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Effects of An Intensive Exercise Program on Fitness and Function for People with Long Term Brain Injury Ann L. Charrette PT DPT MS PCS NCS Laura S. Lorenz,

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Presentation on theme: "Effects of An Intensive Exercise Program on Fitness and Function for People with Long Term Brain Injury Ann L. Charrette PT DPT MS PCS NCS Laura S. Lorenz,"— Presentation transcript:

1 Effects of An Intensive Exercise Program on Fitness and Function for People with Long Term Brain Injury Ann L. Charrette PT DPT MS PCS NCS Laura S. Lorenz, PhD, MEd, CBIS Jeffrey Fong, PharmD, BCPS Karen S. Lamson, MLS Therese O’Neil-Pirozzi, ScD, CCC-SLP Michelle Demore-Taber, ScD, LRC, CBIS

2 Effects of An Intensive Exercise Program on Fitness and Function for People with Long Term Brain Injury o Why Exercise Matters o Chronic Brain Injury and Exercise o Supportive Living Inc, SLI Context: Peter Noonan o Study Methods o Intervention AccesSportAmerica: Ross Lilley o Results o Discussion/ Conclusions o Exercise Participant Peter C o Next Steps o Q and A

3 Why EXERCISE Matters! Exercise is good for you! Exercise as medicine https://www.youtube.com/watch?v=aUaInS6HIGo

4 Healthy People 2020 Overarching Goals 1.Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. 2.Achieve health equity, eliminate disparities, and improve the health of all groups. 3.Create social and physical environments that promote good health for all. 4.Promote quality of life, healthy development, and healthy behaviors across all life stages.

5 Exercise with Individuals with chronic brain injury Exercise has been proven to be good for individuals with disabilities but the TBI population has not been studied extensively Adults with chronic brain injury living in a community setting have not been studied

6 Wise EK, Hoffman JM, Powell JM, Bombardier CH, Bell KR. Benefits of exercise maintenance after traumatic brain injury. Arch Phys Med Rehabil. 2012;93(8):1319-1323. Wise study CONCLUSION: Exercise may contribute to improvement in mood and quality of life for people with TBI and should be considered as part of the approach to depression treatment.

7 Fogelman D, Zafonte R. Exercise to enhance neurocognitive function after traumatic brain injury. PM and R. 2012; 4(11):908-913. Fogelman study CONCLUSION: “Clinical trials that evaluate exercise as an intervention after severe and moderate TBI are needed in the subacute and chronic periods after injury.”

8 Our Research Question What changes will we observe for persons who are long term survivors of brain injury and living in a community setting, after intensive exercise?

9 PETER NOONAN Executive Director of SLI https://www.youtube.com/channel/UCDE5sWF2qgLNgPm4ky6vVaA?feature=watch

10 Sample 14 Individuals who reside in SLI residential settings and who meet the inclusion criteria: can stand independently or with only minimal assistance can walk with or without ambulation device and/ or bracing have an interest in exercise available for 1½ hours on Mon, Wed and Fri for 6 weeks

11 AGEYears since ABI genderspecific brain injuryextremities involvedfunctional status 4216MTBI X 2Right sided weaknessassisted ambulatory, WC user 4830MTBIBUE and BLEassisted ambulatory with rolling walker, WC user 4644MTBIRight side weaknessassisted ambulatory with quad cane, WC user 2717Mmultiple CVABilateral weaknessambulates with walker short distance, WC user 5524MCVA X 2Left sideambulatory with quad cane, WC user 5615FTBI and substantial ortho injuries Bilat. LE’sambulatory short distance with walker, WC user 538MTBILUE and LLEambulates with quad cane, WC user 4524Manoxic encephalopathyBilateral weaknessambulatory with ataxic gait 5031Mbrain tumorKyphotic postureambulatory with rolling walker 375MTBIBLE/ RUEambulatory 308MCVALeft side neglectambulatory 5134FTBILLEambulatory 4613MTBI-ambulatory 4119MTBI-community ambulatory

12 Measures 6MWT- Six Minute Walk Test measure of endurance Gait speed speed of walking HiMAT- High Level Mobility Assessment Tool advanced motor skills POPS- Participation Objective, Participation Subjective Participation in Life Activities Self-Efficacy Scale

13 Research Design Prospective, non-randomized, unblinded interventional trial Utilizing a before and after intervention comparison Statistical analysis: Wilcoxon signed ranks test SPSS 21.0

14 Pre- Test Post-test At 6 weeks At 12 weeks 6MWT Gait speedGait Speed HiMAT POPS Self-efficacy scale

15 Description of the intervention Ross Lilley Executive Director and Founder http://accessportamerica.org/ “The biggest human temptation is to settle for too little.” Thomas Merton

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19 Results Baseline (n=14) After (n=14) 6 weeks follow up (n=14) 6MWT (feet) median (IQR) 431 (87, 1294) 1016 * (298, 1876) 712 * (281, 1566) Gait Speed (m/sec) median (IQR) 0.59 (0.25, 1.50) 1.11 * (0.53, 1.96) 1.10 * (0.46, 1.77) HiMAT median (IQR) 3.5 (1, 27) 9 * (3.75, 33) 8 * (2.75, 29) 6MWT= 6 minute walk test, HiMAT=High Level Mobility Assessment Tool. IQR= interquartile range, *= denotes statistical significant comparison against baseline p<0.05 Comparison of measures over 6 week study period

