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SEX AND REHAB – Tinder, escorts and an age-old taboo

The professionals helping to make sure sex is not forgotten in the drive to improve life quality after severe injury.

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Sex workers can play an important, if controversial, role in boosting confidence and quality of life for people with profound disabilities. Here pioneering sex therapist Tuppy Owens tells Andrew Mernin why it’s time to stop running away from the issue.

“Just because people are disabled, doesn’t mean they don’t have sexual urges,” says Tuppy Owens, who has spent decades helping people with disabilities enjoy sex and find love.

Owens is a sex therapist, campaigner, published author and former adult model. She is also founder of the TLC Trust, which helps disabled people to access sex workers safely.

Users visiting the site can browse a database of sex workers who have been vetted by TLC to check they can provide a safe and understanding experience for people with a range of disabilities; including those related to brain and spinal injury and neurological disease.

Tuppy Owens

TLC is closely linked to the Outsiders Club, also founded by Owens to help people with social and physical disabilities find partners, make friends and enjoy “peer support”.

After “helping a couple of disabled guys get laid” in 1978, she formulated plans for a club run by and for disabled people looking for friendship, romance and support.

The link between experiencing sex – via TLC – and finding love, possibly through the Outsiders Club, is absolutely intrinsic, believes Owens.

Crucially, sexual services can help to build the self-esteem and confidence needed to enter a loving, intimate relationship.

“If a disabled person feels nervous about starting a sexual relationship because they don’t really know what their bodies are capable of, they could go to a sex worker a couple of times so that they could be a better lover when they do find a partner.

“We don’t know how many sex workers are hired, how many disabled people use them or how they find them. Often their assistants or healthcare professionals will organise it for them because they are better [technically].

We vet both the sex workers and the people who want to join Outsiders to make sure the disabled people are safe.”

The legal aspect of helping disabled clients access sex workers is fraught with risks. At a very basic level, the individual must have capacity to make a choice about consenting to sex. But professionals looking to help clients visit a sex worker must of course consider a range of legal and other implications (as case manager John Walker explains below).

Owens’ mantra on the issue of legality is that: “It is illegal not to support disabled people to enjoy the same pleasures as others enjoy in the privacy of their own homes, under the Equality Act 2010 and the Human Rights Act 1998.

“This is great because when someone complains that they aren’t allowed to have sex, I can quote those laws and they have to go back to the person who won’t allow them to do it and say that’s illegal to stop them.”

TLC-vetted sex workers may visit the client’s house, offer services at their own accessible property or at a hotel.

In a residential care setting, Owens says, “there is usually someone running the home” that wouldn’t allow this sort of thing to happen on site.

“Care homes are becoming more interested but whether they would actually allow sex workers in the home is another thing.”

In terms of criminal law, the exchange of sexual services for money is legal in England, Wales and Scotland. A number of related activities are illegal, however, including soliciting in a public place, kerb crawling, owning or managing a brothel and pimping. Prostitution is illegal in Northern Ireland, meanwhile.

“People think sex work is still illegal in this country – even people who should know better,” says Owens.

Once the legal minefield is navigated, other challenges may arise, including the potential threat of emotional attachment issues.

Owens says: “If a person gets too keen on just one sex worker, we might suggest that they find another one because we don’t want them to fall in love. Obviously, a sex worker may have lots of other clients so there’s no point in getting too attached.”

Aside from mere pleasure, there are many other reasons why a person would choose to visit a sex worker. According to TLC, a common motivation for site visitors is to be taught what their bodies are capable of and how to please a potential partner.

Some users seek a “girlfriend or boyfriend” experience – pretending to be partners either in public in a non-sexual way or in the bedroom – or wish to lose their virginity. Others may be unable to achieve an orgasm alone, while acceptance is also an important factor.

TLC says: “Sexual expression may mean many things, and disabled people need to know that you will not be judged by your requests, however embarrassing you find them. People who provide sexual services have heard it all before, and are totally discreet.

“For many disabled people, just being in a warm set of arms, and having their bodies accepted, is incredibly powerful and helps to build your sexual confidence and walk tall ,or wheel tall, in the world

“Having your sexuality taken seriously without stigma or disapproval can be liberating and life-changing. For some, actually enjoying an orgasm at last can bring your life into balance.”

