Enabling people with long-term conditions to be more active. Robert Millett reports
The ‘I Can Therapy Centre’ is a collaboration between charity Valley Leisure and private physiotherapy enterprise Sheffield Neuro Physiotherapy. Rachel Young and Emma Richards are co-lead physiotherapists at the centre and Ms Young says she became involved with the initiative due to her interest in the rehab potential of power assisted exercise equipment.
‘I met the team from Valley Leisure and together we came up with the idea to bring a centre to Sheffield that was a physiotherapy-led service model, where physiotherapists could assess people with complex needs and specific requirements before they exercised, while also offering new power-assisted equipment for people who might not be able to use traditional gym equipment.’ she explains.
The venue houses nine pieces of power-assisted equipment and is able to serve a maximum of nine users at a time, who have access to both physiotherapists and fitness professionals.
‘We have a band 5 physio who is on site 17 hours a week, and Emma and I cover the clinical lead role,’ says Ms Young.
‘And we also have a specialist fitness instructor on site, who has a level 4 exercise referral qualification and a level 5 cardiac rehabilitation award, and she has a lot of experience of working with complex patients who have comorbidities from a leisure centre setting.’
Under a consultancy arrangement with Valley Leisure, the physiotherapists are able to offer clinical supervision and support the entire team, by providing on-going development to enhance both their own skills and the overall service.
‘There is evidence that some people with complex impairments feel concerned about going into standard leisure centre venues, because they worry that the staff in there won’t understand their needs,’ says Ms Young.
‘We are addressing that issue, because here those people have the reassurance of physiotherapists who assess them and provide on-site support.
‘And gradually – as they make repeated visits – users are likely to become more autonomous and gain their own confidence with the equipment, and that will allow them to make a transition from the physiotherapists to the fitness instructors who are also on site.
'There is evidence that some people with complex impairments feel concerned about going into standard leisure centre venues because they worry that the staff in there won't understand their needs'
‘So it’s a progressive model, where people become less dependent on physiotherapy through the use of the assisted exercise machines and a skilled, specialist fitness instructor.’
The centre’s other lead physio, Emma Richards, is also the managing director of Sheffield Neuro Physiotherapy, a private practice that aims to provide personal, client centred, goal oriented rehab programs.
‘We have always attempted to introduce exercise and conditioning into our rehab programs,’ she explains. ‘But not all clients are able or feel comfortable in a normal gym environment.’
Ms Richards and her team first came across power-assisted exercise equipment, produced by Shapemaster, at a conference organised by the Association of Chartered Physiotherapists Interested in Neurology, and they immediately saw the potential for a power-assisted accessible gym in Sheffield.
‘The I Can Centre in Andover had developed a fantastic model, so we approached them to open a centre in Sheffield,’ says Ms Richards.
‘Our main aim was to collaborate to provide a sustainable, accessible exercise venue that would allow more clients to access exercise within rehab pathways, so patients could continue their own rehab after or alongside those provided by stretched NHS services.
‘And we are already seeing some really positive results, both physically and in terms of patient wellbeing.’
Assisted activity and better accessibility
Making exercise easier and more accessible for people with long-term conditions is at the heart of the centre’s approach to rehab.
The venue’s power-assisted exercise equipment leads people through a range of machine-initiated movements.
By generating both initial and ongoing movements the equipment provides a helpful ‘kick-start’ for people who would struggle to initiate movements on standard gym equipment – such as people with Parkinson’s – thereby allowing them to engage in physical activity.
‘Once the machine sets off the movement, we then encourage the users to join in to the best of their ability, and hopefully they can then achieve a physiological response in terms of muscular strength and aerobic demand,’ Ms Young explains.
‘So, for people with stroke or other neurological changes, or for people who fatigue very quickly, it’s a really effective way of achieving a global and sustained workout.’
The design of the power-assisted equipment also makes the machines more accessible than conventional exercise equipment, and the centre has facilities in place to ensure that people with significant mobility restrictions are still able to exercise.
‘My experience of taking clients with limited mobility into conventional gyms is that it’s really challenging, and that’s where my interest in this area started to develop’ says Ms Young.
‘People can access this equipment even if they have significant impairments in terms of mobility, as it is all seated and the machines have detachable arms and legs.
‘So, if we are using, for example, a rotunda transfer aid we can easily help someone from a wheelchair transfer on to the equipment.’
Although more research is required to establish the full benefits of power-assisted exercise facilities, Ms Young believes their use could be of particular benefit to people with neurological conditions.
She explains that the Sheffield centre is the second of its kind to open in the UK, following the launch of the first ‘I Can’ therapy centre in Andover in 2017. Since that first venue opened more than 450 people in the local area have been assessed and attended power assisted exercise sessions.
‘A considerable proportion of the user group at the Andover centre are people with stroke, particularly people with more moderate to severe levels of physical impairment as a result of stroke; as well as people with MS, MND or Parkinson’s,’ she says.
‘And we anticipate a similar demographic of users at the Sheffield centre, as the facilities provide an accessible exercise option for them.’
As well as working at the centre, Ms Young is also a doctoral student at Sheffield Hallam University and she intends to use the facilities to conduct research projects that will examine the effects of power-assisted exercise on people with long-term conditions.
‘We want our service to be a point of data collection, so we can evaluate the impact of the exercise experience from both a physical and a psychosocial point of view,’ she explains.
