ex pres crib sci

8/13/2019 Ex Pres Crib Sci

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EXERCISE PRESCRIPTIONFor PERSONS With

SPINAL CORD INJURY

PT 630 Cardiopulmonary Therapeutics Fall 1999


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Physical activity allows me to step

away from my disability and join avital life force. In a way, exercisereconnects me with myself. It

helps me realize that Im notlimited by my physical body. Ithelps me recognize a whole inner

set of life, full of intensity,discipline and joy.

Jim McLaren, age 31, C5-6 Tetraplegia, World Record HolderTriathlete, Motivation Speaker


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INTRODUCTION

Additional Demands of Physical Disability

Greater Need for Maximizing Physical

Function

Physical Fitness Important for SCI

Enhances Functional Ability

Promotes Better Quality of Life Improvement in Physiologic Systems

Functional Adaptations & Improved ADL


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BACKGROUND Long Term Survival

with SCI Improving

ONCE MEDICALLY

STABLE PERSONS WITH

SCI NEED NOT BECONSIDERED

FRAGILE, IN NEEDOF PROTECTION,OR UNABLE TOEXERCISE


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BENEFITS OF EXERCISE

PHYSICAL

PHYSIOLOGICAL

FUNCTIONAL PSYCHOLOGICAL


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WHATS THE PROBLEM?

People with SCI Become Less Active AsResult of Paralysis

Promotion of Optimal Physical Fitness(as allowed by level of injury) NeglectedComponent of Health Practice for

Chronic Disability


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CYCLE OF DISABILITY


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RISK FACTORS OF

SEDENTARY LIFESTYLE


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PHYSICAL FITNESSTRAINING MAY BE THE

ONLY MEANS OFOVERCOMING NEGATIVEEFFECTS OF SEDENTARY

LIFESTYLE


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MODERATE INTENSITY

ENDURANCE ACTIVITYABLED BODIED

Short Bouts of Moderate Activity

Spread Throughout Day

30 Minutes or Longer

SCI POPULATION

NIDRR Studies Ongoing

Moderate Intensity Regular ExerciseBenefits Not Fully Defined


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IMPORTANT TOOLS FOR

EXERCISE PRESCRIPTION

EDUCATION OF HEALTH CAREPROVIDERS

PHYSIOLOGICAL CHANGES AFTER SCI

RELEVANCE OF CHANGES TO

EXERCISE

ADAPT HEALTH & FITNESS ACTIVITIES


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MOST IMPORTANT TOOL

KNOWLEDGEABLEIN PROGRAMS &

PROTOCALS FOREXERCISE ACTIVITY

SENSE OFCREATIVITY

WILLINGNESS TOTRY NEW THINGS


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GOALS

BENEFITS OF PHYSICAL FITNESS ANDTRAINING IN SCI

PRACTICAL SUGGESTIONS FOR EXERCISEPRESCRIPTION


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Physical Changes Caused by SCI That

Affect Safety & Efficacy of Exercise

Exercise Training Effects in Para &Tetraplegia

Fundamentals of Exercise Prescription

Age, Physical Characteristics, PreviousExercise Experience, Functional Capacity

Safety Strategies for Injury Prevention

Adapted Equipment & Options for Homeor Health Club


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ASSESSMENT

NORMATIVE VALUES FOR STRENGTHENDURANCE AND CARDIOVASCULAR

ENDURANCE NOT YET ESTABLISHEDIN SCI POPULATION


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CARDIORESPIRATORY

For Some, Dependent on Level ofPeripheral Muscle Endurance than on

Central Cardiorespiratory Effects Paralysis of Active Muscle Mass & Loss of

Muscle Pumping--Peripheral Return

T6 and above loss of SNS automaticreflexes for normal exercise response


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QUESTIONS REMAIN

WIDE RANGE OF PHYSIOLOGICALDIFFERENCES DEPENDING ON LEVEL

Para Vs Tetra

COMPLETENESS OF INJURY

BODY SIZE, AGE, GENDER, PHYSICAL

FITNESS BEFORE INJURY,MEDICATIONS, POSTURE


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IN GENERAL, THE HIGHERTHE LEVEL OF INJURY THEMORE LIKELY SIGNIFICANT

REDUCTION INCARDIORESPIRATORY

CAPACITY


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WHY?