While male users may instigate the use of one of TLC’s vetted providers, women are advised to contact TLC first as it can be easy for them to “be lured by unprofessional guys”.

Owens says: “There tends to be more men looking for sex workers than women. With TLC I always tell women to ring me first so I can walk them through it. I want to be absolutely sure that they have a nice time – and that always works.”

An anonymous female user of services promoted on the site says: “Due to a combination of ill health and traumatic personal experiences, I had spent a long period of time avoiding physical contact and intimacy, but had reached a point where I felt confident enough to address the situation.

“I had many concerns, about safety especially, but I liked the way the website gave no- nonsense information and everything seemed very open…I was keen to work with ‘professionals’, as I thought that after all they knew what they were doing and also working with people with all kind of issues, disabilities and health issues meant they had experience of dealing with situations that might not be easy/ obvious for others to deal with.”

The woman was initially advised to meet a practitioner who offered a full body massage to help her to reconnect with herself physically; before considering taking the next step.

She says: “I was extremely nervous but the gentleman providing the service was kind, professional and at all times made it clear that I was able to stop anything that I did not like. In the end, everything went well and was far less difficult then I expected.

“Having taken this first step I then corresponded briefly with the second person I had been put in touch with and set up a booking. Again, the practitioner was lovely, caring, very open and had a great sense of humour and he made me feel safe at all time.

“Both experiences have been really helpful and, in some way, much less of a big deal than I thought they were going to be, in setting me back onto the path of being ‘physical’ again.”

Owens founded the TLC Trust in 2000 with the support of a disabled man who had reached his mid-40s without losing his virginity. Since then, scores of sex workers have been vetted and joined, with many happy customers along the way.

Among them was the young lady who wanted to buy herself a “birthday shag” for her 21st, and a man whose parents sought out a sex worker to help him have his first sexual experience at 38.

Owens would like to see disabled people’s desire to experience sex and love being taken more seriously by the professionals around them and society in general.

“Things haven’t really moved on in recent years, in fact I think they’ve gotten worse. Often people come to the Outsiders because they have been very lonely.

“Not only do they not have a good sex life, but they may have few friends, which is terrible. Even if they don’t end up finding a relationship they’ve been given the confidence to flirt and do other things that help to form relationships.”

Owens, who won a UNESCO award in 2015 for her innovative approach to sexual health and human rights, sees sexual services as empowering and positive to people with severe injuries – not shameful or something to be embarrassed about.

Could their costs therefore be factored into an individual’s care package? Owens would like to see this, although she is doubtful it will happen anytime soon.

“When you think about how much compensation a brain injured person requires, how much would they need to hire a sex worker [regularly] from when they were injured?

Obviously when they are younger, they would have a sex worker more often, maybe twice a month, then a bit less when they are 50 or so and less again when they are 80. It could be quite expensive overall.”

The prospect of sex workers becoming just another intervention on the rehab journey seems somewhat remote.

However, as Owens has long argued, sex is an integral part of the human experience and simply ignoring it under a cloud of taboo benefits no-one.


Sexual services and rehab – a case manager’s view

When a client asks to visit a sex worker, professionals must navigate a tricky terrain with no manual to guide the way, writes brain injury case manager John Walker.

The matter of clients using sex workers predisposes that they have the mental capacity to engage in that relationship. Having the capacity to have sex is a different question from having the capacity to utilise a sex worker however; and from a legal point of view, this is a foremost consideration.

Another consideration is the notion of the law of unforeseen consequences, in that embarking on the arrangement could result in all sorts of unexpected results.

It is therefore incumbent on a professional such as a case manager to risk assess the whole process as best they can.

There is also the potentially complex situation that surrounds the client’s family. The adult brain injured person rarely exists in isolation, but rather in the context of their family.

Understandably, families affected by severe injury tend to be more risk averse and protective, although sometimes, for example, parents who you may expect to be antagonistic towards the idea of sex workers, can actually be very liberal about it.

