2011 APTEI Acupuncture & Dry Needling (ADN) Program

hOMe Care COrner
Community-Based Exercise Programmes for Chronic Neurological Disease
By Kirsti Reinikka, PT, Coordinator, Community Based-Exercise Programmes
St. Joseph’s Care Group/reinikkk@tbh.net
As community physiotherapists, we assess and treat clients in their
homes because they typically cannot get out to access community services.
For many of these clients, goals are set and treatment plans
developed which focus on improving their level of function so that they
can get out for ongoing rehabilitation. What tends to occur is that there
are no suitable community services for these clients to attend.
The Home Care Advisory Committee would like to highlight the
following innovative programme which aims to better link the community
care systems into the broader healthcare system.
The relationship between social integration and support to factors
of successful ageing is well established. The support obtained
from participating in group activities is linked to better overall
mental, physical, and cognitive functioning, as well as lower mortality
risk. In addition, healthcare providers are being asked to take
on the challenge of the Ontario Ministry of Health and Long-term
Care and the Local Health Integration Networks to expand chronic
disease prevention and management strategies, and patient access,
through innovative programming.
The Community-Based Exercise Programmes (Thunder Bay,
ON) were designed to respond to the need for ongoing exercise
specially tailored to meet the needs of people living with chronic
neurological conditions. Partnerships were created between the
City of Thunder Bay – Recreation and Culture and Inclusion
Services Divisions, Lakehead University, and St. Joseph’s Care
Group. Fitness Instructor training modules, and disease-specific
classes addressing the physical impairments and functional limitations
common to people living with Multiple Sclerosis, Parkinson’s
Disease, and Stroke were researched, developed, and pilot-tested.
Classes have now been running for three years post-research
phase. They are held at community recreation centres, and led by
community Fitness Instructors. A Physiotherapist (Programme
Coordinator), Integration Services Facilitator, and local college and
university students all provide support to the classes.
Participants register and pay for the classes as with any community
recreation or fitness class. However, the overall programme
goal is not revenue generation, but rather to “break-even” with
registrations covering the cost of the Fitness Instructors. As a result,
cost to participants remains within reach, and anticipated difficulties
in ability to pay have not materialized.
What is novel about this approach is the ongoing partnerships,
and clearly identified links between the healthcare and community
systems. These were created with sustainability in mind for all parties,
and with the overall goal of more adequately addressing the entire
continuum of care experienced by people living with chronic disease.
The Physiotherapist role includes ongoing evaluation of the
programmes, and recruitment and training of staff and volunteers.
In addition, the PT is responsible for ensuring participant
safety through the screening and assessment of participants, and
the sharing of relevant information with the Fitness Instructors
(exercise modifications, support requirements, etc.). Consultation
with instructors and participants is ongoing, providing a means of
system navigation for participants (back to hospital programmes,
16
equipment prescription, etc.) and support for the instructors. The
Integration Facilitator also provides participants with information
and support to explore other recreation and leisure opportunities
in the community.
Challenges continue to exist, particularly with respect to gaps
in appropriate programming and support for those who require
one-to-one support or mobilize using a wheelchair. However, both
Fitness Instructors and participants continue to express satisfaction
with the programmes as indicated by satisfaction surveys, ongoing
registrations, and lack of staff turn-over. Since 2008, 35 classes have
run with 315 registrations, 31 student volunteers, and five fitness
instructors involved in the community-based exercise programmes
for chronic neurological disease in Thunder Bay.
By connecting the healthcare and community sectors, and creating
sustainable partnerships, class participants experience physical
benefits as well as social support, and a sense of connectedness. In
addition, the community role in chronic disease is better realized;
with appropriate skills and resources used at the right time, in the
right place, and at the right cost.
References:
1. Bassuk, S.S., Glass, T.A., Berkman, LF. 1999. Social disengagement
and incident cognitive decline in community-dwelling elderly persons.
Ann. Internal Med. 131; 165-173.
2. Seeman, TE, LusignoloTM, Albert, M, Berkman, L. 2001. Social
relationships, social support, and patterns of cognitive aging in
healthy, high-functioning older adults: MacArthur studies of successful
aging. Health Psychol. 20; 1-13.
3. Patterson, DH, et al. 2007. Aging and Physical Activity: Evidence
to develop exercise recommendations for older adults. Applied
Physiology, Nutrition, and Metabolism. 32; S69-108.
4. Lupien, ST, Wan, N. 2004. Successful Aging: From cell to self.
Philosophical Transactions of the Royal Society B. 359; 1413-1426.