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BridgingtheGapBetweenPhysicalTherapyandLong-TermPhysicalActivityandTraininginPeoplewithSpinalCordInjury(SCI):RecommendationsfromtheSCISpecialInterestGroupIntroduction:Peoplewithspinalcordinjury(SCI)havevariedoptionsforphysicalactivityaftertheirformalrehabilitationendsbasedontheirinterests,ability,communityresources,andpersonalresources.However,thereislimitedinformationavailabletoguideindividualswithSCIinchoosingthebestoptionsbasedontheirgoalsandresources.TheseguidelinesprovideinformationandrecommendationstopeoplewithSCIandtophysicaltherapists,inordertoguidetheirdecision-makingindeterminingtheirplansforcontinuedphysicalactivity.Objectives:

1. Describereasonsforcompletingformalpost-SCIrehabilitationincludingmaximizingrecoveryandfutureplanningforhealthandwellness.

2. Outlinerecommendationsforalong-termrelationshipwithrehabilitationprofessionals,includingcheck-upsandreasonstore-initiatecare.

3. Describepotentialgoalsofpost-rehabilitationphysicalactivity,includingfitness,wellness,continuedrecoveryofphysicalfunction,andmaintenanceofphysicalfunction.

4. Providerecommendationsforachievinggoals,includingprovidingcriteriaandconsiderationsforevaluatingresourcesandactivityplans.

Thefollowingsectionsprovideabroadoverviewoftherecommendationsfordecision-makingduringthetransitionfromphysicaltherapy(PT)toalong-termphysicalactivityandtrainingprogram(theBriefSummaryofRecommendationssection,page2)andamoredetaileddescriptionofthisprocess(theDetailedRecommendationssection,page3).Targetaudience:TheprimarytargetaudiencefortheBriefSummaryofRecommendationssectionispeoplewithSCI.ThetargetaudiencesfortheDetailedRecommendationsSectionarepeoplewithSCI,physicaltherapists,otherclinicianswhocareforpeoplewithSCI.TheserecommendationswerewrittenbyMeghanJoyce,PT,DPT,NCS,CathyLarson,PT,PhD,andRachelTappan,PT,DPT,NCSfortheSpinalCordInjurySpecialInterestGroupoftheAcademyofNeurologicPhysicalTherapy.KristenGargiulo,SPT;AnnaTessiatore,SPT;andJonathanTsay,SPTprovidedliteraturereviewfortheserecommendations.ThankyoutoTimothyFaw,PT,DPT,NCS;RichardHolicky;KarenHutchinson,PT,DPT,PhD;EricJohnson,CSCS,CIFT;CaseyKandilakis,PT,DPT,NCS;TwalaH.Maresh,PT,DPT,NCS,ATP;andEmilySchwartz,SPTforreviewoftheserecommendations.

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BriefSummaryofRecommendations: Long-termphysicalactivityandexercisehelpsrecoveryfromaspinalcordinjury(SCI).IfyouhavesustainedaSCI,youwilllikelyhaverehabilitation,includingphysicaltherapy(PT).ThisPTusuallylastsaslongasyoumakegainsinyourabilitiesandfunction.

OnceyoucompleteyourfirstboutofPT,youhavemanyoptionsforexerciseandrecovery.Theseoptionsrangefromexercisingonyourownathometohiringatraineratalocalgymtoassistyou.Theserecommendationsprovideguidanceforhowtocomeupwiththebestplanforyou.Yourphysicaltherapistcanalsohelpyoudecidethebestplanforyou.MakingaPlanforLong-TermExercise:

Thefirststepistodecidewhatyourgoalsare.Thesegoalsmaybeto:• Increaseyourindependence• Improveyourabilitytomove• Increaseyourstrength• Improveyourfitness• Improveyourhealth• MakefriendsandmeetotherpeoplewithSCI• Improveyourmentalhealth

Thesecondstepistomakeageneralplantoachievethosegoals.Forinstance,ifyour

prioritygoalsaretoa)improveyourfitnessandb)promoterecoveryforwalking,yourgeneralplanmightbetopracticewalkinganddoaerobicexercise.