But overall, the case manager may be faced with very divergent views from the various people in the client’s life. Even after these challenges have been addressed, there are some relevant legal barriers that must be overcome before you consider putting a client in touch with a sex worker.

One part of the law determines how the process is driven along. Any practitioner in the area must be very clear that they are not, in any way, causing or inciting the process to take place.

Sections of the Sexual Offences Act 2003 ensure that the individual with whom the client would engage, for example, is not underage and is operating in the UK freely of their own volition.

Practitioners have to be very mindful of the legal context and make sure they are operating within criminal law. They must also navigate the fact that lots of bits of legislation can have contradictory effects in the UK.

Of course, as Tuppy Owens mentions in her interview, there are also relevant elements of the Equalities and Human Rights acts, which help to make a strong case for access to sexual services by disabled individuals.

It is important to stress that the majority of brain injured adults who express an interest in visiting a sex worker never go on to do so.

From a rehab perspective, the issue may be approached as a problem-solving exercise. The client might tell you “I want this” but because of their brain injury may not be aware of the range of different factors in achieving it.

Working through the barriers to fulfilling this aim doesn’t mean the client will necessarily achieve it; but the process of pursuing it can serve as good cognitive, psychological and emotional practice that might better equip them to deal with life in the future.

At the same time, taking a client’s sexual requirements seriously is important and can positively influence their rehabilitation.

While most sex-related issues that occur after a brain injury are those that affect existing intimate relationships, some clients will indeed seek a sex worker visit. They may see the process as a stepping stone towards having the skills and confidence to pursue a loving relationship.

Sex is a very basic human need and without it people can become frustrated. After a
brain injury, what wasn’t necessarily a driver towards behavioural problems could become a contributing factor to the overall difficulties the client has.

Obviously, sex is also closely linked with self-esteem and self-worth. There is certainly anecdotal evidence that young men with brain injuries can benefit from a safe, carefully arranged sexual encounter.

For various reasons, including greater frequency of brain injury prevalence, this client group seems to be the most likely to seek sexual services after injury.

If clients have difficulties with inhibitory control caused by the brain injury, addressing their sexual frustrations could help to reduce possible behavioural problems in the community.

There are a number of different agencies who deploy sex workers with experience of working with clients with neurological impairment.

Clearly there is no prescribed method to helping clients narrow this field. Instead, the process involves conversations with agencies to work out whether there is someone with the adequate experience conveniently located for the client.

In the entire management of this tricky issue, case managers can find themselves operating from two very different positions. One is from the perspective of care and nurture and a commitment to introducing new experiences where possible.

The other is slightly opposing in nature, with a remit of control, risk management and consideration of the law. Always being aware of your position on this spectrum can help to manage the situation in the interest of the client’s wellbeing.

In summary, there is no guide book on this topic for brain injury professionals and each case must be considered in its own context. Based on my own experience I would strongly recommend discussing the issue as a multidisciplinary group – and definitely do not ignore any sexual concerns your client has, however awkward the topic may seem.

John Walker is a brain injury case manager who runs Education and Case Management Services with his wife Judith James.


From marital faux pas to dating game pitfalls

How occupational therapists play a key role in unlocking the power of sex in rehab.

Occupational therapy, as defined by the NHS, is supporting people whose health prevents them from doing the activities that matter to them.

When the slightest mention of the activity provokes mass embarrassment among clients and their families, however, the field becomes particularly challenging.

But such awkwardness must be overcome because sex really does matter and can have a huge influence on an individual’s life after brain injury.

So says Rachel Lees, a specialist occupational therapist (OT) at Neural Pathways, which provides therapy and rehab services for people with neurological conditions.

“It’s so important. Sex is a massive thing but as soon as you get to the topic, everyone panics and shys away from it. But it’s an important human need and part of helping people get back their quality of life.

“As OTs we look at everything holistically. We have a duty of care to support the client if they want to get into a new relationship or need help with an existing one as it’s such a huge part of anyone’s life.”

The impact of sex and intimate relationships on any individual extends far beyond the bedroom walls; for brain-injured adults in rehab, failing to meet these basic desires can be hugely disruptive to their recovery.

Lees says: “I had a client who was getting really down because he wanted companionship – a relationship and everything that comes along with that.

