We all know that taking exercise has both physical and mental health benefits. Staying active is easy for some, and not so easy for others. The current campaign run by the Chartered Society of Physiotherapy is “Love activity, Hate exercise”.
Taking this principle we try to prompt and increase where possible, general activity for all our patients at our St Neots neurological service.
For some this may be encouraging them to be more involved on the ward generally, in group activities or on outings.
For the more physically able patients, we were looking for a fun way to engage and push them outside their comfort zone to see if this could potentially improve their function or mobility.
The team at St Neots try to use the local community in the provision of meaningful activity, as this maintains a normalisation to activities and allows the person to undertake these within a natural environment.
We are lucky to have locally the Huntingdon Gymnastics Club in close proximity to the site.
This is the gymnasium used to train the British gymnasts for the Olympics.
Three patients from the St Neots service joined the club’s disability programme which ran for 10 weeks and they attended one session per week.
Each session had a loose structure, and allowed each patient to use the equipment to tailor the activities to test and progress mobility, balance, co-ordination and stamina.
The programme also offered our patients the opportunity to use their soft skills such as turn-taking and socialising.
We were unsure how the patients would respond to the hour long session, the set up of the environment and also the consistency of weekly attendance.
The “Timed up and go test” was used as a simple outcome measure and mobility benchmark as it has been shown to be reliable in patients with Parkinson’s disease and other neurological conditions.
However, the main focus of the sessions was to enable activity and fun. Susan and Richard, both of whom have a diagnosis of Huntington’s Disease, and a gentleman who sustained a brain injury in 1996, all agreed to trial the programme.
All three patients were independently mobile on the ward and accessed the community for various trips.
The programme was designed to drive these patients past their normal activities in a safe environment, allowing them freedom of movement without concern over injury and with a focus on fun not fitness, hopefully with the side-effect of improving their mobility.
Over the 10 weeks, the patients were involved in:
• Balancing on soft surfaces, balancing at height, climbing over uneven surfaces
• Parachute group activities, selective movement and balance games
• Ball throwing, catching, target throwing
• Trampolining, jumping into the sponge pit
• Sponge pit commando crawling. Repeating the Timed Up and Go test
after just six weeks showed the following improvements (see table below).
But perhaps more importantly than the physical improvements in mobility are the subjective benefits, as demonstrated by the following:
Richard: “I just feel better…I’m more confident…I’ve never done a front summersault before, it’s great! Can we keep going?”
Susan: “I feel more active and confident I can do things. It’s important to keep going, I can try things I didn’t think I could do.”
The third patient said: “I feel knackered afterwards, but that feels good.
“I like pushing you in the sponge pit” Feedback from ward staff after the sessions included: “Could he go every day?”
“He seems so calm after he gets back.” “Often he has the best afternoon all week when he gets back.”
Staff from other users of the session also remarked: “Your guys really love this session don’t they? You can see it all over their faces.”
Overall, we were aiming to encourage increased activity to help preserve physical function for patients who have a neurological condition, and to maximise and preserve independence and function for as long as possible.
Over the 10-week programme we have seen a significant improvement in each patient’s mobility. We have signed up for next term and are busy thinking of new activities to continue to provide challenges for the patients outside of their comfort zone; but more importantly, allowing them to have fun whilst being active.
For the less physically able patients that are unable to attend the programme we are looking at incorporating some of the ideas from the sessions into our own programme at the hospital so the patients can be active and have some fun.
Penny Jarrold is a senior physiotherapist at St Neots Hospital, part of Elysium Healthcare. www.elysiumhealthcare.co.uk.