Thethirdstepistofigureoutwhatresourcesyouhaveavailabletoyouintermsofpeople,facilities,andservices.LinkstoprogramsandfacilitiesacrosstheUnitedStatesarelistedintheDetailedRecommendationssectionalongwithquestionsthatyoumaywanttoaskoftheseprogramsandfacilities.Ifyouareunabletoaccesspeopleorprogramstohelpyouwithyourlong-termexerciseplan(e.g.,duetolackoftransportationorsuchprogramsinyourarea),therearestillmanywaystoincorporatephysicalactivityandtrainingintoyourlife.Youandyourphysicaltherapistshouldworktogethertofindaplanthatwillworkforyou.

Onceyouknowwhatyouwouldliketodoandwhatresourcesyouhaveavailabletoyouforcontinuedexerciseandtraining,youarereadytofinalizeyourexerciseplanandputitintoaction.

AdditionalPhysicalTherapyLaterOn Yourneedsmaychangeovertime.Youcancontinuetoseeyourrehabilitationteam(includingyourphysicaltherapistandyourdoctor)occasionallytogetinputandassistanceinaddressingyourneeds,includingforexerciseandcontinuedphysicalrecovery.Youmayalsoreturntoyourrehabilitationteamattimeswhennewproblemsarise–forinstance,ifyouhaveshoulderpainfromusingyourarmsmoreorifyoulosefunctionorenduranceafterbeingonbedrestforapressuresore.

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DetailedRecommendations:Objective1:Describereasonsforcompletingformalpost-SCIrehabilitationincludingmaximizingrecoveryandfutureplanningforhealthandwellness.FormalRehabilitation/PhysicalTherapyAfteraSpinalCordInjury(SCI)

Rehabilitationforaspinalcordinjury(SCI)typicallyincludesintensivecare,acutecare,inpatient,andoutpatientphysicaltherapy(PT).HomePTissometimesincludedaswell.DuringaPTepisodeofcare,peoplewithSCIwillundergotreatmenttoaddressthefollowingareas:

• Maximizingrecoveryofmotorfunction• Improvedabilityandindependencewithfunctionalactivitiesandwalking• Returntoprevioushomeandcommunityroles,aswellasreturntoleisuretime

physicalactivity• Minimizingriskoffutureinjury/medicalproblems• Maximizinghealth,wellness,andadjustmenttochangesinabilities.

ThetypicaldurationofoutpatientPTvarieswidelyfromseveralweekstomanymonths.ThelengthofstayforoutpatientPTineachindividualpersonwithSCIshouldbedeterminedasateambythepersonwiththeSCI,thephysicaltherapist,anyinvolvedfamily,otherhealthcareprofessionals,andthephysician.TheseteammembersshoulddecidehowlongoutpatientorhomePTwilllastbasedon1)objectivemeasurementsofeachperson’sgoalareas(e.g.,transfers,walking,wheelchairpropulsion)and2)theperson’sperformanceofthoseactivitiesinday-to-daylife.ApersonwithSCIshouldconsidercontinuinginoutpatientPTaslongasheorsheismakingmeaningfulandmeasureablegainsinfunctionormotorrecoveryandthenecessaryresourcesareavailable(e.g.,funding,transportation,timeandeffortrequiredtoparticipateintherapy).

TheinitialboutofformalPTmaybediscontinuedforseveralreasons:

· Lackofimprovement:Thetrajectoryofaperson’srecoveryshouldbeassessedwithobjectivemeasurements(forinstance,withtheISNCSCI,theSCIMorFIM,and/orgaitmeasures)1,2aswellasbychangesintheperson’sabilitytoperformfunctionalactivitiesinday-to-daylife.Typically,peoplewillseemostimprovementearlyinSCIrehabilitationwithmoregradualimprovementovertime.3-7DischargefromongoingskilledPTisappropriateoncerehabilitationhasaddressedallareasofimpairmentandlimitationandthereisnotmeaningfulimprovementinmeasuresofrecoveryorfunctionalabilitiesdespitehavingtrialedallappropriatePTinterventions.

