Understanding Brain Injury

Acquired brain injury can be defined as a non-degenerative injury to the brain that has occurred since birth. This includes traumatic brain injuries such as open or closed head injuries, and non-traumatic brain injuries such as those cause by strokes and other vascular incidents, tumors, infectious disease, hypoxia, metabolic disorders or inhalation/ingestion of toxic substances. Most acquired brain injuries are traumatic injuries caused by falls and motor vehicle accidents.

Brain injuries can lead to numerous physical, cognitive, and behavioral impairments. Unlike individuals with developmental disabilities, people with brain injuries are often acutely aware of these limitations. They are still able to remember their abilities prior to the incident and experience significant loss. It is important to note that there is a great individual variation in impairments due to brain injury, because damage to different parts of the brain can affect a variety of aspects of functioning in the world: thinking, feeling, moving, or behavior. A brain injury may result in difficulty planning, remembering, goal-setting, social learning, and problem solving, as well as learning and attention deficits. Behavioral changes may include onset of depression and anxiety, disruptive or combative behavior, lack of inhibition, self-abuse, irritability and detachment from reality. Fatigue, balance difficulties, decreased range of motion, and poor endurance, can affect an individual physically, as well as bladder and bowel problems.

It has been observed that people with brain injuries generally have a greater propensity towards poor health habits as well as having poor health profiles. As in other special needs populations, the benefits of a proper exercise program can be helpful in the avoidance of secondary health problems. Health-risking habits and behaviors that have been observed: smoking, dietary problems, lack of exercise, prolonged inactivity, medications that may be debilitating over time, sedentary lifestyle, indifference, lack of initiation, depression.

Developing the Fitness Program

Exercise can not only improve fitness outcomes, but the skills required to execute and maintain a program may also help improve cognitive function after injury.

Although the needs of an individual with a brain injury are the same as those of a non-injured person with regards to physical fitness, steps must be taken with each individual to ensure that the specific functional disabilities are addressed to ensure the success of the program. Each person has different needs based on health profiles and specific preferences in the activities chosen. Approaches to motivation, communication, and the individual's capacity to understand and follow a fitness program must be individualized. Information profiles from the person's rehabilitation case, team meetings, and consultations with professional resources such as neuro-psychologists, neuro-psychiatrists, and physical therapists can be very important in developing this individualized approach.

Stretching Program

Because most people afflicted with acquired brain injuries have been sedentary for long periods of time, physical activity may be primed with a stretching program. Many individuals with an acquired brain injury will suffer from ataxia, reduced range of motion, spasticity, incoordination, and altered tonus. For some of these participants, stretching may be a tremendously grueling experience, even at its most basic approach.

• Frequency: every day, before, during, after workouts
• Intensity: until tension is felt in the muscle – stretching should never be painful
• Time: hold for 15-20 seconds
• Type: slow, static stretches or PNF stretching (if possible according to client/trainer capabilities and comfort level) for each muscle group
• Considerations: do not hold breath. Explain the stretching process and its benefits, perform in a slow, controlled manner, gradually increase range of motion, demonstrate and post photos.

Strength Program

It is much easier for an individual to progress with strength training, which can provide powerful motivation for a participant who demands immediate gratification. Listing the benefits of strength training, posting this list, and reviewing it frequently may help to motivate participants with short-term memory problems. Because of common short-term memory problems, all aspects of the fitness program should be methodical and repetitive.

• Frequency: 3 days per week
• Sets/Reps: start with 1 set of 8-12 reps for each exercise. Gradually progress to three sets.
• Exercises:1 exercise for each body part: chest, shoulders, triceps, back, biceps, quadriceps, hamstrings, and abdominals. Perform each rep through a full range of motion. The speed of the repetitions should be 2 seconds positive motion, 2 seconds negative motion. Breathe normally.
• Considerations: starting points and fitness levels will differ from one client to another. Expect these differences and document. One set of one exercise may be all that can be accomplished the first time.

Cardio Program

For some clients, something as simple as walking down a 30-foot corridor may be taxing. Before starting your program, consult with primary care physicians and physical therapists to identify the abilities and fitness levels of each participant.

• Frequency: 3-4 times per week, working up to most days of the week
• Intensity: 60%-90% max heart rate
• Time: 20-40 minutes. This can be broken down into 10 minute bouts throughout the day, or shorter if needed.
• Type: walking, bicycling, treadmill walking, dancing, swimming, jumping rope, rowing, calisthenics, aerobic classes