20 Clinically Significance in Change in 6MWT Eng et al, 2004, Chronic Stroke, MDC = 112.76 feet Our data: Chronic Stroke: (Eng et al, 2004) MDC = 112.76 feet Baseline (n=14) After (n=14) 6 weeks follow up (n=14) 6MWT (feet) median (IQR) 431 (87, 1294) 1016 * (298, 1876) 712 * (281, 1566) *= denotes statistical significant comparison against baseline p<0.05

21 Clinically Significant Change in Gait Speed Baseline (n=14) After (n=14) 6 weeks follow up (n=14) Gait Speed (m/sec) median (IQR) 0.59 (0.25, 1.50) 1.11 * (0.53, 1.96) 1.10 * (0.46, 1.77) *= denotes statistical significant comparison against baseline p<0.05 TBI: (Watson et al, 2002) Change in performance of > 0.05 seconds is greater than rater error

22 Clinically Significant Changes in HiMAT, High Level Activity Measure Baseline (n=14) After (n=14) 6 weeks follow up (n=14) HiMAT median (IQR) 3.5 (1, 27) 9 * (3.75, 33) 8 * (2.75, 29) *= denotes statistical significant comparison against baseline p<0.05 Chronic TBI: (Williams et al, 2006) MDC = increase of 4 points or decrease of 2 points on the total score of the HiMAT

23 Discussion Individuals living with chronic brain injury can significantly improve: Endurance Home ambulator to community ambulator Ability to do advanced gait with 6 weeks of exercise!

24 Discussion Individuals living with chronic brain injury at a range of levels can significantly improve with 6 weeks of exercise!

25 Peter C’s data BASELINEPOST INTERVENTION 6 WEEKS AFTER INTERVENTION 6MWT243 feet393 feet385 feet GAIT SPEED.29 m/sec.5 m/sec.42 m/sec HiMAT144

26 Our conclusions Exercise improves function even when the individual is in a chronic state. Can payers be motivated to cover this type of therapeutic intervention? How do we sustain these programs if they are not covered by health care payers?

27 More Questions Does the way the exercise was delivered influence the results? AccesSportAmerica What are some ways that physical therapists could incorporate intense fitness in their work? How can we foster collaboration between Physical Training, Recreation Specialists and Physical Therapy? What if any impact do fitness changes have on the residents daily lives?

28 Next steps Analyze POPS and self-efficacy data Qualitative study investigating impact of fitness improvements and supports and barriers to continued exercise among the participants Can we observe similar types of changes in a new population- individuals living with chronic brain injury who are currently not ambulating? Study to investigate the impacts on health and healthcare utilization, or exercise as medicine; SLI’s wellness approach

29 References Brown M, Dijkers M, Gordon W, Ashman T, Charatz H, Cheng Z. Participation objective, participation subjective: a measure of participation combining outsider and insider perspectives. J Head Trauma Rehabil. 2004;19(6):459-481. Chen G, Gully SM, Eden D. Validation of a new general self-efficacy scale. Organizational Res Methods. 2001;4(1):62-83. Durstine J, Moore G, Painter P, Roberts S. ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. 3rd Ed. Champaign, IL: Human Kinetics; 2009. Eng JJ, Dawson AS, Chu KS. Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption. Arch Phys Med Rehabil. 2004;85(1):113-118. Fogelman D, Zafonte R. Exercise to enhance neurocognitive function after traumatic brain injury. PM and R. 2012;4(11):908-913. Hassett L,Moseley AM, Tate R, Harmer AR. Fitness training for cardiorespiratory conditioning after traumatic brain injury. Cochrane Database Sys Rev. 2008;(2):CD006123. doi:10.1002/14651858.CD006123.pub2. Hassett LM, Moseley AM, Whiteside B, Barry S, Jones T. Circuit class therapy can provide a fitness training stimulus for adults with severe traumatic brain injury: a randomised trial within an observational study. J Physiother. 2012;58(2):105–112. Hellweg S, Johannes S. Physiotherapy after traumatic brain injury: a systematic review of the literature. Brain Inj. 2008;22(5):365– 373. Mossberg K, Amonette W, Masel B. Endurance training and cardiorespiratory conditioning after traumatic brain injury. J Head Trauma Rehabil. 2010;25( 3):173–183. Mossberg K, Ayala D, Baker T, Heard J, Masel B. Aerobic capacity after traumatic brain injury: comparison with a nondisabled cohort. Arch Phys Med Rehabil. 2007;88(3):315-320. Mossberg K, Fortini E. Responsiveness and validity of the six-minute walk test in individuals with traumatic brain injury. Phys Ther. 2012; 92(5):726-733. van Loo MA, Mosleley AM, Bosman JM, de Bie RA, Hassett L. Inter-rater reliability and concurrent validity of walking speed measurement after traumatic brain injury. Clin Rehabil. 2003;17(7):775-779. Watson MJ. Refining the ten-metre walking test for use with neurologically imparied people. Physiotherapy. 2002;88(7):386-397. Williams G, Robertson V, Greenwood K. Measuring high-level mobility after traumatic brain injury. Am J Phys Med Rehabil. 2004;83(12):910–920. Williams GP, Greenwood KM, Robertson VJ, Goldie PA, Morris ME. High-Level Mobility Assessment Tool (HiMAT): interrater reliability, retest reliability, and internal consistency. Phys Ther. 2006;86(3):395-400. Wise EK, Hoffman JM, Powell JM, Bombardier CH, Bell KR. Benefits of exercise maintenance after traumatic brain injury. Arch Phys Med Rehabil. 2012;93(8):1319-1323.

30 Q and A


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