In part two of this blog, I will consider how a rehabilitation ‘mindset’ can help you to get the best results from using the technology of your choice. I will focus on the following top tips:
- Rehabilitation isn’t something that is done to you, it’s something you must be engaged with and take ownership of…
- Physical and cognitive recovery after a brain injury is difficult. It is important to get the right intensity of treatment and know when to push yourself.
- Take ownership of your physicality – the recovery process needs to have a purpose, otherwise, it could feel like constant hard work.
Enjoy it! Rehabilitation isn’t something that is done to you, it’s something you must be engaged with …
It is important to find a technology that not only helps you to achieve your goals, but also one which also brings you some pleasure whilst you are doing it!
Let’s be honest, it’s rare to find a person who is 100% motivated when it comes to their fitness, and who always enjoys exercising!
Part of the rehabilitation journey for a young person with a head injury is having the grit and determination to continue to engage in rehabilitation.
I work a lot with young people on game-based, goal-orientated, immersive technology – think Super Mario mixed with Xbox Kinect.
What is great about this type of treatment is the focus is on the gaming element, rather than on what your body is doing to achieve that goal! Enjoying your rehabilitation journey can sound counterintuitive to some young people, as we have medicalised the nature of rehabilitation.
My view is that effective rehabilitation is the intersecting of:
- Having a clear purpose behind what you are doing,
- Keeping a goal-orientated focus,
- and gaining pleasure when you achieve a goal.
Take ownership of your physicality – the recovery process needs to have a purpose, otherwise it will constantly feel like hard work.
Purposeful movement can bring a huge amount of joy – think about a dancer doing a routine or a sport’s person moving their body purposefully to achieve an outcome or result!
Let’s not forget that most young people, brain-injured or not, are what we call ‘digital natives’; technology has been part of their lives since birth. Even those from a neurodiverse background will have the potential to use aspects of technology subconsciously, and if used correctly, I think that this can bestow an element of empowerment.
Physical and cognitive recovery after a brain injury is difficult. Hit the right intensity and know when to push yourself.
- We know that young people with acquired brain injury get less exercise than the non-brain injured population (you might find it helpful to watch my talk on this).
- We also know that there is level 1a evidence (the best kind!) that suggests greater intensities of physiotherapy & occupational therapy will lead to improved functional outcomes in patients.
- Much like when you are exercising at the gym, to see results you need to push yourself to a higher intensity of exercise.
- In reality, if a young person with an acquired brain injury wants to regain function of their upper or lower limb, improve their balance or walking speed (or whatever their aim is); around 300 to 400 repetitions of that exercise per day is necessary, as this has been shown to yield a significant improvement in animal test subjects (Krakauer et al, 2012).
What I like about immersive technology is that we can selectively increase the intensity of rehabilitation through very measurable parameters.
- Increasing intensity does not always mean increasing repetitions, or heart rate, or perceived effort.
- For people with a brain injury this might mean increasing the complexity of the exercise, increasing the amount of thinking you need to do to complete the exercise (e.g., get through a maze by shifting your balance), or increasing the physical task itself (e.g. doing two or more physical tasks at once – standing, shifting your weight, teaching for an item and aiming your upper limb focus).
- With immersive technology is that we can layer in complexities like cognitive loading, executive function tasks and dual tasking, whilst also increasing the physical challenge of a task.
Something I have come across in the neuro-diverse population when using rehabilitation technology is the role of overwhelm and fatigue. It’s important not to underestimate the cognitive effort it takes to string a complex task together – (take the photo above as an example).
Not only is the young person required to understand the task, but they also need to:
- Understand the implications of their movement and what happens as a conscience of their actions (called feed-forward in neurological lingo),
- They are also required to stand up, maintain their balance, arrange their body in an equally distributed way.
- Keep their focus.
- Pre-empt the next movement.
- Engage the correct part of their body to the task at hand, in the correct plane of motion, at roughly the correct power and speed.
This challenges the nervous system and asks the parts of the brain that control the ‘stringing together of movement’ to really fire up!
Over to you:
For me, specific types of technology that are used for specific types of bespoke rehabilitation can occupy the ‘grey area’ between dependency and independence.
- If we consider what the young person’s actual challenges are, what their specific goal is, and what the barriers are to achieving this goal; we can start to use all the tools at our disposal to ‘build out’ a rehabilitation programme that integrates the potential power of technology to help them.
- Before selecting a technology to further your rehab potential it is important to know your goal; what is the purpose of you engaging with this particular type of rehab?
- This comes back to using the right type of technology for the correct purpose, measuring what you are doing to ascertain if it is having the desired effect.
- When using technology, it is important to ask yourself: does it layer in enough complexity, and are you getting some pleasure from the activity?
- It is also important to consider when to stop: when has your rehab journey on that particular technology moved from you achieving more (even marginally more) compared to when is the technology helping you maintain what you have, versus when is the technology not doing any more than something less costly.
I am sorry to say there are no shortcuts, but the intersectionality between the young person with a specific need and identified goals, the knowledgeable therapist, the correct type of technology that matches the young person’s needs at that moment in time, and the correct bespoke rehabilitation programme. If you are going to engage with rehabilitation after a brain injury it is important to get the balance between purpose and pleasure correct.
Mike Greaney is a neuro-physiotherapist and a lecturer in physiotherapy at the University Of Central Lancashire. He takes a clinical interested in integrating technology into neurological rehabilitation.
- Link to my talk on technology: https://vls.uclan.ac.uk/Player/i91f2DH2
- Krakauer, J. W., Carmichael, S. T., Corbett, D., & Wittenberg, G. F. (2012). Getting neurorehabilitation right: What can be learned from animal models? Neurorehabilitation and Neural Repair, 26(8): 923–31.