Episode Transcript
[00:00:00] Speaker A: Welcome to Vicarious Insights, the podcast where we deep dive into the world of disabilities. Today we have Kira from Rehab Aid exercise physiology. Could you give me, like a quick thing on what a exercise physiologist is or does?
[00:00:14] Speaker B: Yep. So an exercise physiologist is a part of the allied health world. We specialize in chronic disease, illness and disability management.
That rehab aid. We work with people with disabilities to manage fatigue and pain, hoping to do this within 12 weeks of them seeing us. This is to just really help them get their. Maintain their independence, but also improve their quality of life to be able to do activities outside the home, grocery shopping, hanging out with family and friends, and just being a part of community.
[00:00:50] Speaker A: Important stuff. What got you into exercise physiology? What sparked your interest?
[00:00:56] Speaker B: Honestly, I started as an exercise, exercise and sports scientist, and I was going into physiotherapy. Once I finished my bachelor's degree, I didn't know where I wanted to go. I was thinking occupational therapy, physiotherapy. And I. Before I made the big decision to spend some money on a master's or a doctorate, I worked for a year. So I actually found a private clinic that was run by an ep, so an exercise fizz. And that was just fluke. I didn't. I just wanted some private practice and then working there for a year. So I was running like group classes for people with, like, chronic conditions, seeing people with disabilities in their home. So where the EP would write a program and then I'd facilitate it as an allied health assistant. I loved it. I loved the challenge. It was different every time I saw a new client. It steered me away from physio because I also had a physiotherapist working in that clinic. And whenever I oversaw what they were doing, it was really the same thing. Knee rehab, hip rehab, shoulder rehab, hip shoulder. It was just recurring and not to say that's really important. And the physios do an amazing job. But I found more challenge with my EP appointments that I was going to. So, yeah, that's what led me into my master's degree. And I did that while working, which was awesome. I was getting industry experience and learning about the physiology of each condition. We went through, like, cardiovascular, metabolic, everything in the degree. But then I was implementing it and I just knew it was the career path for me, the way to do.
[00:02:34] Speaker A: It, learning, doing, tying those neural pathways together.
[00:02:36] Speaker B: It's something I recommend to many people. Because I didn't do that in my bachelor's. I was fresh out of school. I just wanted to Go to uni and have a good time. My second degree, I was much more engaged, and I was, in all honesty, after I finished it, I felt like I was a year ahead of my peers. You don't always have the luxury to do that as well. I was pretty grateful that I had that behind me, too, when I finished up. Yeah, yeah.
[00:03:01] Speaker A: Cool, cool. Excellent. And so whip you, you do a few different things. Broad scope in the EP realm, what's the main focus we're talking about today?
[00:03:16] Speaker B: Yeah, so, main focus which I fallen into is disability management in terms of fatigue as a major symptom, that up to 60%, 70% of people actually report that they have fatigue as a daily symptom, and how that relates to adherence to exercise in supervised sessions with us as EP pts, doing our thing with them, and then unsupervised sessions. How does their adherence rate correlate? My main focus now as an EP is fatigue management for people with disabilities.
[00:03:49] Speaker A: Yeah. A big one is someone with chronic fatigue or specific condition. Thank you. So someone with chronic fatigue who's got a specific condition that's to do with fatigue, but it's going to spread out more than that. There's going to be other conditions that are going to cause fatigue, either from this, the condition itself, from the medication, from the mental load that they're going through, dealing with, whatever else happens. Do you have ways to deal with each of them?
[00:04:18] Speaker B: Absolutely. Fatigue is split into two categories. Primary fatigue is from the specific disability or condition. For instance, a lot of our spinal cord injury clients that we see, it's because of that lack of the motor neurons and the damage that's happened that has correlated to them having the fatigue. And then there's a secondary fatigue. Right. So secondary fatigue can come from medications, can come from environmental factors, treatment that they may be undergoing. So, yeah, there's two different areas, is there, in terms of the exercise prescription, we look at it in three ways as well. Okay. What type of fatigue is caused directly from their primary diagnosis? And then how can we prescribe a safe and appropriate exercise program? Then on top of that, we have to have a look at secondary. So that's why we always are wanting to know medical history, surgical history, medications that they're currently on, treatment that they're currently undergoing so that we can tailor it even further to be more individualized to that person.
