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Melanie Cole, MS (Host):   Welcome. This is Shepherd’s Center Radio, I'm Melanie Cole. Today we’re discussing developing an adaptive fitness routine. Joining me is Lisa Eagen. She’s the lead exercise physiologist in Shepherd Center’s ProMotion Fitness center. Lisa, it’s a pleasure to have you join us today. Before we get into actual workouts, how does injury—brain injury, spinal cord injury—effect the ability of a patient to maintain a fitness routine? There must be so many things that play into this.

Lisa Eagen, BS, ACSM-CPT (Guest):   Oh absolutely. The things that are effected, it’s on so many different categories. First of all for patients simply the lack of a facility, an appropriate facility. It might not have knowledgeable staff that have any idea about injury and how to help those with disabilities. Along that line, patients just might feel uncomfortable in that environment even though that during their stay here they’ve been trained on what to do out in the community, how to take what they’ve learned in the hospital out to the community. We’re human beings. So there's still that possibility that they're feeling uncomfortable. Lack of family support unfortunately does happen a lot. Transportation. If they're no longer able to drive, getting to and from any facility. The cost, of course. After an injury a lot of times, unfortunately, our patients aren’t able to maintain the same level of income prior to their injury. So just the cost of a membership. Some physical applications like respiratory complications, cardiac complications. They have a decrease in bone density which could lead to fractures. So on many different levels lots of challenges.

Host:   So as you’re talking about those aspects of quality of life whether it’s income or transport of family support, there's also motivation and really the mental aspect of working out. How can feelings of depression play into this desire or lack of desire to get involved in a fitness routine?

Lisa:   That is absolutely a big aspect. Looking at some of these questions I actually went to ask some of our not only former patients, but we’ve got a few staff members here at Shepherd that have either been former patients or they themselves have a disability. So I went straight to the source about feelings of motivation and depressing. An interesting thing. One of the patients, she said, “Both motivation and depression keeps me coming back for more.” The fact that as human beings if we fall into a circle or a downward spiral of depression, it’s really hard to get out of it. If you know that you have something to look forward to, for example, your fitness family—so to speak—or your tribe of people in your gym that you know if you show up there you're going to be able to work out. You're going to be able to socialize. You're going to be comfortable in the environment. Along the lines also, motivation. It helps to make exercise a habit. Once it becomes a habit then I think that can combat some of the aspects of depression that one might deal with.

Host:   Well sure. It builds on itself as they see progress and maybe they're feeling better mentally and physically then that really encourages that ability to keep going. So when you are approaching a fitness routine with someone who’s suffered an injury that would meet their needs. What are some of the things you're doing with patients Lisa? Tell us about how you work with them.

Lisa:   First of all you have to get to know the patient. Everybody’s different regardless of your injury. We look at the patient as who they are as a person not as what their disability is. So first thing is just talking to them, getting to know them. What they used to do, what they used to do for fun, what they used to do for activity, where they're from. Just any questions that you can ask just to get to know who they are. Then from there we’ll just figure out what they want. For patients coming through Shepherd Center they're given lots of opportunities under the recreation therapy bubble.  They can choose from horticulture, sports, art, music, exercise. So in that aspect, again I’ll just ask them what their goal is and then go from there. We’ll show them equipment that we have here in our facility that’s certain adaptive equipment that they can use while they're here and then get them on it, get them comfortable with it. Also train their family members too because a lot of times people coming in here, they're not going to be working with a therapist all the time. So our role down in the ProMotion Fitness, we want them to be independent. So show them the equipment, get them on it, show them how to use it safely and effectively to the point where they're comfortable. On their own time they can come on down and use it if they want.

We also work on gathering resources for them once they go home. There's not a lot out there, as I said earlier. Trying to find a facility that’s going to meet their needs can be quite challenging, but we will research, call different places, see if they have specific equipment that our patient would need. Also ask specific questions about staff and their experience. Surprisingly I would say there's not a lot out there. We have been presently surprised with some gyms that are kind of starting to step it up as far as getting adaptive equipment for our patients. Once they go home, we try to follow up with them also. I think that’s key with a lot of therapy modalities that you actually do follow up. See how they're doing, get feedback from them. I think that’s probably one of the biggest aspects as far as having a successful carryover for them.

Host:   Well, you're right. I think that continuum of care and that follow up really helps, again, to keep the person coming back. Now you’ve mentioned adaptive equipment. Tell us about some of the cool stuff you’ve got going on at Shepherds Center. When you say adaptive equipment, what do you mean?

