Importance Of Exercise Flashcards
What are the benefits of Ex in patients with TBI?
Help integrate back into community, reduce depression, improve social inclusiveness
Increases learning of visual and auditory tasks
Improved association of shapes and figures
Improves fatigue resistance to allow to return to work
-TBI patients may fatigue >2.5x faster & only ~3h per/day
Minimise weight gain and accumulation of cardiac risk factors.
Exercise/functional Testing:
Pre-screening requirements:
Must screen for health risk factors, e.g. ACSM guidelines then PAR-Q
Screen for behavioural factors [impulsivity, outward aggression, lack of judgement, misunderstanding of directions]
- aggressive patients may need to exercise individually, at quiet times of day in a gym
- lack of judgement requires greater supervision
- those who lack impulsiveness/initiative might benefit from group environment
Can use FIM [functional independence measure] & FAM [functional assessment measure]
Exercise Testing - Endurance
Exam long answer question - give example of a testing/training program
Remember bimodal age range and varying levels of physical and cognitive impairment, so need to be creative
VO2 or HR measured on treadmill, but may need harness to prevent falls
Use bicycle, arm/leg ergo or stair climb if greater impairment - may need to strap hands/feet if lacking coordination or grip
20m progressive shuttle probably better than 12min run, as hard to self pace or predict own HR
Exercise Testing : Muscle fatigue
1 min sit up test shown to be reliable and requires little coordination
Timed pull up, arm flexion, etc. useful and shown reliable
May need to specifically test muscle groups/movements… be creative
TBI patients may demonstrate muscle weakness, hypertonicity, increased fatigue and inability to perform isolated movements
Exercise Testing : Muscle Strength
No special concerns, but testing needs to be individualised
Standard dynamometer tests useful - variety of movement patterns, muscles/joints
Some individuals may be only able to move in stereotyped manner, so test had to be specific [e.g. May only be able to extend knee if hip is also extending]
Exercise Testing: Flexibility
Particularly important
Arthritic complaints more common in TBI
Lesser ROM:
-multiple joint trauma in addition to brain injury
-reduced mobility in acute phase of injury
-heterotopic ossification
-muscle weakness and hypertonia
Can often use standard flexibility tests [with goniometer], but may need to support patient
Slow vs fast stretches to determine ROM/contracture versus spasticity
Exercise Prescription - Aerobic
Selection of mode depends on patient’s impairments
Target large muscle masses, especially if some limbs paretic.
Think about specificity of long term therapeutic goals
-centre of mass base of support, balance training [e.g. May use stair climb to practice weight shifting rather than cycle]
Think about accessibility [may bit drive, need elevator, cost of gym memberships, etc] and enjoyment/social [e.g. Group exercise, aerobics classes] issues.
Walking/jogging usually OK, but watch foot drop, which increases tripping, but severe cases may need cycling or wheelchair programs.
Exercise Prescription - Strength
Good for addressing muscle weakness - not a problem for those with hypertonia!
May need to adapt movement patterns for postural stability issues, or adapt equipment.
Consider use of Velcro straps if weak grasp
Follow standard guidelines for strength programming, but may need to progress slower on hypertonic muscles due to increased DOMS
Supervision requirements vary on individual basis.
Exercise Prescription - Flexibility
Very important to maintain appropriate ROM
May perform 1-2x/day if spasticity
Unclear effects of stretching on spasticity possibly due to different mechanism of action: spasticity driven by continually active noradrenaline and serotonin receptors, changes with stretching driven by ‘learning/tolerance’ with some reduction in muscle stiffness
Contractures may be a result of tissue changes [e.g. Shortening of muscle or tendon] may be treated with stretching or splinting.
Standard stretches performed for 2-4 reps for >15s
Contractures and for postural alignment may hold stretches for up to 20min
Recent evidence for ‘stretch with muscle contraction’ e.g. Weak isometric contraction during stretch and hold phases [eccentric exercise may be useful]