PROGRESSIVE LOSSOF SKELETAL

MUSCLE WITHEACH HIGHERLEVEL OF INJURY

DISRUPTION OFSYMPATHETIC

OUTFLOW TRACTSWITH LEVELS OFINJURY ABOVE T6


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MUSCLE PARALYSIS

FACTORS LE Paralysis Limits Amount of Muscle

Available for Exercise-InducedChallenge to Heart

Small Muscles of Arms Easily Fatigued--

Peripheral Restrictions--Limit ExerciseCapacity Before Central Cardiac SystemStressed


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SYMPATHETIC

DECENTRALIZATION Unopposed PNS via Vagal Nerve

Limits Cardiac Output

Cardio Acceleration Shunting of Blood from Inactive to Active

Muscle

Blunting of HR Response to ExerciseDue to No Vagal Withdrawal

110 to 120 BPM


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CV RESPONSE TOEXERCISE ABOVE T6

VASOMOTOR PARALYSIS

PREVENTS NORMAL BLOODREDISTRIBUTION IN UPRIGHT EXERCISE--VENOUS POOLING

COMPROMISED VENOUS RETURN TOHEART

LIMITS CARDIAC PRELOAD, EXERCISE SV,EXERCISE INDUCED CO--ABILITY OF HEARTTO RESPOND TO EXERCISE REDUCED


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MORE FACTORS ABOVE T6

Impaired Shunting of Blood to ActiveMuscles--Early Onset of Fatigue in small

muscles of arms Inadequate Sweating

Reduced Thermoregulation

Increased Fatigue


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CV Response to Exercise

T6-T10

NORMALREGULATION OFCARDIACFUNCTION--NormalHeart RateResponse to

Exercise DISRUPTED

VENOUS RETURN

BELOW T10

SNS SPLANCHICINNERVATION TOABD ORGANS

PARTIAL SNSINNERVATION TOLOWER

EXTREMITIES

SOME VENOUSRETURN


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SPLANCHNICNERVES


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EXERCISE RESPONSE INTETRAPLEGIA

Unique Challenge to Aerobic Exercise &Cardiovascular Health

Studies Have Shown Training Effectswith Exercise tolerance, muscleendurance, peak VO2, peak power

output (Figoni, 1993) Physiological Training Effects Peripheral

Muscle Endurance Rather Than Central


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EXERCISE RESPONSE INPARAPLEGIA

Less ANS Disruption

Normal Heart Rate Response to Exercise

More Available Muscle Mass May Still Have Venous Pooling &

Decreased CO & SV for same level of VO2max in able bodied (Figoni, 1990)

Limited CO can limit oxygen to exercisingUE muscles and have less peakperformance than AB, but more than tetra


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ADAPTATIONS TO

ENDURANCE TRAINING CENTRAL TRAINING

EFFECTS

Changes in HR @Rest and SubmaxExercise, and CO

LESS PRONOUNCED

WHEN TRAININGWITH SMALL UEMUSCLES

PERIPHERALTRAINING EFFECTS

Increased O2 Use &increased bloodflow to exercisingmuscles

Mm Hypertrophy

IncreasedLocalized Strength& Endurance


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ASSESSMENT TOOLS

Vary Widely in Complexity & Practicality

GOAL OF ASSESSMENT

Level of Fitness--Max & Submax Testing

Identify Cardiorespiratory Problems (OH)

Determine wheelchair propulsion capacity

Comparative Data Over Time


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TESTING FOR TETRAS

Impossible to Evaluate Central CardiacFitness Because Small Muscles do not

Adequately Stress Heart Measure Peak Exercise Capacity of

Other Physiological Support Systems

Glaser (1988) & Figoni (1990, 1993) Extensive Testing on Voluntary Arm

Exercise in Tetraplegia


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DESIGNING PROGRAM

Complete Medical & Activity Profile

Basic +

OH, ROM limitations from contractures,fractures, heterotopic ossification, UEoveruse, skin problems