Lisa:   A couple different things. There's some equipment that they can just role up to and use from their chair. So, for example, upper body cycles, upper body ergometers. Rowers can be made to be adoptive. There's different seats that if they're able to transfer onto a seat on a rower that the seat is stationary. So all they have to do is transfer onto it. We put their feet up in the foot plates and they can row. With a couple of rowers that we have we can actually detach them. So the client can roll up to the rower and use that. We have some recumbent steppers. There's, again, one that you can roll up to in your chair, put their feet on a foot plate, get them wrapped. It’s kind of like a recumbent Stairmaster essentially. We have functional trainers that are very similar to a cable crossover machine, again, where they can do it from their chair. May need help making the adjustments, but it’s at least something that maybe once they're set up they're able to use. We have different grasping devices—cuffs—that if they need a little help with holding on to a dumbbell or a bar or a handle, we have those, grasping cuffs. Then just some other auxiliary items like binders and wraps and stabilizers that we have available for them.  

Host:  Before you mentioned, Lisa, about the family and getting them involved and the support system, which is so important for this, tell us how you encourage working together to achieve their fitness goals. What do you do with the families? Do you take them through the routine with the patient? Do you show them how to do these exercises at home? How does the family get involved?

Lisa:   Well first of all education is important for both the patient and the family member. During the patient’s stay here at Shepherd in addition to their therapy sessions they have a lot of education sessions. The family go through education sessions. It’s so very important to know what you're dealing with and know what you're talking about. So we’ll train any of the family members that come down with their patient. We will show them how to use equipment, how they can set up their patient. Basically we train them on what we do. Then also we want to address the issues of the family member too because if they're going to be taking care of their loved one, it’s important for them to be both physically and mentally healthy also. So we do offer a free membership to our fitness center, which includes both the weight room and the pool, and highly encourage them to come down and use it. I think it’s another aspect of that that’s good for the family members is that they kind of form a network with either other family members or other staff. It’s a nice go to happy place for them so they can get away from the ins and outs of the therapy sessions and everything that they have to deal with with the family member’s injury. Just come down, focus on themselves for a while, try to stay healthy.

Host:   Well that certainly is a great goal. Tell us about your team Lisa and what do they do to go above and beyond with patients?

Lisa:   So our environment is pretty unique. It’s basically Livingston Gym. It’s a very large basketball gym. It entails the ProMotion Fitness, which is a community gym. It includes both a weight room and a pool and a walking track and a basketball gym. So you have the community fitness aspect of it where anybody can join the gym just like a YMCA or LA Fitness. Then we also have our Beyond Therapy program, which is an outpatient program. We also have our sports teams that utilize both the gym and of course the basketball gym and the weight room a lot.

So lots of different facets, lots of different things that go on down in our area. We have about 14 exercise physiologists, two physical therapists. The PTs are primarily with the Beyond Therapy program. We have a PT/OT aid. We also have a wellness manager, an aquatics coordinator, and a sports team coordinator. So very diverse group of people. We all come from different areas of the country, different experiences, different interests, but make a really great team. The fact that we respect each other and also work together. Part of trying to give the best that we can to our clients and our patients is that we try to develop friendships, which in turn will create trust with that particular family member. A lot of times our staff are very heavily involved in research whether it’s for trying to figure out a new modality or a new treatment for our patients. We also don’t really follow the same recipe as far as treatment options. We have to get really creative in what we do. So I think that’s pretty much going above and beyond. There's not a ceiling for what our staff can do.

Host:   As we wrap up, do you have any final thoughts for listeners on really adaptive fitness routines and what you're offering at Shepherd Center?

Lisa:   There's no one perfect routine. Just like anybody who’s trying to get into a workout program, there's no one perfect routine. There’s no one perfect formula. It’s just a matter of moving, doing something. There are resources out there. I've found that going to social media is actually a very beneficial thing. There's a lot of people out there, especially on Instagram where they just show videos of the things that they're doing. There is a website called Spinalpedia that was actually created by one of our former patients here. It’s a resource tool for people with injury that they can upload photos of things that they're doing—ADLs—or doing some type of exercise routine. Like I said, I think it’s important for people to understand that no matter what your disability, you can continue a routine. Just keep moving, stay active, and search for things that are available for you out there.

Host:   That’s great advice. What a wonderful program you have Lisa. Thank you so much for joining us. That concludes this episode of Shepherd Center Radio. Head on over to our website at shepherd.org/promotion for more information and to get connected with ProMotion Fitness Center. Please remember to subscribe, rate, and review this podcast and all the other Shepherd Center podcasts. Please follow us on your social channels for more health tips and updates. I'm Melanie Cole.