Specific interventions for each of the targets were defined and assigned to the appropriate members of the healthcare team. In this Rehab Cycle, in addition to the standard healthcare professionals, a sports therapist, physical therapist and psychologist would be added to meet Lisa’s athletic, physical therapy and psychological needs.
Figure 5 offers greater detail on the assignments for specific interventions in Lisa’s Cycle.
Interventions in the areas of physical therapy and sports are clearly closely related and mutually supportive. Together, the interventions would help improve muscle endurance, sporting abilities and promote the supportive functions of the arms, as well as work to broadly further the other two Cycle Goals.
In Lisa’s case, the physical therapist was responsible for her overall fitness, the improvement of which was a pre-requisite for most sporting activities. For instance, her transferring abilities and wheelchair mobility skills would need to be developed to a degree that would allow participation in athletics.
Therefore repetitive training of various transferring techniques and wheelchair maneuvering (e.g. around and over obstacles) was undertaken.
Interventions in the areas of physical therapy and sports are clearly closely related and mutually supportive.
To improve Lisa’s body balance and overall movement ability, reaction training was tailored and integrated into her physical therapy as well as into group training led by the sports therapist.
The sports therapist also focused on building muscle power in the upper extremites through circuit resistance training and on increasing Lisa’s exercise tolerance three times weekly.
...her transferring abilities and wheelchair mobility skills would need to be developed to a degree that would allow participation in athletics.
With guidance from her sports therapist, a range of sporting activities appropriate to Lisa’s level of injury and degree of recovery were included in her rehabilitation.
Basketball and other games were added to her fitness training. Lisa was enrolled in a swimming course which took place once a week.
Four times per week she took lessons to learn archery, a sport that is one of the early rehab program sports activities and which precludes participation in other sports such as competitive racing. Based on her initial experiences, Lisa decided to test her capacity in two areas.
A canoeing test offered the hope that she would discover an activity she could share with her boyfriend. A handbike racing test established her as a competitor in the sport. She was extremely enthusiastic about both.
Finally, in order to address the intersecting needs of Lisa’s body functions and her emotional state, her psychologist began Feldenkrais therapy— a technique of complementary medicine that utilizes body movement for raising awareness (see Box 2).
Additionally, a number of interventions were included that would impact her overall fitness. In addition to all-around care (including the instruction of independent bladder and bowel management, and improvement of dressing and transferring abilities), Lisa’s nurse fit and managed her compression hose which helped control her blood pressure.
Hippo therapy was utilized by the physical therapist to help improve the muscle tone in Lisa’s lower extremities. To improve the increasing spasticity, sauna and drug treatment were also started.
Lisa’s occupational therapist would help support her ability to dress and look after her health, as well as organize and manage the purchase of assistive devices and the adaptations required for her home and automobile.
Psychological counselling helped to alleviate Lisa’s fear of falling and support her coping with the disease.
Box 2 | A Brief Introduction to the Feldenkrais Method
Movement is life. Life is a process. Improve the quality of the process and you improve the quality of life itself.
Dr. Moshé Feldenkrais
The Feldenkrais Method is a movement-based learning system that focuses on somatic education. This somatic learning aims to heighten self-awareness of and through movement, while minimizing stresses to the body and other limitations to body movement.13 The method was originally developed by Dr. Moshé Feldenkrais, a physicist, engineer and martial arts practitioner, in an effort to overcome his own knee injury. Dr. Feldenkrais went on to teach the method to other practitioners.
While not specifically intended as a medical therapy, the Feldenkrais Method can help individuals to move more efficiently and less painfully. Focusing on poorly organized movement, chronic tension and emotional stress, the Feldenkrais Method seeks to help both healthy and injured individuals overcome the immobility associated with such conditions.14 While the mechanisms of the Method are not clearly understood and its effects are not yet conclusive, some studies have shown improved health related quality of life and self-efficacy of pain.
7 Two main approaches to the Feldenkrais Method exist — each with differing in structional philosophies: 7 awareness through movement and functional integration. The former is led verbally by an instructor and can be undertaken in groups. Functional integration involves the instructor using his or her hands to guide the student’s or patient’s movements.
In addition to the athletic interventions, a number of non-sports related activites were included that focused on recreation and leisure in Lisa’s weekly schedule (see Figure 4). These included spiritual guidance, art therapy and Spanish lessons. Lisa received a great deal of enjoyment from each of these, particularly her art therapy which utilized clay sculpture as a medium.
Focusing again on the recreation and leisure Cycle Goal, as an example of Lisa’s interventions, sporting and athletic activities played a central role. In this case, selection of many of these athletic activities were guided by the sports therapist; a physical therapist may also be able to take on this role, depending upon his or her expertise.