Here’s how cognitive rehab fitness works
Each part helps patients progress
All parts of the JFK-Johnson Rehabilitation Institute’s cognitive rehab fitness program are designed to help patients work on cognitive issues. Just getting on the bus to go to the fitness center can challenge brain-injured clients: They need to remember they have the group exercise program on a certain day and initiate getting to the bus.Once at the center, clients are responsible for picking up the folders that contain instructions for their exercise program, finding a space to exercise, and gathering any necessary equipment.
Patients do upper-extremity exercises, multi-joint squat exercises, and aerobic exercises using equipment such as treadmills, bicycles, and ski machines. Some equipment has been modified for the more disabled clients, says Pamela R. Nelson, MA, PT, one of the administrators of the program, which is located at JFK-Johnson’s Center for Head Injuries in Edison, NJ.
The exercises themselves are newly learned activities that clients must remember. If they are using equipment, they must learn and remember how to operate it. The program uses the "square root" method of exercise progression, which increases the amount and intensity of exercise for each session based on performance in the last one.
"When our clients exercise, the need to follow the components of that program. They must keep track of repetitions, stick to the speed, and follow the set work/rest intervals. It requires a lot of attention and concentration on their part," Nelson says.
Endurance is a big problem for stroke and brain injured patients. "We are asking clients to exercise until they are tired, targeting their endurance level, and asking them to do a little more next time," she says.
Clients also monitor their exercise performance by taking their heart rates after each set of exercises and using the Borgs scale of perceived exertion to rate how they feel after the exercise. Those numbers help them decide whether they should continue to exercise.
The therapists look at the clients’ ability to complete the exercises and to make decisions about progression the program. Patients receive written guidelines on how to make those decisions.
"At some point, they may be able to come into the gym, get their folder, determine what they did last session, and go ahead and complete this session without assistance," Nelson says.
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