“It was impacting on his performance in other areas of his rehab. Because he was feeling low and had self-esteem issues, he was getting frustrated and agitated.

“Not having sexual and relationship needs met might increase frustration and anxiety and affect self-esteem. It really can affect everything.”

As well as helping clients address sexual and relationship needs, OTs in multidisciplinary teams are key in assessing whether they have capacity to consent to relationships.

Part of this involves considering how sex or a relationship would impact on the rest of
their rehab.

As an OT, Lees has never been involved in facilitating a brain-injured client’s visit to a sex worker or escort. She has, however, helped them to overcome the anxiety that might precede a planned sexual encounter.

A crucial part of her role is helping clients deal with behavioural changes that can affect relationships.

“After a brain injury, sexual and social disinhibitions rise quite commonly and people can become more inappropriate. They may have never said anything inappropriate before their injury but now they just can’t filter it out.”

This can cause obvious problems in marriages and other relationships that pre-dated the injury.

“Their partner could be embarrassed by their behaviour. For example, I had a client who was out with his wife and paid attention to, and made a comment about, another woman’s breasts. So it can be a bit embarrassing.”

Similar challenges occur when single clients attempt to navigate the dating game in an age of Tinder and other instantly accessible apps.

“They may need support workers to act as the filter they no longer have or be that person looking over their shoulder who says: ‘Do you think that’s an appropriate thing to say? How can we make it more appropriate?’”

While sex and relationships influence an individual’s overall wellbeing, they can also be a useful area in which to hone problem- solving skills.

Even the mere process of going on a date can involve numerous tasks that may be highly challenging for a person with cognitive difficulties. Overcoming them with the help of the OT can be an important part of rehab.

“A lot of clients don’t have the skills to use computers because of their cognitive impairments. They go online and struggle to write information about themselves – so they struggle in terms of putting a dating profile together and we can work on their computer skills.

“Then, if they are going out for a date, do they need support to attend it? How do they budget for the date? What would they wear? There is a whole list of things we could get involved in as an OT as part of their rehab programme. We often look at pros and cons of different options and then seek a solution to each problem.”

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Symptom variation over time – learning in real time from lived experience

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In the UK, the average patient will see a GP around seven times a year, according to the Royal College of GPs. This is a rise from 20 years ago, when a patient would see their family doctor around three times a year.

With an average appointment time of 9.2 minutes, British patients see their family doctor for less time than patients in the United States, Sweden, Canada, Spain and Japan. 

There are 8,760 hours in a common (not leap) year. In the UK, patients have about one hour per year on average with a UK GP. During the other 8,759 hours, symptoms come and go over weeks or months, so what is recalled at the consultation may not be accurate. Such symptoms sometimes just go away, but at other times these symptoms are a sign of something that needs treatment. We are often told “if it doesn’t go away within x days, see your GP”. Yet 2020/1 has made this more challenging to do, whether virtually or face-to-face.

So much to say – so little time

There’s the challenge of getting the phone call answered at the GP surgery, getting a consultation time that suits and the anxiety of getting there and waiting for your time slot. How easy is it to forget some of the detail of the illness? How can doctors solve problems with imperfect information and poor communication as well as recall error? Is “doorknob syndrome” becoming a greater problem?

Healthwatch UK advises: “Before you see your GP, think about what you want to say. You can always write down your symptoms, worries and any questions that you would like to ask, so you don’t forget.”

Similarly, Cancer Research UK and other organisations provide tips to help patients to get the most from such precious but brief appointments. Top of their list are:

  • Write down your symptoms including when they started, when they happen and how often you have them.
  • Write down anything that makes them worse or better.

How many patients do this, or have the capability or opportunity to do it even more effectively?

Empowerment? 

How can doctors feel empowered when their time is so pressurised, when there is a tsunami of data, information and knowledge let alone a mountain of paperwork and covid precautions on top of that? How can patients feel empowered when it is so difficult to see a doctor when they are most worried about their signs and symptoms?

COVID-19 makes things more complicated. Patients with multiple symptoms that vary from day to day find it especially hard to give a clear and concise summary. Even worse if they have fatigue and brain fog. Recall error is more of a problem. Could the patients be more empowered?

