THE IMPORTANCE OF HOME

EXERCISE PROGRAMS FOR

PAT I E N T S W I T H S P I N A L C O R D
INJURIES

Anna Bradley

PTH 825
 Health Condition: C6-C7 SCI

BACKGROUND
AND PURPOSE:
ICF MODEL
Body Functions and Structures: Activities:
Quadrapeligia Participation:
Difficulties moving and menaruvering power
Pain in BUE Restricted ability to perform BADLs such as
chair
Pain in R shoulder feeding, dressing, brushing teeth
Difficulties reaching
Flexion contractures in BUE Relies on public transportation
Ineffective cough Difficulties holding onto objects
Often hospitalized for infections
Extensive history of pressure sores Difficulties with pressure relief techniques
In bed for long durations through out day
Often fatigued from being in chair too long
Hypersensitivity in R shoulder, L thumb

Environmental factors:
building structures
unreliable public transportation Personal factors:
(sometimes) unreliablle caregiver Male, 59 y/o
staff
Lack of support system
 Evidence-based scientific exercise guidelines for adults
BACKGROUND AND with spinal cord injury: an update and a new guideline
(2017)
PURPOSE: LIT REVIEW Purpose Utilize evidence-based data to develop
guidelines that outline type and minimum
dosage of exercise to improve overall fitness
and cardiometabolic health in adults with
SCI.
Methods 4 researchers experienced in exercise with
SCI patients utilized AGREE II instrument
to formulate a clinical practice guideline.

Results Cardiorespiratory fitness and strength

benefits  20 min of mod-vigorous
intensity aerobic exercise 2x/wk AND 3 sets
of strength exercise for each major muscle
group at mod-vigorous intensity 2x/wk
Cardiometabolic health  30 min of mod-
vigorous aerobic exercise 3x/wk
 The Efficacy of an Implementation Intention Intervention for
Promoting Physical Activity Among Individuals with Spinal Cord
Injury: A Randomized Controlled Trial

Purpose To determine if developing an

implementation intention increases physical
activity in individuals with SCI.

Methods 2 groups implementation and control,

BACKGROUND asked to engage in 30 min of mod-heavy
physical activity 3x/wk. Physical activity
measured by PARA-SCI interview
AND PURPOSE: instrument.

Results Intervention group strengthened intentions-

LIT REVIEW behavior relationship greater physical
activity participatioin
Implementation-intention intervention
improved prediction of physical activity by
intentions.

Clinical implications Implementation-intentions should be used to

increase physical activity levels among SCI
population.
 BACKGROUND AND PURPOSE: LIT REVIEW

A Prospective Study on Physical Activity Levels After Spinal Cord Injury During Inpatient Rehabilitation and the Year After
Discharge
Purpose Examines the physical activity levels over time in patients with SCI
Methods Prospective cohort study, 5 measurements occurring at the start of inpatient
rehab, 3 months later, at discharge from rehab, 2 months after discharge, and 1
year after discharge. Participants were n=40 people with SCI.

Results Increase of physical activity during inpatient rehab, but then a sharp decline
shortly after discharge. This decrease in physical activity was continuous
through out the rest of the year.

Clinical Implications People with SCI often do not get enough exercise after their injury. PTs are
responsible for introducing safe and easy ways for people with SCI to be
active.
 • Occurred on July 7, 2022 over the phone due to patient
availability limitations.
• Questions asked:
How much physical activity do you participate in per
NEEDS week?

ASSESSMENT What kind of physical activity do you regularly perform?

How often is somebody available to help with exercises?
What are some aspects of physical activity that you enjoy?
Why do you think physical activity is important for people
with spinal cord injuries?
GOALS

• By the end of the intervention session, the patient and caregiver will demonstrate
understanding of an outlined plan to achieve to achieve the exercise guidelines for
patients with SCI by performing the exercises for the SPT.
• By the end of the intervention session, the patient and caregiver will be able to explain
the importance and benefits of exercise to the SPT.
I M P L E M E N TAT I O N

Health-focused model How this can be applied with this case

• Screen and intervene with healthy • Needs assessment

behaviors • Develop appropriate exercise program
• Determine patient’s needs, beliefs, and that the patient can do independently or
motivations when considering with caregivers
interventions • Present interventions and practice the
• Provide intervention/ behavior change exercises with patient and caregivers
• Reassess • Reassess by following up with patient
periodically
I M P L E M E N TAT I O N

• Created a packet for the patient’s caregivers which included:

Reasons why exercise is important for SCI patients
SCI exercise guidelines
Description of RPE scale
An aerobic exercise circuit
A strength exercise circuit

• Discussed and demonstrated contents of the packet with patient and caregiver.

• Answered any questions

I M P L E M E N TAT I O N
I M P L E M E N TAT I O N
I M P L E M E N TAT I O N
ASSESSMENT
• Exercise log

• Modified Quality of Life Index- Spinal Cord Injury

Version-III
- Assessed 11 items from 1-6 (very dissatisfied to satisfied)
- Patient scored 55/66
- Indicated satisfaction with health, health care, energy,
and happiness
- Indicated dissatisfaction with amount of pain
FUTURE REACH

SCI exercise support groups to

motivate each other and hold
each other accountable

Program instructing caregivers

on how to implement exercise in
patients with SCI
REFERENCES

• Martin Ginis, K.A., van der Scheer, J.W., Latimer-Cheung, A.E. et al. Evidence-based scientific exercise guidelines for
adults with spinal cord injury: an update and a new guideline. Spinal Cord 56, 308–321 (2018).
https://doi.org/10.1038/s41393-017-0017-3
• Latimer, A. E., Ginis, K. A. M., & Arbour, K. P. (2006). The efficacy of an implementation intention intervention for
promoting physical activity among individuals with spinal cord injury: A randomized controlled trial. Rehabilitation
Psychology, 51(4), 273–280. https://doi.org/10.1037/0090-5550.51.4.273
• van den Berg-Emons RJ, Bussmann JB, Haisma JA, et al. A prospective study on physical activity levels after spinal cord
injury during inpatient rehabilitation and the year after discharge. Arch Phys Med Rehabil. 2008;89(11):2094-2101.
doi:10.1016/j.apmr.2008.04.024
• Donald H. Lein, Jr, Diane Clark, Cecilia Graham, Patricia Perez, David Morris, A Model to Integrate Health Promotion
and Wellness in Physical Therapist Practice: Development and Validation, Physical Therapy, Volume 97, Issue 12,
December 2017, Pages 1169–1181, https://doi.org/10.1093/ptj/pzx090