Because really, it's. The general consensus is slow, controlled, safe prescription, especially if they're only starting out with exercise. But then again, yes, we have to individualize that and understand them As a whole, with the prescription of exercise. Yeah.
[00:05:39] Speaker A: So the more information that you're going to have will be given by the individual than the better choice of tools you're going to have to use with them, which should then result in a speedier or more efficient pathway.
[00:05:54] Speaker B: It can be a bit of a roller coaster to understand. And that's where the adherence factor has come into play, because. Yeah. As I mentioned prior to us jumping on here today, there's studies that are coming out that if people have mental fatigue specifically, they actually correlate with exercise probably being worse off for them. So they will choose to. So if they exercise, they will choose to pull back on the amount of effort that they're actually putting into the session because they've assumed that's going to cause more of a decline in their fatigue than improving it and managing it. Yeah. So it gets more session by session. We have to understand their fatigue levels. At rehab aid, we use outcome measures to manage that. We do a questionnaire to see how that may have changed. Because, as I mentioned, there's the secondary fatigue that comes into play that can be different week by week. If we've got a lower level there on one week, we then have to redirect the exercise program or modify it to make sure that we're keeping them adhered to that program as best as we can as well.
[00:06:59] Speaker A: Yeah, yeah. If I'm comparing that to weight loss, you're looking at the big picture rather than here to here, because it might have big jumps. Whereas in the long run, you've made that directional change, aiming for weight loss with fatigue management, 100%.
[00:07:14] Speaker B: It could even be day by day. Like, I use a. For one client, she likes to use a spoon analogy. So in her day, she's got 10 spoons, our highest level of energy. That's how we measure it. So we'll go in and go, all right, so what spoon level are we at today? How much can we use? And she might say a 3 out of 10. So that session's gonna look very different to how maybe she would say like a nine or eight out of ten. Right.
[00:07:40] Speaker A: Heard a bit of this spoon analogy through Facebook groups. Makes this. How many spoons have you got left? Some days I wake up and I've got no spoons today. For me, I've got clients myself. As a pt, I have days like today. I went to the gym. It was shoulder day. Shoulder day is usually great. I get in there and enjoy it, especially since I've had shoulder issues. Now I can get in there and do stuff today. Wasn't feeling it. I got the main things done and it just, it wasn't on. And I knew I know enough about myself to go, okay, if it's not on, I'll put in enough effort that I know that I've had a workout and it's not going to be a smasher. I get the good pump. I'm not going to be impressed at myself in the mirror, but I've done something. So that's a similar sort of thing as what you're measuring with these clients as they come in is going, what can we do with the energy and fatigue levels?
[00:08:26] Speaker B: Absolutely. That's exactly the same with fatigue, physical function fatigue. Thing is we have to individualize it to that person and we have to understand. Yeah. What they're feeling on that day and throughout the week. How can we adjust that? For instance, a lot of people say fatigue hits them in the afternoons. A lot of people will say after 2, 3 o'clock they're not doing much. They're probably going to go have a lie down or sit on the couch. It's about how we structure their day to prioritize exercise. So for that particular individual, I'm not encouraging afternoon or night exercise or physical activity because they're not going to do it. Same in general population. We've got to find what we enjoy. I enjoy working out in the morning, my partner enjoys working out in the afternoon. A lot better personal preference but it's also listening to your body and what is your body telling you. And there's no way that someone with high fatigue in the afternoon is going to be doing anything. So let's do it in the morning. Let's try and do it when we first wake up.
[00:09:23] Speaker A: Eat the frog, Brian, Tracy, Brooke, eat that frog. Just get it done.
[00:09:27] Speaker B: Yeah.
[00:09:27] Speaker A: The worst thing done in the startup.
