Course Sampler
Here are the first two sides of each course Unit
UNIT 1 – Brain, muscle and trauma
Nervous System Structure
Classically divided into the central and peripheral nervous system:-
The peripheral system can be further divided into somatic, supplying the skin
and muscles, and autonomic, supplying the viscera:-
In this course, we will be mainly concerned with the central and the somatic
peripheral components.
Central Nervous System - the Brain
1.2-1.5 litres (1200cc-1500cc) in volume, floating on a cushion of
cerebrospinal fluid, and encased in a bony protective skull. The most active
region of the body at rest, taking up 25% of blood sugar and oxygen.
The apparent complexity of brain structure can be simplified by dividing it into
subsystems, reflecting its evolution:-
4
3
2
1
1. Brainstem: the spinal cord terminates into the medulla oblongata (cardiac
and breathing centres) and continues forward as the brainstem. The
brainstem is mainly concerned with automatic functions like breathing, acting
as a relay station for motor and sensory pathways (through the pons), and
contains the reticular formation, a diffuse network of neurons that regulate
consciousness/sleep states.
It terminates in the diencephalon, which includes the: thalamus - relays sensory information and contains nuclei dealing with
motor planning and control
 hypothalamus – controls and integrates pituitary/autonomic NS
activities, such as body temperature, regulation of food/water intake,
sleep patterns, circadian rhythms
 epithalamus – pineal gland
2. Cerebellum: not part of the brainstem but arising from it. About one tenth
of brain mass but contains 50% of the brain’s neurons. Divided into two
hemispheres with a central strip (the vermis). It is crucial for smooth
movements, motor learning and regulating posture and balance.
The cerebellum evaluates movements as they’re being carried out and feeds
back to the motor areas via the thalamus, correcting errors, smoothing and
coordinating movement sequences. It acts as a timer, comparator and fine
tuner, receiving sensory information from all over and inside the body, so it
can modify movements in the light of the body’s position in space. The
cerebellum can act in feedback and feed forward modes, and is active before
movements are made.
This is shown clearly in tests for cerebellar function:-
Unit 2
Key fitness components
Cardio respiratory fitness
This is often quite obviously poor. It is key to work and build on cardio
respiratory fitness however it is vital to communicate with the patient’s GP and
Phase III team and make an educated exercise prescription using the
patient’s medical information.
Muscle endurance
Muscle weakness and fatigue is common due to a typical sedentary lifestyle
and again it is key to work on this; however again we need good
communication with the patient’s GP and Phase III team.
Muscle strength, speed and power
Reduction in muscle strength is common and can reduce daily functionality,
however working to extremes of strength, speed and power should be
avoided.
Flexibility
Flexibility should be trained in the same way as for healthy individuals. If they
have had a coronary artery bypass graft (CABG) then it is also beneficial to
work on the pectorals due to the trauma caused during surgery.
Skill, coordination and balance
Skill, coordination and balance should be trained as per the healthy individual,
however watch out for a possible earlier onset of fatigue.
Exercise prescription
Cardiovascular

Intensity should be in the range of 40-80% of heart rate reserve.

Frequency should be ≥3 days per week.

Duration should be 20-60 minutes per session, including time for
warming up and cooling down effectively.
(ACSM 2009)
Muscular Endurance and Strength

Frequency should be 2-3 days per week.

2-4 sets of 12-15 reps should be aimed for.

Intensity should be between 30-40% of 1 repetition maximum for the
upper body and 50-60% of 1RM for the lower body. At all times the
Valsalva Maneouver must be avoided. (ACSM 2009)
Flexibility Training

Frequency of stretching should be 2-3 days per week.