Symptom-tracking and real time data

There is a conundrum – how do we empower the patient-doctor relationship and strengthen the therapeutic alliance when there is less face-to-face time and longer waiting lists and more complex conditions? Achieving any of these might be easier if there was an increase in consultation time. 

This draws attention back to the advice to patients to prepare to get the best from their consultation, how can digital technology help a good proportion of patients to do this ahead of the consultation? It is accepted that all patients will not use technology. 

Accurate responses to questions about when symptoms started or when they happen and how often they occur could become digital real time data – provided this is sufficiently easy and well-structured. The acceleration of public health awareness and communication between doctors and patients via NHS Digital tools regarding symptoms has been a legacy of covid-19. While accepting that all patients won’t need or want digital, empowering those who do want or need it can relieve some pressure on the system as a whole and, over time, more will embrace it.

TIYGA™ – time is your greatest asset

So how do we manage to utilise time with GPs, nurses and specialists more efficiently? Patients and doctors must use their time together more productively and anything that can be captured, measured, calculated, and displayed in the right way ahead of the consultation must happen. Healthcare professionals are trained to deliver consultations, but patients are not trained in how to prepare to see different healthcare professionals with different specialities. In these time-poor days, it is more important than  ever that patients present the right data to the right person at the right time and in the right place.

Personalised medicine is increasingly important in preventing, predicting, and managing many health conditions and we don’t just mean at genomic level, but more holistic treatment and accepting that not all one size fits all. In 2019, the UK had 55.5m smartphone users and this is expected to rise to 64.9m by 2025. According to Statista, in 2024, the smartphone user penetration rate is expected to reach 88.1 per cent of the total UK population – 93.7 per cent in 2025. In 2020, 70 per cent of 55–64-year-olds owned a smartphone. How can we justify not making better use of this high adoption rate?

Talk to many clinicians and they’ll tell you that all their patients don’t have a smartphone and don’t have access to broadband. In 2020, the overall share of households in the United Kingdom (UK) that had access to the internet was 97 per cent. The overall share of households in the United Kingdom (UK) with internet access was six percent higher than the average of the European Union (EU-27). 

The challenge is not in the technology. We send people into space, we replace human vital organs, we can replace joints and even create and successfully rollout vaccines to fight novel virus at record speed. Do we encourage people to use popular consumer devices to record simple, routine health data in a way that can help our healthcare professionals to get more efficient input to consultations? 

We will always need GPs, and nobody expects every poor pensioner to become a geek but symptom-tracking by smartphone could reduce the time many patients need to spend with a GP, fewer consultations might be required to make a diagnosis and the first consultation at secondary care could be more efficient. Taken together, these factors could reduce some pressure on waiting lists.

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Who am I? Self-identity following an Acquired Brain Injury

Dr Anita Rose, consultant clinical neuropsychologist at Renovo Care Group, explores the issue for NR Times

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Who am I? Arguably life’s most defining problem. The answer as we all know is identity. But this is not the complete answer because “who I am”, my identity, is an all-encompassing system of memories, experiences, feelings, values, roles, thoughts and relationships.

When I am asked who I am my answer is likely to be multi-faceted and the answer will depend on the situation I am in.  I might say. I am a mum, a wife, an Ouma (Grandmother), a sister, a clinical neuropsychologist, a friend, a regular church goer and so the list goes on. 

This question permeates my working life as I sit with patients who want to know who they are now, how they can be who they used to be. They are scared, frustrated, anxious and believe that they can no longer be “me”. They face what the world calls an “identity crisis”. They are looking backwards prior to the traumatic, sudden, life changing experience they have gone through to this moment in time, to now after the brain injury. 

This exploration highlights a gap, the gap between who they were before to who they are now.  It is this gap that leads to the questions of “Who am I now?”, “What can I do now?”, “Where do I fit in?”.   

Dr Anita Rose

Prior to their injury they had roles, “identities”, felt valued, helpful, independent, and confident in their life’s purpose. But now they report feeling lost, useless, frightened, insecure, stupid, lazy, and unreliable.

