Download 2.2. Neurological

MODULE 2. ASSESSMENT AND EXERCISE PRESCRIPTION FOR CHRONIC CONDITIONS
Unit 2.2. Neurological Conditions
Learning Activity 2.2. Introduction to Neurological Conditions
This unit addresses key concepts pertinent to exercise prescription for neurological patents. Typically, neurological
pathologies result in movement disorder and are likely to be affected influenced by; (1) muscle weakness, (2)
spasticity, (3) a loss of balance, and/or (4) impaired gait. As such, general goals for exercise prescription should
include developing muscle strength, balance, and gait, in addition to reducing the risk of falls and increasing
functional ability.
Furthermore, you should be aware that neurological patients may present with a number of secondary comorbidities
(e.g. cardiovascular disease/dysfunction, glucose intolerance, fatigue, frailty, etc). As such, prescribing exercise for
neurological patients may be complex as a variety of pathophysiological conditions must be considered and
appropriate risk management strategies need to be applied.
Groah, S. (2006). Clinical exercise testing in individuals with disabilities caused by neuromuscular disorders. In L.A.
Kaminsky (Ed.), ACSM’s resources manual for guidelines for exercise testing and prescription (5th ed.). Baltimore:
Lippincott Williams & Wilkins. [e-Reserve]
Mulcare, J.A. & Jackson, K. (2006). Neuromuscular disease and exercise. In L.A. Kaminsky (Ed.), ACSM’s resources
manual for guidelines for exercise testing and prescription (5th ed.). Baltimore: Lippincott Williams & Wilkins.
[e-Reserve]
Neurological pathologies: This URL provides a brief description of typical neurological pathologies that experience
spasticity, a list of common anti-spasm medications, and information regarding exercise therapy for the management
of spasticity.
Romberg test: This URL provides a link to the Romberg test. This is a very simple objective assessment of static
balance and can be used to indicate the need for a more comprehensive balance assessment.
Balance in stroke survivors: This URL contains information and resources related to. Although the website is
specifically aimed towards stroke patients the same principles apply to all neurological patients with poor balance
and an increased risk of falling.
Mathias, C.J., & Kimber, J.R. (1990). Postural hypotension: causes, clinical features, investigation, and management.
Annual Review of Medicine, 50; 317-336. [EBSCO]
How is postural hypotension defined??
What is the basic cause of hypotensive symptoms?
How could you assess if a patient may suffer from postural hypotension? (hint: it involves comparing BP
measurements in different positions)
EHR503 Clinical Assessment and Exercise Prescription in Rehabilitation | Charles Sturt University
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MODULE 2. ASSESSMENT AND EXERCISE PRESCRIPTION FOR CHRONIC CONDITIONS
Unit 2.2. Neurological Conditions
Barnes, M.P. (1998). Management of spasticity. Age & Ageing, 27; 239-245. [PubMed]
Provide a definition for spasticity:
Outline three (3) movement characteristics are more likely to exacerbate spasticity?
1.
2.
3.
What forms of exercise may be successful in managing spasticity? What general prescription guidelines for these
exercises do you think would be most appropriate and why?
Learning Exercises:
Answer the following questions after completing the required readings and have accessed the URLs;
Develop a table that; a) identifies the possible risks for exercise in neurological patients; b) the specific pathologies
affected; c) lists possible complications associated with each risk; and d) risk management strategies. Hint: it may be
useful to categorise the possible risks under the appropriate systems involved
EHR503 Clinical Assessment and Exercise Prescription in Rehabilitation | Charles Sturt University
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MODULE 2. ASSESSMENT AND EXERCISE PRESCRIPTION FOR CHRONIC CONDITIONS
Unit 2.2. Neurological Conditions
Identify the route of administration (e.g oral, subcutaneous injection, etc) for each of the medications used to
manage spasticity listed below AND research their basic actions?
Baclofen
Diazepam
Tizanidine
Clonazepam
Botulinum
Toxin
Intrathecal
techniques
What are some common side effects associated with medications used to treat spasticity? How are these likely to
influence exercise capacity in neurological patients?
Ask a healthy elderly person to complete the ABC scale, Romberg test, Berg Balance Scale, and Tinetti Assessment.


When do you think one assessment tool may be more appropriate than another?
How would results influence exercise prescription for neurological patients?
EHR503 Clinical Assessment and Exercise Prescription in Rehabilitation | Charles Sturt University
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MODULE 2. ASSESSMENT AND EXERCISE PRESCRIPTION FOR CHRONIC CONDITIONS
Unit 2.2. Neurological Conditions
How would you develop a balance in neurological patient? What type of activities could it include and how would you
apply progression? Hint: balance rehabilitation often requires the development of a number of specific physiological
capacities (e.g. strength and proprioception)?
Key Points: Outline three (3) key learning points from this topic.
1.
2.
3.
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