[00:09:28] Speaker B: Just get it done. Yeah. Non negotiable. With a lot of clients we do calendars on the fridge, on the phone, reminders if they need me to email them out of the no extra cost or anything. It's trying to get them into a routine to increase adherence to their exercise and more movement.
[00:09:48] Speaker A: One of the things that they must have really drummed it in but it made the most sense is what is the best workout plan? What is the best meal plan is the one that gets done.
So that's what you're saying too. It's don't give them something in the afternoon if they're going to be tired, give them something when they will do it. Yeah.
[00:10:06] Speaker B: So 72, 72% of individuals over the age of 15, they do it 16 to 85 years.
They're not reaching exercise guidelines and that's people with disabilities. 72% of our Australian population is not meeting it that have a disability. Probably about 50% for people without disabilities. So we're already working with a high statistic there. Right. That are not meeting guidelines which if we want to make it as simple as possible, 150 minutes per week of aerobic based exercise is what we're trying to achieve. 30 minutes, five days a week. What is causing that high statistic? So there's a lot of factors. Right. But fatigue is.
I said 60% of participants are actually reporting that as a self reported symptom. That does not keep them motivated to exercise to the right intensity or capacity. The biggest goal is increasing that movement capacity and trying to get people to move their bodies with structured exercise or if it's encouragement of physical activity, which are two different things. Right.
[00:11:07] Speaker A: Is there a difference between physical and intellectual disability percentages?
[00:11:12] Speaker B: Are you aware of that that percentage? No, I think it's just general consensus of disability. I'd have to have a look with the comparison between physical and mental. But yeah, tech what we see and this is not going off stats or anything.
Yeah, yeah, yeah. Is our psychosocial clients definitely more higher in terms of non adherence to exercise. It is a struggle in those individual sessions that we're having with them to motivate them to continue to move their bodies in comparison to our physic physical disability clientele. So that's just in terms of what we're seeing out in the fit that.
[00:11:56] Speaker A: You work with, with the guys that have physical disabilities, would the majority of them be born with those disab or if they happened during their life?
[00:12:05] Speaker B: No, ours is majority.
It's probably 50, 50. So most of my clientele is usually I would see spinal cord injury clients and our psychosocial clients. So diagnosis has been after birth. But yeah, but in saying that my staff member that does work, she. All of her clients are from birth, they've had their disabilities but they are younger anecdotally.
[00:12:30] Speaker A: So just from what you see, what are you seeing A difference in the adherence with the people that have had the disability their whole life versus the people that have had an injury that's caused the disability later on in life. Is. Is there a difference there?
[00:12:46] Speaker B: I guess there's a slight. What I have noticed is because I've had a few of my clients prior to their injury happening, disability happening. They've been very active surfers, runners. And then this has happened to them and they've gone, my life is over. This is it. And then setback in rehabilitation early on in their injury too has then caused them setback because it's now mental health has kicked in. I see with those particular clients, it's less adherence to the exercise. I think it's more coming from the mental health side of things. With that is why should I be doing this and what is the point? I have a physical disability. This is never going to get any better. That's the conversations that we would be having, which is really hard because then you're sitting there going, we need to do this every single week, twice a week. They're just looking at you like, you're forcing me to do this. So it's a lot of education on the importance of it. Once you have a physical disability, like a spinal cord injury, for instance, your risk of comorbidities, so cardiovascular disease and metabolic conditions is much higher. And this is what we've seen. So when there's a lack of adherence because of mental fatigue within that five year period, five to ten year period since their injury that has caused the disability that they do get diagnosed with cardiovascular metabolic conditions because they're not moving.
[00:14:16] Speaker A: It's interesting. That wasn't the answer I was expecting, which is cool.
[00:14:19] Speaker B: Did it answer your question? I just want to make sure.
[00:14:22] Speaker A: No, no.
You know, you come up with, I'm like, oh, think this is my brain. So you asked the question, you're like, my brain's oh, I was wrong.
