many years of injury.
Far-reaching benefit
Finally, alongside the physical benefits of Activity Based Rehabilitation, there are also psychological and social benefits, which impact on not only the participant, but also their families, friends, work colleagues and employers. The combination of these positive impacts leads to a strong case for the Health Economics of Activity Based Rehabilitation as individuals who participate are likely to be healthier and more independent through the physical exercise, but also display superior mental health. This leads to greater resilience and more ability to cope with the demands of their altered lifestyle. As someone who specialises in Activity Based Rehabilitation at Neurokinex, I can honestly say it’s a hugely rewarding area to work in.
Jane Symonds, Clinical Lead, Neurokinex www.neurokinex.org
