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Physical Activity Module

Figure 4.0 Primary service components for the direct provision of physical activity programing, AND health promotion efforts aimed at increasing self-directed physical activity. Further, the reimbursement models and historical scope of practice for traditional rehabilitation have not been consistent with establishment of physical activity services that focus on increasing participation. In particular, the immediate medical needs of the individuals and traditional physical therapies, focusing on neurological recovery and mobility, often take precedence. The relationships between “therapy” and “exercise as therapy” are certainly not well understood, nor do we have a thorough understanding of how “exercise as therapy” might enhance therapeutic outcomes. In practice, current health service and reimbursement frameworks further compound these inter-relationships. The result is that proportionally little time is allocated to structured healthpromotional programs or interventions that may result in adoption of an active lifestyle, after discharge from inpatient rehabilitation. In addition, while the majority of specialized SCI rehabilitation programs offer fitness-related services to individuals, there is significant variance in how these are conducted. Current Canadian SCI Physical Activity Practice Profile summarizes the status of current practice across Canada. Of note, there is inconsistent usage of either standardized protocols or outcome measurement tools across sites. Figure 5.0 shows the variety of fitness-related equipment in use and the relative availability of each piece of equipment, across participating E-Scan sites. E-Scan respondents indicated that the sites are generally well equipped, with a variety of equipment to meet a range of fitness needs (e.g., arm and bicycle ergometry, variable-speed treadmills, standing frames, Motomed, FES-cycling ergometers) However, it is unclear if this equipment is available for fitness-related activities or limited to therapy service provision, as several programs noted availability limitations (mainly for outpatients). Figure 5.0 Distribution of equipment used for physical activity programing in Canadian SCI rehabilitation centres. 0 2 4 6 8 10 12 FES - Walking FES - Biking FES - Rowing FES - Other Treadmill - Variable Speed Treadmill - Wheelchair Treadmill - Regular BWS Over Ground BWS Treadmill BWS Harness Other Fitness Equipment Ergometer - Wheelchair Ergometer - Rowing Ergometer - Bike - Reclining Ergometer - Bike Ergometer - Arm Ergometer - Other Motomed Tilt Table Stander - Strap Stander Stander - Standing Frame Stander - Other Therapeutic Pool Raised Exercise Mats Hi/Lo Plinth Parallel Bars Number of Sites Regardless, when these results are coupled with the findings on the availability of fitness centres and provider types, it is apparent that while most sites are capable of delivering physical activity services, (in terms of space and equipment), staffing may not reflect interprofessional care – perhaps due to inadequate resources or other priorities. Of note, no site identifies kinesiologists as service providers who deliver physical activity programming – although it may have been that the “fitness specialists” identified are kinesiologists. This suggests that kinesiology, although representing a discipline specializing in human movement and fitness expertise, has yet to be routinely included in the rehabilitation team. PHYSICAL ACTIVITY | PARTICIPATION 169


Physical Activity Module
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