Which is good. It's good to be wrong. I was expecting you might say something, hey, these guys were surfers and stuff like that and they were professional athletes or whatever. And I've had this happen and they're like, I'm going to get back on the surfboard. Somehow I've lost that thing that was.
[00:14:45] Speaker B: Yeah, you see all the current affairs stories where that has happened and they're 10 times better because they're motivated to get back to their life and just go for it. But in all honesty, like in the clientele that I do see, I get them six, seven years past their injury. It depends on that first rehabilitation process, that one to two years where they have a spinal cord injury and they're like, this is the time that you're going to get. If you do all of this rehab in the next two years, you're going to be able to walk. They're trying to motivate this person, get them doing daily intense Rehab. I get the ones six, seven years down the track and they've had a bad experience in that first couple of years with their rehab and that sets the tone in their mental health going. I went to a physio and something happened and it set me 10 steps back and now I'm never going to be able to walk again, so why should I exercise? And that's where I get them. And it's. No, let's look at it from this perspective. We're trying to prevent other chronic conditions where you have to be on more medication, where you have to have more carers into your home showering you and helping you. Like, this is where I want your mindset to be. And trying to keep them on a track where it's, I can live a life with my disability. It's okay. They've had disappointing results in the first couple of years.
[00:16:10] Speaker A: So you've got a. I'm sorry, this is the way that my brain works. So you have a fridge full of magnets and each magnet is like the potential bad thing that can happen if they don't exercise. And you want to be asked, getting them to like, how many of these do you want to remove from the fridge? You've got 20 of them. Then now we can remove some of those magnets. I don't know why magnets came into my head.
[00:16:33] Speaker B: Yeah, no, that's not good.
Sorry. I'm going to use that because that's the perfect explanation. People think that as eps, we're trying to manage their con, their condition, which we are. But like I spoke about secondary things around that that we're really trying to prevent and control through power of exercise. If that exercise was in a pill, everyone would be popping it every day. It's not. This is where we're trying to help with that lifelong management of people with their disabilities and getting them to understand in 10 years time you can be here if you want to be here and not have that heart condition where you have to take five medications to control and keep you up and happening. If we just got this sort of adherence to exercise and managing your fatigue.
[00:17:20] Speaker A: And yeah, it's that again. Another picture. It's like when you've got that fork in the road, you can go left or right and then you get to the next road and go left or right. If you go all the way left, 20 forks down the road, it's going to take a long time to get back.
[00:17:37] Speaker B: Yes, 100. It's prevention and management of their current condition and how we can keep them Motivated to continue moving.
[00:17:47] Speaker A: Yeah, yeah. Keeping that up. Back to what you were saying about the. Within the first couple of years, do you think that again, this is going to be anecdotally, but from what you've seen, do you think that is them setting the bar too high or too low?
[00:18:03] Speaker B: Setting the bar high as the individual they are, but also the research. Right. Physios and eps. When we get someone that's just recently had an injury, if it's through motor vehicle accident, whatever it might be, we know that stat that in the first two years it is so important to get them doing the right safely prescribed rehab program to get them to a certain stage, usually around walking and movement. Where can we get you as close to where you were prior to your injury? Unfortunately, from the practitioner, we're putting a lot of pressure on that person because we know those statistics and that's so natural because we do want them to get back to where they were or as close to. And I think that mentally sets the bar quite high because there's a lot of success rate too. If someone's doing the right rehab program in those first couple of years and doing all the right things to get their body stronger. Some individuals, it doesn't happen for them, I do think setting the bar high for the individual, but it's also us as practitioners because we know research is so strong there that we just want to give them as best chance as possible. Yeah.
[00:19:16] Speaker A: So you're needing to crack the work, but they're, you're trying to get them there and if they haven't hit that thing, they're like, I'm a failure. This is shit. That's the onset of other emotional and psychological things.
[00:19:28] Speaker B: I'll share a story with you. So a long term client of mine, this exact situation has happened to him. He got to the stage where he was walking with assistance in a rehab session with a particular practitioner. And it was not anyone's fault really. But unfortunately in assistive assisted walking on a treadmill, his hip was broken.
