Exercise program helps head-injury patients
Physical, cognitive activities are combined
When head-injured clients exercise to increase their strength and endurance at JFK-Johnson Rehabilitation Institute’s Center for Head Injuries in Edison, NJ, they work on their memory and organizational skills at the same time.The center’s Cognitive Rehabilitation Fitness Program for day treatment and transitional living patients takes a nontraditional approach to the usual physical therapy activities by incorporating cognitive activities into an exercise regime.
Pamela R. Nelson, MA, PT, and Sandra M. Neumann, MA, PT, who administer the Cognitive Rehabilitation Fitness Program, spoke in October at the 18th annual Neurorehabili-tation Conference sponsored by Braintree Hospital Rehabilitation Network. They report that clients participating in the fitness program have suffered brain injuries from trauma, disease process, or stroke, and are receiving multidisciplinary cognitive rehabilitation at the center, either as outpatients or as part of the transitional living program. Most have goals of returning to work, school, or independent functioning at home. Clients in the program work to improve their strength and/or endurance, which are common problems for brain-injured individuals.
The cognitive physical fitness group is run by therapists who also work with clients in the outpatient program. Clients initially may receive individual and group fitness sessions or just individual sessions, depending on their physical needs. Later, the program may be tapered to include fitness sessions only.
"This is a plus because therapists can use the individual sessions to work on problems like balance and motor control, while addressing strength and endurance issues during the fitness sessions," Nelson says. (For details on how to adapt the program for your rehab facility, see story, p. 21.)
The program was created 10 years ago as a fitness and exercise-oriented group in the cognitive rehab program. It began in a smaller gym within the hospital and moved to the community fitness center six years ago. Some of the clients sign up to be members when they leave the cognitive rehab program. Six to eight patients in the hospital’s day treatment or transitional living head injury programs participate in each hour-long session. They are supervised by two to three physical therapists and an aide, depending on their functional level.
The sessions have included as many as 13 patients, with additional staff as necessary. The staff-to-patient ratio is determined by the patients’ abilities and need for attention. "We may, at any given time, have eight clients who are relatively independent or we may have six who need one-on-one help. Staffing may vary based on client make-up, "Neumann says.
Lower-level patients added to program
Initially, the program was intended only for clients with a high level of physical ability, but it has been modified to allow lower-level patients to participate, particularly those with significant hemiparesis or balance deficits. As it evolved, staff added the cognitive components.The program is conducted at an off-site fitness center owned and operated by the hospital. The off-site location allows patients to exercise in a real-life setting instead of in the clinical setting of the therapy gymnasium.
"Even if we try to simulate the group setting, there are distracters and social indicators that wouldn’t be present in the clinical setting. Clients have to do more problem solving and deal with more complex skills than in the clinic," Neumann says. "The clients enjoy it. They like getting off site and into what they see as a non-hospital setting."
The fitness group format uses a task analysis approach to monitoring clients’ performance and identifying cognitive barriers to independent function. The exercise task is broken down into components such as meeting the fitness bus on time, gathering needed equipment, completing the exercise program for the day, monitoring and recording exercise response, progressing in the program following written guidelines, and returning equipment. (For more information on the exercise program, see story, p. 22.)
The goal is for clients to perform the entire exercise program independently. Therapists look at the clients’ ability to complete the program and where it may breakdown. For example, many clients have trouble with memory, attention, concentration, or problem solving, which may interfere with their ability to perform all or part of the exercise regime. Once the therapists identify how and when these cognitive deficits are interfering with the task, they can develop effective strategies to help clients overcome the problem. (Some of the problems and solutions are outlined above.)
The program also helps patients identify the effects of their cognitive defects. Clients’ memory problems may show up when they do tabletop activities, for instance, but they often minimize this by saying the activity does not relate to real life. "But exercise is a real-life thing. They can see right then and there that their memory problem is impacting their exercises," Nelson says.
Another advantage is that clients can continue in the program after discharge. Most rehab clients feel they aren’t finished at discharge and like the idea of having an exercise program that can help them continue to progress, Neumann says.
The therapists help them adapt the program to whatever setting they choose — some exercise at home, others go to another gymnasium, and some join the hospital fitness center.
The staff may train a family member or someone from the outside gymnasium as a facilitator to help the clients continue the exercise program after discharge. This allows clients to continue to work on their rehab goals.
[Editor’s note: For more information, contact the Center for Head Injuries at (732) 906-2640.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content