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Evidence based practise: Exercise and rehabilitation programmes for paralysing conditions
David Akroyd-Jones 1 and Diane Crone 2
Spinal cord injury and other forms of paralysis result in a chronic condition, and for certain individuals’, full recovery is not an option (Hammell 1995).
This investigation demonstrates how an interdisciplinary approach (BASES 1997) can determine and achieve rehabilitation objectives for an individual with spinal chord injury (C6,C7 incomplete).
Rehabilitation in this context is defined as “optimising fitness, redefining the boundaries and constraints that those conditions may impose” (Jones D 1999)
More than one area of sport and
exercise science working together in an integrated and co-ordinated
manner to solve a problem (BASES 1997). This intervention was derived
from integrating theory and application from the following
The World Health Organisation model of
disability emphasises the need to reduce the risk of secondary
impairments such as cardiorespiratory, cardiovascular, systemic
dysfunction and metabolic alterations (Noreau & Shephard 1995).
Assessment of movement dysfunction, dynamic stability and muscle balance (S.Klein Vogelbach approach).
Needs analysis - to establish client-centred goals
Base line assessments - to determine performance measures
Intervention - 13 week Exercise Prescription programme including:
Passive stretching: Upper and lower extremity
Prescribed weight assisted and resisted exercises for the lower trunk and lower extremities
Electrotherapy to assist in developing ‘normal’ muscular function
Swiss ball therapy to improve dynamic stability and pre-gait training (S.Klein Vogelbach approach).
Partial weight bearing gait therapy (3 sessions per-week)
Cardiovascular programme (3 sessions per -week)
Osteopathy and Homeopathy
Baseline assessments recorded during week 1 included:
Motor assessment index (Wade 1996) - To assess voluntary muscle activity by verbal command. Provides a subjective visual assessment of the ability to contact a muscle under certain conditions
Balance assessment (Mountjoy 2000, Berg 1989) - assessment of balance by observational analysis
Cardiovascular Endurance (Mc Ardle et al 1995) - Using Borg’s rate of perceived exertion, target zone heart rate and blood pressure measurements during combined arm and leg ergometry.
Gait training assessment (Wernig & Muller 1992) To include duration, distance walked and body weight bearing support (BWS)
Lung Function ‘Vitalograph’ PEF/FEV measurement
Results - assessments at week 1 and week 13
Using an interdisciplinary approach to rehabilitation improved the
clients performances in six of the base line assessments undertaken.
BASES, (1997), Future directions a
discussion paper, The interdisciplinary section, p 3
Rehabilitation centre with disabled access and accessible parking, specialising in exercise therapy for individuals affected by spinal cord injury, head injury, stroke, multiple sclerosis & other paralysing conditions
The Old Convent, Beeches Green, Stroud Gloucestershire GL5 4AD +44 (0) 1453 75 55 57
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