Each stretch should be held for a minimum of 10-30 secs.
Unit 3
Background
Stroke devastates lives and is a leading killer and disabler. It is the single
most common cause of severe disability in the UK and the third leading cause
of death.
Every year, an estimated 150,000 people in the UK have a stroke. Most
people who are affected are over 65, but anyone can have a stroke, including
children and even babies. Around 1000 people under 30 have a stroke each
year and it is the third most common cause of death in the UK. More than
250,000 people in the UK live with disabilities caused by a stroke. (Stroke
Association)
The World Health Organisation has defined stroke as rapidly developing
clinical signs of focal (at times global) disturbance of cerebral function, lasting
more than 24 hours or leading to death with no apparent cause other than that
of vascular origin” (WHO 1980) stroke symptoms that last less than 24 hours
are traditionally determined as transient ischaemic attack or TIA.
Therefore a person is defined as having a stroke where symptoms last longer
than 24 hours and TIA where symptoms last less than 24 hours, regardless of
the severity of symptoms of the stroke.
More recently stroke is referred to as a ‘brain attack’ to indicate the severity of
the condition and also to separate it from heart attack.
Acute care
Recent Stroke Association advertising campaigns are raising awareness of
stroke using the FAST campaign
Stroke is a medical emergency. Act FAST Call 999!
Stroke is a medical emergency. By calling 999 you can help someone reach
hospital quickly and receive the early treatment they need.
Ambulance crews use FAST and with hospital staff can act fast to identify and
diagnose a stroke quickly.
F - Facial weakness. Can the person smile? Has their mouth or eye drooped?
A - Arm weakness. Can the person raise both arms?
S - Speech problems. Can the person speak clearly and understand what you
say?
T - Time to call 999
It is still fairly common for people to confuse stroke and heart attack. You may
well meet people who still think that a stroke and heart attack are the same.
It’s not certain where this confusion arose but it is possibly because they have
been linked together or due to the registered charity Chest, Heart and Stroke
association. In Scotland and Northern Ireland they continue to be linked under
the Chest, Heart and Stroke association but in England they are separate.
The Stroke Association http://www.stroke.org.uk/ provides information, raises
money and supports research for stroke and for heart attack it is the British
Heart Foundation http://www.bhf.org.uk/
There are numerous information leaflets and resource links on the Stroke
Association web site that you might find useful for your clients or the facility
where you work.
Stroke – what is it and how is it diagnosed?
Our brain actions and its functions are supported by our circulatory system.
The cardio-vascular system is dependent on good, patent blood flow between
our heart, arteries and veins. When the circulatory system is jeopardised by a
blockage or rupture in this system this can lead to a stroke or brain attack.
Arteries in the brain are known as cerebral arteries and originate from the
aorta. The arteries that arise from the aorta to the brain are the carotid
arteries. The carotids ascend either side of our neck before linking directly to
the main cerebral arteries in the brain.
Unit 4
Background
Participation in regular physical activity provides health and social benefits.
There is good evidence that this is true for people experiencing disease and
disability. For people experiencing disability and lack of mobility, exercise may
help reduce the risk of the associated common and serious complications
associated with impaired mobility e.g. joint contractures, skin breakdown and
thrombosis.
People with physical disabilities have low levels of motivation and therefore
have low levels of participation in physical activity. One reason for this is
perhaps their fear of the complications mentioned above and their perceptions
of being isolated.
The treatment and rehabilitation they receive may not be adequate. Some
patients receive a short course of hospital-based rehabilitation but after this is
completed there may be little offered within the local community to help with
further
rehabilitation
and
help
prevent
deterioration
or
secondary
complications. Access to community facilities is also sometimes limited, which
can further decrease motivation.
The UK population of adults affected with neuromuscular conditions is about
25,000, but their physical activity levels are not known. A pilot study in 2005
showed a low level of general activity and a desire to increase exercise
participation. (Freebody, J., et al., 2005). This is not surprising due to the fact
that adults, particularly those diagnosed more than five years ago, were told
that nothing could be done. Many patients, doctors and therapists still believe
this to be the case. Clinical research is limited, however there are indications
that adults with neuromuscular disease benefit from exercise, especially if
functional and targeted.
Assuming that physical activity is good, the issue remains how best to get
these patients motivated to adopt this lifestyle change and to take on and
adhere to a gym programme. Several specific barriers have been highlighted:
a lack of appropriate fitness facilities, a lack of knowledge and disability
awareness among facility staff, a lack of knowledge amongst disabled people
of the benefits of exercise, physical barriers of the condition itself and lack of
energy due to fatigue and decreased levels of self efficacy and negative
attitudes to exercise.
One possibility is that a motivational interview may help patients to overcome
these barriers. A lot of research has been done and there are many examples
of motivational interviewing being used in the clinical field. Much work has
been done in drug and alcohol dependency (Stein M, Charuvastra A et al,
2001), cardiac rehab, (Brodie D, Inoue A, 2004) and schizophrenia, amongst
others.
Motivational interviewing is a strategy that originates out of the fields of
behavioural therapy, social psychology and humanistic psychology. It uses a
patient-centred approach; this allows the patient to provide the focus and the
direction of the issue rather than the provider of care. This will then reduce the
risk of any resistance occurring between the patients and the provider of care.
The motivational approach arose from the field of substance abuse and has
been effective in assisting with a number of behaviour changes (Butler,
Rollnick, & Stott, 1996, Hayward, Chan, Kemp, & Youle, 1995; Miller, 1996;
Miller, & Rollnick, 1991; Colby et al., 1998; Kemp et al., 1998; Pill et al., 1998;
Sims, Smith, Duffy, & Hilton, 1998).
There are four basic principles in motivational interviewing, to express
empathy and exploring and resolving client ambivalence (Miller et Rollnick,
2002), to develop discrepancy, to roll with resistance and finally support selfefficacy. The four principles are expanded below and are from the work of
(Miller et Rollnick., 2002).
1) Express Empathy
Unit 5
The referral process- Inclusion/Exclusion Criteria
Basic Medical Screening before exercise prescription.
The Physical Activity Readiness Questionnaire (PARQ) form is the first stage
of screening an individual for exercise participation. There are seven standard
questions on the PARQ form. These questions are designed to screen the
individual’s current health status and see whether the fitness professional
needs to obtain clearance from a medical professional such as a GP or
consultant.
If the individual answers yes to any of the following statements whilst
completing the PARQ it is recommended that a doctor’s note may need to be
obtained, or at least the individual should consult their GP.