The gap seems insurmountable as they will report feeling they have gone from being kind, caring, and happy, to angry, sad and being a burden. These feelings are driven by the comparison of self-perceived capabilities pre- and post-injury. Such comparisons lead to the experience of “I am not me anymore” as the brain injury at a deeper level alters the sense of self and the qualities that define who they once were.

When I first started working in neuropsychology many years ago, I found the concept of loss of identity a real challenge. How can I support those whose lives have been dramatically changed “in an instant”, who maybe now very physically disabled and cannot return to their employment, their sport, their previous life? 

I noted that many times individuals would turn to those around them to feed their self-worth.  They would seek reassurance and praise from others to feel okay about themselves. Whilst in the moment such validation might support their emotional wellbeing, dependency on external validation is extremely detrimental.

Often patients would be perceived by caregivers as presenting with behaviours that challenge because they might be seen as demanding, for example constantly buzzing their call bell for reassurance.  The reality is that sense of self should not come from other people but come from within. The most important relationship we can have is with ourself.

Over the years of clinical work, participating in research and listening to my patients stories I have learnt that the only way to support a person to develop that new sense of self is to recognise each patient brings with them their own unique life history, values and social context. 

I have found that for many of my patients it has been about working together in a collaborative and supportive therapeutic relationship, a collaboration where the individual in is the centre. Based on mutually agreed goals we start out on a journey of rediscovery.

The initial stages of the journey are about grief and loss and enabling someone to express their grief and being given permission can be very powerful moment. The next stages are often around building awareness of the results of the brain injury as much raising self-awareness of the “me before” and the “new me”. 

What is different? What is still the same? Can we build the bridge between the two parts of “me”? 

Moving along the journey we start to look at the most important relationship in their lives, the one with themselves.  When self-identity is challenged the ability to be compassionate towards one’s self is reduced.  Finding news ways to promote self-compassion i.e. kindness and understanding towards one’s self can support the individual in finding meaning in their lives and achieve their personally valued goals.  

Kenneth Gergen (1991) said: “One’s identity is continuously emergent, re-formed, and redirected as one moves through the sea of ever-changing relationships. In the case of ‘Who am I?’ it is a teeming world of provisional possibilities.” 

The journey can be full of mountains and valleys, monsters to face but in my work at Renovo Care Group we recognise the various challenges these cause both the individual and their families.

We appreciate the need for a directed multi-disciplinary approach to work collaboratively with our patients by supporting them to re-engage in meaningful activities and to find meaning in their life following their brain injury. In other words, we are trying to re-establish the “bridge” across the gap between old and new. We support the patient along the journey leading to the “new me” after brain injury and look at how a comprehensive IDT evaluation and treatment of the “damaged sense of self” can lead to increased self-esteem, self-efficacy, and self-empowerment. All this leads to an improved quality of life for both our patients and their families.

But to end, it is the patient voice that speaks the loudest. A recent patient after going through this journey spontaneously said in his last session, whilst leaving the therapy room, “I have re-found myself”. He may still be profoundly disabled as a result of his brain injury and not met his original goal to walk again, but he has found an identity, a new sense of self that has emerged and reformed as he has found reconciliation between his self “before” and his “new me”. A bridge has been built across the gap. 

It is for this reason that I find my role, and the role of the IDT (Interdisciplinary Team), in neurorehabilitation so fulfilling. As a patient learns to be self-compassionate, moves towards reconciliation and acceptance of the “new me”, regardless of whether or not their original goals have been met, the end of their rehabilitation process has been positive as they leave feeling empowered and able to believe they have a world of “teeming provisional possibilities”.   

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The importance of continuing rehabilitation in the home environment

The team at Neurokinex share insight into the role of rehab at home and how to maximise its potential

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Community-based rehabilitation centres are powerful tools which can support you in your recovery journey. 

As well as offering you access to expert advice and guidance, specialist equipment, novel and intensive training modalities, you will have the opportunity to receive client-centred sessions as part of structured rehabilitation programmes supported by neurorehabilitation experts. Together, they create the optimal environment for you to work towards goals and maximise your recovery potential. 

