Acquired Brain Injury (ABI) and Exercise
What is an ABI?
Acquired brain injury (ABI) is an umbrella term that refers to any damage to the brain that occurs after birth. ABI can refer to accidents, stroke, lack of oxygen and degenerative neurological disease. The result of this injury is a reduced ability for the nerves within our brain to function efficiently as well as a loss of efficient energy metabolism. ABI-related effects can include cognitive, physical, emotional and independent functioning.
However, the functional profile for a person with ABI can vary enormously. For example, a person may use a motorised wheelchair for mobility, and depends on personal support for self care, whereas someone else may be fully independent in self-care, mobility and employment.
ABI is more common than you think, with around 1 in 45 Australians, or 432,700 people living with an ABI that cause activity limitations. Almost a quarter of these people are aged 65 years or younger. ABI prevalence increases with age, with people aged over 65 years twice as likely to have ABI.
The Benefits of Exercise for those with ABI
People with ABI are often physically inactive, with those who have severe brain impairments being significantly less active than those with mild to moderate impairments. The lack of physical activity is detrimental for their health, mobility and function.
No two ABI cases are the same, they differ in complexity, needs of the patient, the collective goals and the range of deficits the patient exhibits. Therefore there is a need for an individualised approach within a multidisciplinary team to provide a comprehensive treatment plan. Integral to this is the use of exercise therapy in the subacute and chronic phases to assist in maintaining and improving current physical and cognitive function. Currently, the literature does not advocate for one specific dose of exercise, rather is influenced by the individuality of the treatment. However, there is significant research that indicates that:
Aerobic exercise improve cardiorespiratory fitness
Strength training improves muscular strength, mobility
Regular functional exercise, such as sit-to-stand, walking, step ups, can improve performance of these tasks.
There is collective evidence that exercise can improve quality of life, physical function, independence and improve social participation.
It is recommended that an Exercise Physiologist is involved in the program design, as they have the knowledge, skills and experience to ensure that the training volumes and style of exercise is tailored to the individual.
Changes after an ABI
There are two types of ABI, traumatic (TBI) and non-traumatic. TBI is defined as an alteration in brain function or pathology caused directly by an external force (e.g. motor vehicle accidents, sports injuries). Non-traumatic brain injury is caused by internal factors such as lack of oxygen (hypoxia), hazardous substances/toxins, secondary complications to tumours, strokes or infectious diseases.
Changes that can arise following an ABI are varied however, can be broken down into different groups. These include:
Physical effects
Weakness, shaking, stiffness
Tiredness, change in sleep patterns
Seizures or headaches
Altered vision, touch or smell
Cognitive effects
Problems with memory or concentration
Problems with planning or communication
Confusion
Behavioural or emotional effects
Mood swings
Being irritable or feeling on edge
Personality changes
Recommended Type of Exercise
Because the effects of ABI are variable, specific, prescriptive recommendations for exercise programs are not possible. However, some general recommendations can be made. People with ABI are encouraged to be as physically active as they can.
For optimal health, the recommended amount of aerobic and strength exercise are the same as the general population:
Aerobic exercise: Greater than 30 minutes of moderate intensity aerobic activity at least 5 days per week, or greater than or equal to 25 minutes of vigorous intensity on at least 3 days per week.
Strength exercise: Three sets of 8-10 repetitions of resistance exercises at moderate intensity using major muscle groups on at least 2 days per week.
These recommendations may initially be unrealistic for many people with ABI, particularly those with severe mobility impairments, and those who have been inactive for extended periods.