Any form of cardiac surgery.

Any form of cardiac disease, such as, heart valve disease, heart failure
or congenital heart disease.

Use of prescribed cardiac medications.

Experience of chest discomfort with exertion.

Experience of unreasonable breathlessness.

Experience and episodes of dizziness, fainting or blackouts.

Diagnosis of diabetes

Diagnosis of lung disease or asthma

Burning or cramping sensations in the lower legs on walking short
distances.

A musculoskeletal problem that limits physical activity

Use of prescription medications

Pregnancy
If the individual answers yes to two or more of any of the following
cardiovascular risk factors whilst completing the PARQ it is recommended
that a doctor’s note may need to be obtained or at least the individual should
consult their GP.

They are male and older than 45 years

They are female and older than 55 years, have had a hysterectomy or
are post menopausal.

They smoke or quit smoking within the previous 6 months

They have a resting blood pressure above 140/90 mm Hg.

They take blood pressure medication

Their cholesterol level is above 200mg/dL

Their cholesterol level is unknown

They have a close blood relative who had a heart attack or heart
surgery before the age of 55 (father or brother) or age 65 (mother or
sister)

They are sedentary, getting less than 30 minutes of physical activity on
at least 3 days per week.

They are more than 20 pounds over weight.
AHA/ACSM Health/Fitness Facility Preparticipation screening questionnaire
Before commencing any exercise prescription the individual should obtain and
give to you a signed letter from the GP. As the GPs are usually very busy and
short of time it is better to have a letter already set up for the GP to sign.