· Limitationsinfunding:DifferentpayershavevaryinglevelsofcoverageforPT.ThedurationofPTmaybelimitedbasedonaperson’savailablefundingresources.Anylimitationsinfundingshouldbeexploredanddiscussedasearlyintherehabilitationstayaspossibletooptimizetheperson’sabilitiesdespitepotentiallimitationsinfunding.Strategiestoprioritizeandoptimizeuseoflimitedresources,suchasearlyreferralto

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communityprogramsanddevelopmentofcomprehensivehomeexerciseprograms,shouldbeutilizedaswell.

· Personalcircumstancesorpriorities:PeoplewithSCImayhavepersonalcircumstances,suchasmedical,family,ortransportationissues,thatmayleadthemtodischargefromPTpriortoachievingoptimalrecoveryfromtheSCI.Inaddition,peoplewithSCImaydecidetodiscontinuePTservicesduetopersonalpreferencesorpriorities.Objective2:Outlinerecommendationsforalong-termrelationshipwithrehabilitationprofessionals,includingreassessmentsandreasonstore-initiatecare.

RehabilitationAftertheInitialEpisodeofPTCareIsCompleted

ItisappropriateforpeoplewithSCItomaintainlong-term,intermittentrelationshipsandcommunicationwithrehabilitationprofessionals(includingphysicaltherapists)evenaftertheinitialepisodeofrehabilitationhasbeencompleted.Theseintermittentrelationshipsandcommunicationsmayoccurinmultipleformats,including:1)additionalboutsofcaretoaddressspecificproblemsthatariseortoupgradetheperson’sfunctionalactivitiesorexerciseprogramsbasedonchangesintheperson’sabilities,2)reassessments,and/or3)consultationforasecondopinion.(SeeFigure1)Insurancecoverageforthesetypesofvisitsmayvaryandshouldbecheckedonanindividualbasis.PeoplewithSCIandtheirrehabilitationteamshoulddiscussaplanforfutureinteractionsandfollow-upspriortodischargefromtheinitialepisodeofcare,includingpotentialindicationsforadditionalboutsofcareorreassessmentsinthefuture.Withopendiscussionofthisnature,peoplewithSCIcanhaveabetterunderstandingofwhentheyshouldconsiderre-initiatingcontactwithandcarefromtheirrehabilitationteaminthefuture.Figure1:ContinuumofRehabilitationafterSCI

AcuteCare InpatientRehabilation

OutpatientTherapy/Home

HealthPT

CommunityFitnessandWellness

PeoplewithSCIwilltypicallyprogressthroughthelevelsofrehabilitationshowninalinearfashion initially, and return to outpatient therapy intermittently once the first bout ofrehabilitationiscompleted.

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Attimes,animprovementoradeclineinfunctionorabilitymaymakeitnecessaryforsomeonewithaSCItoundergoanadditionalepisodeofskilledPT.Forinstance,peoplewithSCIhaveahighincidenceofshoulderpain8duetoheavyshoulderuse,andphysicaltherapymaybeappropriatetoaddressthisshoulderpain.9AnotherexampleisifapersonwithSCIhasadeclineinfunction;forinstance,someonewhohasmoredifficultywithtransfersafteraperiodoftimenotperforminglateraltransfersduetoapressuresore.Ingeneral,theneedforareturntoPTshouldbeconsideredwheneversomeonewithaSCIexperiencesasignificant,measurableimprovementordeclineinmotorfunctionorfunctionalmobility.

ItmayalsobeappropriateforpeoplewithSCItofollow-upwithrehabilitationprofessionalsforreassessmentrelatedtotheirSCI.Thesereassessmentscanoccurfromquarterlytoannually.AreassessmentwithaPTshouldbeindividualizedtoeachperson’sneedsandmayinclude:

• Reassessmenttodetermineprogressionordecline• ReassessmenttodetermineneedforfurtherPTcare• Modificationtofunctionalmobilitystrategies• Equipmentassessmentandmodification• Review/modificationtoexerciseprograms.