Self-Dressing & ADL Status

Transfers, W/C Propulsion Time up in Community, Home

Management


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GUIDELINES FOR

EXERCISE ACTIVITIESACSM Guidelines for Able Bodied

Absent Guidelines for SCI Population

Modify & Adapt from NonDisabledGuidelines For Less Muscle Mass

Training Principles Same

Overload Progression

Specificity Consistency


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FITTE FACTORS FREQUENCY

3 TO 5X/WK

Modify forAdequate Rest BtwSessions

INTENSITY

ACSM Guidelines

for THR as Guide Borgs Rate of

Perceived Exertion(RPE)

TalkSing Test

TIME (DURATION) 15-60 min

Very DeconditionedGuidelines

TYPE (MODE)

Largest MS Mass

FES+LCE (+ACE)

$20,000 FES Bike

ENJOYMENT


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TYPES OF ACTIVITIES FOR

CARDIOVASCULARTRAINING AND STRENGTHTRAINING


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C5

MANUAL W/C PROPULSION ON HARDLEVEL SURFACES FOR ENDURANCE

DELTOID, BICEPS, SCAPULARSTRENGTH WITH SET UP

LOW WEIGHTS, HIGH REPS

ACE WITH ADAPTED HAND GRIPS

Trunk & Chest Strapping

CHEST FLEXIBILITY, GOOD POSTURE

REGULAR PASSIVE STANDING DECREASE SPASTICITY, STRETCHING


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C6

SCAPULAR AND LATS FOR ROTATORCUFF AND SCAPULAR STABILITY

Prevent Rounded Shld Posture & Shld

Impingement

ENDURANCE W/C ACTIVITIES

Runs, ACE, Hand Bikes -hand adapt, chest

& trunk stability (Use RPE) FLEXIBILITY OF SHLDS, BACK,NECK

REGULAR STANDING IN FRAME


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C7 TO T1

STRENGTH & ENDURANCE OF ALLSHOULDER GIRDLE MUSCLES FOR

TRANSFERS, W/C MOBILITY, DRIVING ENDURANCE THROUGH W/C PUSHING,ACE, HANDCYCLING

Adapted Gloves or cuffs as needed Trunk or chest strapping as needed

RPE


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T2 TO T6

UE STRENGTHENING & UPPER BACK

Emphasize pulling to balance back

muscles with strong anterior muscles dueto w/c and crutch activities

EXERCISE OUT OF CHAIR

VARIETY OF STRENGTH & ENDURANCE

Free weights, machines, handcycles, w/cruns, swimming

RPE


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T7 TO T12

Include Abdominal and Back Exercisesfor Strength & Endurance

Increases in Aerobic Endurance Possible Central Training Effect May Occur

HR + RPE for Monitoring


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L1 TO S5

Strength and Endurance as for OtherParaplegic Individuals

Involve Legs

Cycling, Swimming, Walking

Hip Flexibility for Ambulation & UprightActivities

Balance Fitness & Function to PreventOveruse & Injuries to Shld, Wrists andelbows


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SAFETY CONSIDERATIONS

POSTURAL HYPOTENSION

AUTONOMIC DYSREFLEXIA

HYPERTHERMIA/HYPOTHERMIA

SKIN BREAKDOWN

OVERUSE & INJURY


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EQUIPMENT

CONSIDERATIONS FACILITY CONCERNS

SCI User Friendly

Allow for Independence of User

Safety

Padding on Benches and Seats

Gloves & Handwraps Lifts or Ramps for Pools


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HOME EXERCISE

Transportation, Lack of Facilities

AEROBIC EQUIPMENT

Videotapes (seated aerobics) = $10

Table top ACE = $200-500

Hand Crank Cycles = $1500-2500

Lightweight W/C = $1500-2000


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HOME EXERCISE

STRENGTH

Dumbbells=$6-20 per weight, $200 set,

Cuff Weights=$6-80 per weight, 90-200 set Medicine Balls=($20-60 per ball)

Multistation Machines=$200-$1000

FLEXIBILITY Stretch Bands, Wands, Sticks

Floor Mats=$20-500

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