Know and understand the pathology of each condition and how it may interact with a resistance training program (i.e., progressive disorders often result in increased weakness and high levels of fatigue).
Determine which muscle groups are still functional (neurological innervation) and which muscle groups are weak (paresis) or paralyzed (paralysis).
Determine the progression of resistance exercise through consultation with the client's physician, physical therapist or qualified health provider. With certain individuals, the progression may vary regularly because of exacerbations that occur throughout the person's lifetime. Periods of exacerbation may require the instructor to return to baseline or below baseline levels of strength.
Focus on muscle groups that are essential for performing ADL (i.e., shoulder abductors for combing hair and dressing) and IADL (i.e., triceps and forearm and shoulder stabilizers for wheelchair transfers).
Make sure that blood pressure and heart rate responses remain in a safe zone.
Make sure that associated conditions (i.e., autonomic dysreflexia, hypertension) are dealt with properly.
Make sure that exercise facility is accessible for wheelchair users. Guidelines can be obtained from the Americans with Disabilities Act.