SomepeoplewithSCImayelecttopursueaconsultationforasecondopinionabouttheirrehabilitationplanofcareatafacilitythatspecializesinSCIRehabilitation.Suchaconsultationtypicallyconsistsofasinglevisitwithoneormorerehabilitationteammembers,includingaphysicaltherapist,occupationaltherapist,and/oraphysiatrist(aphysicianwhospecializesinphysicalmedicineandrehabilitation).SuchvisitsaretypicallymostsuccessfulwhenthepersonwithSCIispreparedwithspecificquestionsandconcerns.Areasthatcouldbeaddressedinsuchaconsultationinclude,butnotarenotlimitedto:

• Appropriatenessofcurrentrehabilitationplanofcareintermsofcontent,duration,andfrequency

• Anyadditionalinterventionsthatmaybebeneficial• Equipmentrecommendations• Prognosisforfurtherrecovery• Recommendationsrelatedtoreturntodailylifefunctionssuchasdriving,school,

work,familyresponsibilities,and/orhouseholdmanagement.

Aplanforfollow-upcareofthesetypescanbedeterminedbypeoplewithSCIincoordinationwiththeirrehabilitationteam.Ultimately,itistheresponsibilityofeachpersonwithSCItodeterminetheirgoalsandneedsforrehabilitationthroughouttheirlifetime.ItistheresponsibilityoftherehabilitationteamtoassistthepersonwithSCItodetermineandimplementanappropriateplanrelatedtothosegoalsandneeds.Therefore,peoplewithSCIshouldinitiatecontactwiththeirrehabilitationteamanytimetheybelievethattheirrehabilitationteamcanbeofassistance.Thiscontactmayoccuratpre-determinedtimesoronanadhocbasis.

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Objective#3:Describepotentialgoalsofpost-rehabilitationphysicalactivity,includingfitness,wellness,continuedrecoveryofphysicalfunction,andmaintenanceofphysicalfunction.PotentialGoalsofPost-RehabilitationPhysicalActivityPhysicalactivitybeyondactivitiesofdailylivingiscriticalforpeoplewithSCIfor:fitness,wellness,continuedrecoveryofphysicalfunction,and/ormaintenanceofphysicalfunction.Recommendationsrelatedtospecificparametersforexerciseafteraspinalcordinjuryareavailableelsewhere.10Aphysicalactivityregimenmayoccurathomeorinthecommunity,withorwithoutassistancefromotherpeople.Physicalactivityregimensareoftenmostsuccessfulwhentheyaregoal-directed.PeoplewithSCImaychoosetoparticipateinpost-rehabprograms/communityfitnessandwellnesscentersforthefollowingreasons:❏ Promotefunctionalindependencethroughcontinuedpracticeofcompensatoryand

restorativebasedinterventions.❏ Promoterecoveryoffunctionandneurologicstatus.❏ Optimizephysicalandmentalhealthandwellnessthroughoutthelifespan

❏ Maintainadequaterangeofmotionandstrength,withconsiderationofsecondarymedicalconditionsassociatedwithspinalcordinjury.

❏ Decreasecardiovascularriskfactors.Regularexercisemayhelptoimprovecholesterollevels,11-14exercisecapacity,14-17andbloodpressurecontrol,18aswellaspreventobesity.19,20

❏ Slowthedeclineinbonedensity.21Afterspinalcordinjury,bonedensitydecreasesrapidly,increasingtheriskoffractureandosteoporosis.

❏ Exercisepromotesadequateinsulinuptakeandreleasetoreducetheriskandconsequencesofdiabetesmellitus.22,23

❏ Preventionofsecondaryinjuryandhealthcompromise❏ Participatinginawellnessprogramcanenableparticipantswhoare

wheelchairuserstobeoutoftheirwheelchairsmorehoursoftheday.Remainingactiveandreducingsedentarybehaviorscanreduceriskofskinbreakdown24,25andjointcontracturesortightness.26Morespecificstrengtheningandstretchingmayalsopreventoveruseinjuriessuchasbiceptendinopathyorothershoulderpathologiesassociatedwithfull-timewheelchairuse.27-29

❏ Developandmaintainsocialsupportthroughbuildingcommunitywithpeersandprofessionals.Regularparticipationinacommunityfitnessandwellnesscenterprovidesuniqueopportunitiestolearnfromandsharewithpeerswithsimilarinjuriesandabilitylevels.❏ Peermentorship-sharingsuccessfultips,exercises,methods.

