Spinal Cord Injury – Fitness/Medical (Corrective) Exercise

          Post-Rehab clients, families, and allied health professionals have seen many ups and downs in the rehabilitation process for stroke survivors. With our current insurance system, physical therapists are at limits. They are usually discharged under the premise that they reach a plateau with therapy intervention. Longer-term problems are reported by stroke survivors 1 to 5 years post-stroke (Saunders et al., 2014). The most common include mobility (58%), fatigue (52%), concentration (45%), and falls (44%) (Saunders et al., 2014). Around half of those surviving report that their needs relating to these problems are not being met, which is higher among those who are more disabled (McKevitt et al., 2011). Stroke survivors and caregivers are looking for alternatives for continued stroke recovery following discharge from therapy services.

          Extending therapeutic intervention for chronic stroke survivors is a hard sell for insurance reimbursements. The chronic phase of stroke recovery is usually three months to the end of life. Some of the most common deficits after a stroke are the effect of functional mobility and fitness level. Approximately 80% of stroke survivors have hemiparesis or weakness in the body opposite that of the stroke (Dipietro et al., 2007). Rehab cannot just be the default. We have to transition to a performance-based model that includes insight into the management of stroke survivors in the chronic phase, using 4 key components of the Positive Outcome Stroke Survivor Training Exercises (PosstEx) program which includes Medical Exercise Protocols, 7 Patterns of Human Movement (function), Fitness (metabolic equivalent), and Ability (Performance) Training.

Home Exercise Program Management

• Individual design exercise program based on clients' goals
• Adjust the program based on the progress 
• Support Groups and one on one coaching calls

References

Fawcett, J. W., Curt, A., Steeves, J. D., Coleman, W. P., Tuszynski, M. H., Lammertse, D., Bartlett, P. F., Blight, A. R., Dietz, V., Ditunno, J., Dobkin, B. H., Havton, L. A., Ellaway, P. H., Fehlings, M. G., Privat, A., Grossman, R., Guest, J. D., Kleitman, N., Nakamura, M., … Short, D. (2006). Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: Spontaneous recovery after Spinal Cord Injury and statistical power needed for therapeutic clinical trials. Spinal Cord, 45(3), 190–205. https://doi.org/10.1038/sj.sc.3102007