In-centre rehabilitation sessions are a must have for any rehabilitation plan: those who can, should attend as much as possible to maximise their progress. However, for many people, barriers – such as travel and funding – stand in the way of them attending for the advised and required frequency. It is likely, therefore, that this time constitutes just a fractional part of the overall time most individuals should be committing to their rehabilitation. 

Research has consistently shown that both exercise intensity and high repetition are essential to maximising recovery following neurological injury. Therefore, individuals should look to establish a strong home exercise routine as part of their rehabilitation plan to maximise on these principles. An established routine will also maximise the benefit of your other therapy sessions, keep you focused, active and committed to your rehabilitation journey. 

However, building and dedicating to a home exercise programme can be challenging. Here is some advice from our team at Neurokinex for upgrading your home exercise programme based on our experiences with clients.

“What should I be doing at home?”

Firstly, make sure that your home exercise programme contains everything it needs.

Many of you will already be following a rigid and intensive stretching programme and this should continue to formulate the core of your home exercise routine to help manage spasticity and contractures. Dedicate time to moving your body into different positions, prone is great, which can be effective in allowing muscles to be stretched for prolonged periods of time and in alleviating pressure.

Standing should comprise a proportion of your daily routine. Standing for 30 to 60 minutes a day can help with bladder and bowel function, joint range of motion and bone demineralisation, along with promoting improved quality of life.

Decreased activity also increases the risk of developing cardiovascular disease and diabetes, therefore it’s important to find a way to incorporate some regular aerobic exercise to benefit cardiometabolic health. One guideline suggests 30 minutes of moderate to vigorous exercise three times per week.

Last but not least, dedicate additional time to completing any rehabilitation exercises prescribed by your trainer.

“The requirement seems like a lot, how do I fit it all in?”

Fitting all the above into your daily routine might feel impossible alongside incorporating the additional exercises prescribed by your trainer. The best way to start is by identifying if any of your rehab exercises can be integrated into time spent doing other things.

A couple of examples of this would be completing your shoulder or hand exercises whilst in your standing frame. Or completing your upper or lower limb exercises whilst spending time prone or as part of your morning stretching routine in bed. This would help maximise your efficiency, achieve those all-important repetitions without the feeling of having to go out of your way to put aside too much extra time. 

Just like your sessions with your trainer, home exercise should be effectively programmed and this can be another helpful way to save you time. As well as helping you remain engaged and feel like you are progressing.

Typically, you’ll have many areas that you wish to improve on with many associated exercises to do. It is easy to fluctuate between these if you don’t have a plan and though rarely are these goal areas mutually exclusive, it is important to work each area independent of the other.

We often prescribe clients five exercises, taking no more than 30 to 45 minutes a day, that can be progressively tracked over four to eight weeks. This helps to promote overload, adaptation and better tracking of progress towards the goal area. It also means that you set a point of review and importantly introduce variation to keep things fresh and exciting.

Some common short-term goals that we use with clients include increasing the number of repetitions, timed seated or standing balance and physical exertion tests, such as a five-minute time trial. 

“I over-did it last week”

Consistency beats intensity. Often, clients feel the need to work themselves to the maximum every session. Though this approach can produce short term results, it usually leaves them exhausted and they rarely maintain consistency long enough to see significant change.

Remember we’re playing the long game here. Our advice is to choose an exercise routine that you can execute even on your worst week. 

“I’m worried about doing exercises incorrectly” 

An unfortunate side effect of client-centred exercise is that people can become nervous to perform exercise without the keen eye of a trainer by their side.

If this is you, start with a few exercises that you are comfortable with and have completed in your rehabilitation sessions. Follow this up by challenging yourself to try a new exercise, film it and take it to your next therapy session for your trainer to okay.

Nine times out of ten they’ll be delighted you’re trying new things!

“I can’t remember what I did”

Keep a log! The most important piece of advice that we can give you is to start keeping a diary. In it note the rehabilitation you do each day and reflect upon how it went. Don’t forget to include your achievements and any significant milestones. This will form an essential part in your rehab journey and help you to stay committed and invested.

Most importantly, take this with you to your next session and show your trainer all the great rehab that you have been up to. We want to hear that you are continuing your rehabilitation at home.

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