❏ Participatinginongoingwellnessopportunitiespostrehabcanimproveone'squalityoflifeandreducetherelianceorlevelofphysicalassistanceneededfromothers.30-33

❏ Maintainmentalhealthand/orreducetheriskofanxietyanddepression.34

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Whenestablishinggoalsrelatedtotheareasabove,considermakingS.M.A.R.T.goals.S.M.A.R.T.goalsareSpecific,Measurable,Achievable,Responsible,andTime-related.Forinstance:

• Insixmonths,Iwillpropelmywheelchairfor1milein20minuteswithoutarestbreakandwithnoshouldermusclesoreness.

• Inonemonth,Iwillcompletemy15-minutelegstrengtheningroutineatleast3days/weekconsistently.

• IwillperformFEScycling3timesperweekfor8weekstoslowmuscleatrophyandimprovecirculation.

FormoreinformationaboutsettingS.M.A.R.Tgoals,seehttps://www.cdc.gov/healthyyouth/evaluation/pdf/brief3b.pdfObjective#4:Providerecommendationsforachievinggoals,includingprovidingcriteriaandconsiderationsforevaluatingresourcesandactivityplans.RecommendationsForAchieving“AfterInitialPhysicalTherapy”Goals:(includingprovidingcriteriaandconsiderationsforevaluatingresourcesandactivityplans)OnceapersonwithSCIhasdecidedontheirgoalsorareastobeaddressedinpost-rehabilitationcare,aspecificplancanbedeveloped.Thisplanshouldberealistic,safe,andaneffectiveuseoftime,effort,andresources.Ideally,thisplanwillbedevelopedpriortocompletingtraditionalrehabilitation,whichwillallowthetherapyteamtohelpgenerateaneffectiveandsafeplanandwillalsoavoidalapseintraining.Inaddition,aphysicaltherapistcanhelpwiththeinitialimplementationofthisplanbyassistingwiththedevelopmentofspecifictrainingactivitiesandbyhelpingthepersonwithSCItoeducateanyprovidersaboutSCIandtheperson’sindividualneeds.Forexample,aphysicaltherapistmaytrainacaregiverorapersonaltrainerinhowtoset-upand/orassistthepersonwithSCIwithtransfers,walking,orexercises.Itishighlyrecommendedthatyou,yourphysicaltherapist,andanypost-rehabilitationproviders(suchaspersonaltrainers)collaboratetocreateanindividualized,optimallyeffective,andsafeprogram.Ataminimum,peoplewithSCIshoulddiscusstheirplansforexercisewithanappropriatehealthcareprovider(suchasaphysicianorphysicaltherapist)todetermineanyguidelinesorlimitsfromamedicalstandpoint,includingvitalsigntargetsandlimits,weight-bearingprecautions,appropriateorinappropriatetypesofexercise,proceduresintheeventofmedicalemergenciessuchasautonomicdysreflexia.Whendevelopingaplanforpost-rehabilitationphysicalactivity,thefollowingstepsarerecommendedforapersonwithSCI:

1. Identifyyourgoals.Whichoftheabovegoalsfeelmostimportanttoyou?2. Determineageneralplantoachievethosegoals.Forinstance,ifyourprioritygoals

aretoa)improveyourcardiovascularfitnessandb)promoteneurologicalrecoveryforwalking,yourgeneralplanmightbetopracticewalkinganddoaerobicexercise.Yourphysicaltherapistcancollaboratewithyoutodetermineanappropriateplantoachieveyourgoalsaseffectively,efficiently,andsafelyaspossible.

