with one or more impairments,
all of which will need
consideration for exercise. Some
are obvious and can be
observed, but there are many
others that may not be
recognised unless time is spent
with the client.
‘That itself poses problems,
with communication often being
a big challenge for instructors
due to the client’s
communication challenges. It’s
important to remember however,
that it’s the brain that’s causing
the impairments to present.
Stroke is a neurological
condition and progress and
gains in fitness and strength will
take longer.’
It’s on this point that
Cartwright confessed he’s at an
is both rewarding and
challenging, even for specialist
exercise instructors.’
Most REPs members will have
enough experience and skill to
help in some way, but for the
greatest impact a place on Later
Life Training’s Level 4 Exercise
and Fitness Training after Stroke
(EfS) instructor course is
recommended.
‘A Level 4 instructor working
with stroke survivors and clinical
population groups has a higher
duty of care and responsibility.
Before embarking on working
with them, you should be clear
about your personal skill set and
knowledge in relation to
qualifications and associated
insurance provision.’
advantage, having experienced
both a stroke and the recovery
period.
‘In my experience their
cognitive behaviour needs to be
addressed first. So I tend to help
by getting their mind more
positive and getting them to
believe in themselves and their
recovery.
‘On this level and on a
physical one, basic functional
training tends to work best. This
could be getting them to use a
treadmill, push a shopping trolley
or just stand,’ explained
Cartwright.
‘An important message
though,’ Townley wanted to
stress, ‘is that nothing is
impossible.
‘Working with stroke survivors
STROKE SURVIVORS: COMMON TRAITS
•
•
Often low level of fitness to
start, and sedentary lifestyle
factors.
Potential underlying cardiac
issues.
•
•
•
Stroke-related fatigue.
Executive dysfunction.
Stroke-related
pain/neuropathic pain.
•
•
Tonal changes – made
worse if exercise loads are
too high.
Sensory impairments,
problems with sensation.
KEY STARTING POINTS WHEN WORKING WITH STROKE SURVIVORS
•
•
•
Positioning/posture set up
is critical prior to any
movement.
Adequate base of support
and support options critical
in seated and standing
positions.
Know which component of
fitness you are training.
Cardiorespiratory and
muscle strength and power
are the two components
most important to address
28 FM
•
•
www.exerciseregister.org
based on research, but
mobility will feature in a
warm-up.
Sublux shoulders and
flaccid upper limbs are
extremely vulnerable during
exercise and specific
cautions apply.
Appropriate outcome
measures are essential for
motivation and to monitor
the impact of your training
programme.
•
•
Aim to include the
impairment in the
exercise/movements. Don't
focus on it, but don't ignore
it either.
Don't forget that there will
be times when the
individual may not be ready
for you ‘yet’ and will require
assessment and advice
from a physiotherapist.