‘The final stages of my PhD will be based on data collected at the venue, focusing specifically on the stroke population.’
Ms Young says the Stroke Association have already shown support for the centre’s plans, along with the MS Society and community church groups in the area.
And later this year, she hopes to recruit participants to take part in her PhD research. The study, which will involve an eight-week programme of power-assisted exercise, aims to monitor and measure the physical impact of the intervention.
She hopes her research will help to address a current gap in the evidence base, particularly in relation to stroke.
Since the first venue opened in 2017, over 450 people have been assessed and have attended sessions.
‘There has been a growth in the evidence base related to exercise for the stroke population, but most of that research has excluded people who aren’t able to mobilise independently,’ she says.
‘So this equipment provides an opportunity to study people who aren’t independently mobile, but could still benefit from exercise.
‘The key question we want to explore, in relation to power-assisted exercise, is the extent to which it strengthens muscles and the extent to which it also offers an aerobic workout as well.
‘There is a lot of testimonial evidence at the moment and we have a feasibility study that was published last year in relation to the equipment, but we are looking forward to growing that evidence base and further understanding the exact impact of the equipment.’
As well as contributing to the evidence base, the results of the study may also be used to update and inform the future development of power-assisted exercise equipment.
‘We are working with computer science teams within the university, to look at product development, alongside measuring the impact of using the equipment.’
Bridging the gap
Ms Young, who has experience of working as a physiotherapist within the NHS, higher education and independent practice, hopes that the new centre can also provide a transition between NHS services and community based leisure services.
‘We are looking to bridge the gap, by providing a service to the population of people who aren’t ready or able to go to bigger venues, like conventional leisure centres,’ she explains.
‘Our centre is clinically led, but it sits outside the NHS, so it can act as a stepping-stone for people who have a recovering condition, who might be in a period of transition, while they progress towards activities that are higher impact or more challenging.
‘And for people who have a progressive condition it might be that it’s a more long-term choice.’
She adds that clinical services are always finite and clinicians need places to signpost to, which they know will offer a safe environment for more complex and vulnerable users in transition from their NHS pathway.
‘So we are in communication with GPs and hospital consultants as well.’ In addition, the centre is recruiting volunteers from the local community and aims to provide programmes that not only boost people’s physical activity, but also improve their social and mental wellbeing.
‘We have a great team of volunteers, including retired people, students and experienced service users,’ says Ms Young.
‘And their roles include welcoming people through the door and ensuring people are comfortable – getting drinks and snacks, talking to carers – but also, where appropriate, assisting people (not physically or manually) to access the equipment, and alerting the site manager if something needs attention.’
Liz Murray is the partnerships manager for Valley Leisure LTD
Why did you want to collaborate with physiotherapists?
Physiotherapy input provides the essential clinical oversight to provide credibility and quality assurance to users of the centre and potential partner organisations and clinicians. Users know that with physiotherapy input they are going to be well cared for.
It provides assurance that a ‘professional’ is supporting them on their physical activity journey. The word and title ‘physiotherapist’ is incredibly powerful from a user perspective as physiotherapists are held in such high regard.
What are the benefits of physios and exercise professionals working alongside each other?
Combining physiotherapy and exercise professionals’ skills, expertise and practice is advantageous for all involved. Users gain the investigative, therapeutic and often more hands-on practice applied by physiotherapists, who are able to pinpoint and treat the exact joints requiring attention and specifically tailor complimentary therapeutic exercise, which enables often unconfident and apprehensive exercisers to begin their physical activity journey.
Meanwhile, exercise professionals provide a more hands-off and group mentality with motivation and encouragement further developing users’ confidence and increasing independent use of the centre and increasing independence outside of the exercise facility setting.
Mainstream leisure centres are often too intimidating and have equipment that will not cater for less able / disabled users.
At the heart of I Can is the passion and desire to enable our users to move more and feel better, this is an ethos and foundation shared by both physiotherapy and exercise professionals and it enables great things to be achieved by bringing together different yet similar industries.
Hannah Wright, one of the physiotherapists at the I Can Therapy Centre, explains how physiotherapy assessments help users to become more active.
‘The one-to-one assessment ensures a full health and social history from the user. It facilitates insight into their perspective and enables us to set realistic goals, which are reviewed after 25 sessions.
‘And the objective assessment provides an overview of range of movement, neurological function and global strength. We incorporate outcome measures including the Timed Up and Go and the Berg Balance Scale so that we can evaluate physical progress at each review.’
Pip Lee is a level 4 fitness instructor and circuit coordinator at the centre.
She says one of the main benefits of the centre’s approach is that it provides physical, mental and social support that inspires users and keeps them motivated.
‘No-one is on their own at the centre, we our here to support users through even the toughest challenges, to enable them to believe in themselves and improve their overall health.
‘Anything is possible, and our team are here to support users and enable them to achieve their goals.’
The user experience
Sally Fellows has been exercising at the centre since February and says: ‘When part of your body does not work and then the machine moves there is a weird sensation of the brain working with the body again.
‘This could not happen on a normal exercise machine. It gives me so much confidence and now I can stand better for transfers. I was worried that my mobility had got worse but now I feel so much stronger. I’m not needing to raise my chair so high to stand which is amazing.’
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