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3. Determinewhatresourcesyouneedtoimplementthatplan.Again,yourphysicaltherapistcancollaboratewithyoutodeterminewhatresourcesyouwillneedtosafelyandeffectivelyimplementyourplan.Intheexampleabove,theresourcesyouneedtopracticewalkinganddoaerobicexercisewilldependonyourleveloffunctionandpreferences.Forinstance:

a. Someonewhoisabletowalkwitharollingwalkerindependentlymaybeabletoachievebothwalkingtrainingandaerobictrainingbywalkingintensivelywitharollingwalkerorbyusingatreadmillifsafetodoso.

b. Someonewhoneedsphysicalassistancetopracticewalking,mayneedaperson/trainerandspecialequipmenttoassistwithwalkingtraining.Ineitherscenario,thispersonmayelecttouseotheraerobictrainingequipment(e.g.,anarmbike,recumbentcross-trainer,recumbentbike)toworktowardthegoalofimprovedcardiovascularfitness.

4. Assesstheresourcesthatyouhaveavailabletoyou,includingpeople,facilities,andservices.Considerprogramssuchaslocalgyms,YMCAs,andcommunityprogramsaswellassupportpersonnelatthoselocations.Peoplethatyouneedtohelpyoumayincludecaregivers,personalassistants,familymembers,orpersonaltrainers.Insomeareas,specializedprogramssuchasadaptivesportsprogramsandfitnesscentersareavailablethathavefacilities,programs,andactivitiesthataretargetedtopeoplewithspinalcordinjuriesandotherdiagnoses.Yourphysicaltherapistcanalsobearesourceinhelpingtoidentifywhatresourcesareavailableinyourarea.IntheAppendices,youwillalsofindthefollowingresources:

a. Linkstolistsofprogramsandfacilities(SeeAppendixA)b. Questionstoaskprogramsandfacilitiestohelpdetermineappropriateness

(seeAppendixB)c. Linkstoinformationaboutdevelopinganappropriateexerciseprogram(see

AppendixC)5. Determinewhetherthereisagoodmatchbetweenyourgoals,generalplan,and

availableresources.Ifyes,continueto#6.Ifno,returnto#2andassesswhetheryoucanmodifyyourgeneralplantomatchtheresourcesthatyouhaveavailable.

6. Determineyourspecificplanforachievingyourgoals.Ifyoufindthatyouhaveagoodmatchbetweenyourgeneralplanandyourresources,youarenowreadytodecideexactlywhatyouwilldo.

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AppendixA:ListingsofFacilitiesandPrograms:Seeifthereisafacilityortrainernearyou:

1. NationalCenteronHealth,PhysicalActivityandDisability(NCHPAD)hasanationaldirectoryofprograms,facilities,andorganizationsthatareavailableforpeoplewithhealthconditionsanddisabilities:

http://www.nchpad.org/Directories

2. CertifiedInclusiveFitnessTrainers(CIFTs)whohaveundergonecertificationthroughtheAmericanCollegeofSportsMedicine(ACSM)andNCHPADareabletoprovidepersonaltrainingservicestopeoplewithhealthconditionsanddisabilities.WhilethisisnottrainingexclusivetoSCI,thesetrainersaremorelikelytohaveexperienceandtraininginexerciseforpeoplewithdisabilities.Adirectoryisavailablehere:

https://certification.acsm.org/pro-finder

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AppendixB.QuestionsforIndividualswithSCItoAskAboutPost-RehabilitationFacilities:Whatarethegoalsforyourparticipants?Purposeoffacility?❏ Health&Wellness❏ Weighttrainingorstrengtheningintactmusclesaboveleveloftheinjury❏ Recoveryorstrengtheningbelowtheleveloftheinjury❏ Improvecardiopulmonaryfunction❏ Improveendurance❏ Improveflexibility❏ Weightmanagement❏ Practicefunctionalactivities(mat/bedactivities,transfers,balance,etc.)❏ Multi-purpose

Facility:Isthisfacilityaccessible?❏ Accesstomedicalassistance(onsiteorcall911)❏ Enoughroombetweenequipmenttomaneuverwheelchairs❏ Water(hydrationisimportant!)❏ Towels❏ Wheelchairaccessibleexerciseequipment(e.g.,weighttrainingequipmentwith

movableseats)❏ Wheelchairaccessiblerestrooms❏ Wheelchairaccessiblelockerrooms

❏ Isthereanavailablematinthelockerroomfordressing,ifneeded?❏ Isthereassistanceavailablefordressingorundressing?

