Adapt this rehab exercise program for your facility

Strategy can be used for many settings, patients

You don’t need access to an off-site fitness center to combine cognitive rehab with an exercise program. In fact,Pamela R. Nelson, MA, PT, andSandra M. Neumann, MA, PT, say their cognitive rehabilitation and fitness program can be used at any facility and adapted to meet the needs of patients with all levels of brain injuries.

"It’s important for people to realize that they can use the same sort of approach we do, but in a different setting," says Nelson, who works with Neumann in cognitive rehab at the JFK-Johnson Rehabilitation Institute in Edison, NJ.

In an inpatient setting, therapists could ask patients to count exercise repetitions rather than guiding the entire session. This helps the therapist identify some of the cognitive issues patients may face and helps patients learn to deal with them.

Patients with very low levels of function could use a procedural checklist or follow a series of pictures to learn one or two simple exercises. Or they could be asked to look at a clock and monitor when 20 minutes have passed.

If your hospital doesn’t have access to an off-site gymnasium, here are some tips for adapting the program to your setting:

1. Identify a group of patients with strength or endurance goals and create an exercise program for them.

2. Set up a central area with a file drawer where the clients must retrieve their exercise folders.

3. Give the patients responsibility for setting up the exercise space.

4. Start out slowly with the low-level patients. They might start by counting 15 repetitions, for instance, then progress to doing a bicep curl on their own.

5. Keep sessions predictable for the most cognitively involved clients. Start with simple arm exercises, for example, then add the aerobic portion when clients are comfortable with the arm exercises.

"Our clients are constantly shifting between arm exercises, squats, and aerobics. But with more cognitively involved clients, you need initially to capitalize on predictability until they get used to the routine," Nelson says.

6. During one-on-one therapy sessions, take some of the responsibilities the therapists typically would guide and give them to the patients. For instance, the patient would follow written instructions for an exercise rather than waiting for the therapist to say, "I want you to do this 10 times."

"Sometimes therapists are so excited about doing therapy that they tend to take over, and the patient isn’t an active learner in the process," Neumann says.