❏ Wheelchairaccessibleshowers❏ Grabbarsinrestroomsandshowers❏ Cleanandwell-maintainedfacilities❏ Handicapparking❏ Distancefromparkingtofacilityentrance❏ Ramp–entryin/outofbuilding❏ Workingelevatorsifmultiplefloors❏ Isthefacilitynearyourhome?Youaremorelikelytogoexerciseifthelocationis

convenient.❏ Whataretheopenhours?Somefacilitiesareopen24hours,whileothershave

limitedhours?Whenisthefacilitybusiest?❏ Areparticipantsrequiredtohavemedicalclearanceorahealthhistory?❏ Canyoutakeatour?

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SCI-SpecificConcerns:❏ Accommodatepeoplewithtetraplegia:Doyouhaveequipmenttoadaptexercise

equipmentasneededforlimitationsinhandfunction,suchasadaptiveglovesoracewraps.

StaffBackgroundandTrainingWhoisavailableonsitetoassistanindividualwithSCI?❏ Personaltrainerwithorwithoutcertification,suchas:

❏ CertifiedInclusiveFitnessTrainers(CIFT):❏ https://certification.acsm.org/acsm-inclusive-fitness-trainer❏ http://certification2.acsm.org/profinder?_ga=2.254101768.12

86397395.1495148201-581199747.1495147925❏ Certified Special Populations Specialist (CSPS):

❏ https://www.nsca.com/Certification/CSPS/❏ AthleticTrainer(ATC)❏ ExercisePhysiologist❏ PhysicalTherapist(PT)❏ OccupationalTherapist(OT)❏ Pre-PT/OTorPT/OTstudents❏ Nutritionistordietitian❏ Pilatesorotherspecializedtraining❏ Other_______________________

Whattrainingdoesthestaffhave?❏ Doesthecenterhaveyoufilloutahealthquestionnairetodetermineyourrisk

factorsandthemostsuitableactivitiestomeetyourneedsandinterests?❏ Howdoesthefacilityhandleemergencysituations?Hasstaffbeentrainedin

cardiopulmonaryresuscitation(CPR)andfirstaid?❏ IfthestaffarenotlicensedintheareaofworkingwithpeoplewithSCI(e.g..,arenot

PTsorOTs),aretheytrainedto:❏ Workwithpeoplewithdisabilities(suchaswithCertifiedInclusiveFitness

Trainers)❏ WorkwithindividualswithSCI❏ PasscompetenciestobeabletoworkwithindividualswithSCIorotherneurologic

dysfunction❏ Monitorbloodpressureand/orheartrate❏ Monitorpulseoximetry❏ Recognizeandaddressorthostatichypotensionandautonomicdysreflexia❏ Implementanexerciseprescription❏ Appropriatelyprogressexercisesordecreasefrequency/intensitywhenneeded❏ Performskinchecksafterexercise,whenappropriate

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Extentofassistance❏ One-timetouroffacility❏ One-timeorientationtoequipment❏ One-on-onepersonaltrainer❏ Onetrainerfor___(numberofpeople)❏ Groupworkoutsorclasses?(whattype?)❏ Monitoreverysession,weekly,monthly❏ Assistwithset-uponeachpieceofequipment❏ Assistwithtransferson/offequipment❏ Ifnoassistance…

❏ Canafamilymember,orpersonalassistantattendtohelpme?❏ Cantheaboveindividualalsoexercise?Ifso,whatisthecost?

Listtheequipmentthatisavailableatyourfacility.(Whilehavingallofthe“latestandgreatest”equipmentavailablemaynotbeneededtoobtainyourpersonalgoals,youwillwanttofindoutifequipmentthatyouneedisavailable).❏ AutomatedExternalDefibrallator(AED)❏ Weight-trainingequipment(chestpress,bicepscurls,triceps,etc.)

❏ Withorwithoutabilitytomoveseatoutofthewayforwheelchairaccess❏ Freeweights❏ Elasticbandsortubing❏ Armergometers/armbikes❏ Recumbentbikes❏ Inclinedplanebodyweightdevices❏ Standingframes❏ Treadmills

❏ Withorwithoutoverheadharnesssystemorothersupportsystemforsafetyand/orbodyweightsupportduringtraining

❏ Overheadharnesssuspensionsystems❏ Sturdyrollingwalkers(SecondStep,RiftonPacer(adult,andtall/heavyduty),

platformwalkers,etc.)❏ Parallelbars❏ Pool

❏ Liftforentry/exit❏ Rampforentry/exit

❏ Underwatertreadmill❏ Equipmentforbalancetraining(foam,Swissballs,bolsters,etc.)❏ Pedometersand/oraccelerometers❏ Slingswithoverheadsuspension❏ Functionalelectricstimulation(FES)cycling❏ Electricstimulationforindividualmuscles❏ Wholebodyvibration❏ Roboticorpoweredexoskeletons

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Finances❏ Approximatecost_______________(persession,perweek,permonth,annual)❏ Privatepayoracceptanyinsurances❏ Scholarships❏ Reducedratesforfitnesscentersthathaveequipmentwithlimitedaccessfor

disabledindividuals❏ CanIobtainatemporarypassforasmalldailyfeeoratnocosttotryoutthe

facility?CommunicationwithHealthcareProvidersOpencommunicationamongstyourteamiscriticalfordeveloping,implementingandprogressingyourtrainingprograminawaythatissafeandeffective.Questionstoaskapost-rehabilitationprogramorproviderinclude:❏ Istheprogramorproviderwillingtocommunicatewithyourrehabilitationteamor

PT?❏ HowwilltheycommunicatewithyourrehabilitationteamorPT?

❏ Oneormoremeetingsface-to-facewiththerapistforcommunicationandtraining

❏ Email❏ Phone❏ Other:______________________________

❏ WhenwilltheycommunicatewithyourrehabilitationteamorPT?❏ Toalerttherapistsofpotentialoractualmedicalstatuschanges(e.g.,fractures,majorillness)andseekinputforappropriatephysicalactivitymodifications

❏ Toseekassistanceoftherapistifneedtoupdateprogram❏ Toalerttherapisttowhenapatientincreasesordecreasefunctiontothepointofneedofre-entryintotherapy

❏ Atregularlyscheduledintervals❏ Other:_____________________________

OtherResourcestoConsider:FromNCHPAD:ChoosingaFitnessCenter:http://www.nchpad.org/308/1909/Choosing~a~Fitness~Center

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AppendixC.InformationaboutDevelopinganAppropriateExerciseProgram:FromNCHPAD:

● ExerciseGuidelinesforPeoplewithDisabilitieshttp://www.nchpad.org/14/73/Exercise~Guidelines~for~People~with~Disabilities

● DiscoverAccessibleFitness:bookletthatservesasaguideforindividualsusingwheelchairsforusingfitnessequipment.http://www.nchpad.org/discoverfitness/index.html

● LifeonWheels:“aguideforlivingahealthy,activelifewithaspinalcordinjury”http://www.nchpad.org/1200/5830/Life~on~Wheels

FromtheModelSystemsKnowledgeTranslationCenterFactsheetaboutSCIandExercise:http://www.msktc.org/sci/factsheets/exerciseFactsheetaboutSCIandAdaptiveSportsandRecreation:http://www.msktc.org/sci/factsheets/adaptive_sportsFromtheU.S.DepartmentofHealthandHumanServices:PhysicalActivityGuidelinesforAmericans:https://health.gov/paguidelines/pdf/paguide.pdfFromExerciseandSportsScienceAustralia(ESSA):PositionStatementonExerciseandSpinalCordInjury:10https://www.essa.org.au/wp-content/uploads/2015/10/ESSA-Position-Statement-on-Exercise-and-Spinal-Cord-Injury.pdf

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