So he had a spinal cord injury that was 18 months into his rehab. He got back up and walking, still assisted, but walking. And then that has happened. So that has set him back physically because he had surgery.
Then it's months and months of rehab again for that hip. But it also sets back all of that progression that they had with their, with the walking capacity. Strength is lost, starting from square one. So you can only imagine what that has done for his mental health.
[00:20:26] Speaker A: Yeah, demoralizing. Like just like I did all this.
[00:20:29] Speaker B: Stuff, it Sets everything back, personal things that happen that you're aiming for. At that time, he was wanting to walk his daughter down the aisle, and it didn't happen. That didn't happen for him. So there's things that are really out of control, out of our control as practitioners. Mentally. If they go, that's it. That was my only chance. Why even try again? And you're hoping that they're going to take that other road and go, no, it's okay. It's a setback, it's just a bump in the road. Restart again, it'll be okay. For this person, it was the other direction. I see him twice a week to get him moving in a chair now, because he will not stand, he will not try and walk. Nothing.
[00:21:14] Speaker A: Even all of the other stuff aside, that extrinsic motivator walking the daughter down, now that's. If that's gone. Now that's gone. And if that was like he was holding on to and helped push without that, then. Oh, I can see the co. So how was it like? If. I don't know if this is asking too much. Is this was it? He was walking and he slipped in the land, broke the hip.
[00:21:37] Speaker B: So this is where it gets really interesting. Right. So practitioner. So there's two practitioners. So when doing walking rehab on a treadmill, and the one person is doing assisted lifting through the feet and placing of the feet as that person's walking on the treadmill. So it was the movement of the foot coming off and onto the treadmill. The strength in his legs were not where they needed to be. And that already puts a lot of risk and pressure into that joint. And it might have just been the direction where the foot was placed on that walk. So that's how it's happened. So there was a fracture done into the hip, and that impact can cause it. It really could be many different factors, but this is what does happen sometimes. And it's usually a really rare thing. But yeah, yeah, that happened to him. Yeah, yeah.
[00:22:29] Speaker A: You. You've got pieces of paper saying you've learned stuff, and a lot of that's going to be the physical stuff. Working in with this, a lot of that. There is going to be a lot of psychology, especially dealing with fatigue, working on their mindset, things that are all in here.
How much psychology are you needing to apply? How much do you feel or how much have you had to learn to do that?
[00:22:51] Speaker B: It's probably been the most professional development I've done in the last five years. Like the psychology around conversation and Keywords. One lady wouldn't do any balance training exercises because she felt she wasn't old enough to be at that level to do that. So it's also just trying to find. Yeah. The differences with triggers. Exercise is going to trigger them to not want to do the exercise and what is going to trigger them to go, yes, I'm going to do this today because Kira said that this is going to be really beneficial for me to be able to go see my grandkids and run around with them in the afternoon. Yes. It's probably been the most mental fatigue and mental health care, I guess, has been the biggest professional development area that I've done. Coming into this sector, you definitely have to deal with clients. I was naive to how much psychology is based around the sessions and that's a consensus across all practitioners in the NDIS space. We have to have a level of psychology to connect with that person and understand them, to then be able to prescribe and do our primary job. Yeah.
[00:24:02] Speaker A: I think a lot more of it is the cycle. Like, I know how your body moves. I'm going to try and get your body to move that way. Why is it not. Is it the cool or do you just not want to? Or like, where is that? So actually, I'm going to ask you what.
Because I always need to upskill. There's a lot of things that I do.
I feel this is the right thing to do in this situation. I think this is going to help. I've done a few courses. I've got a few bits and pieces to help with the mind stuff. Have you got any courses or things that you would say would be good?
[00:24:37] Speaker B: Similar pathways, You've probably done them right. The biggest one I recommend is getting mental health first aid done.
Yeah. Going into this, I think it's an essential.
In all honesty, I think it should be a requirement for people working in this sector because that has helped a lot in terms of navigation of conversation and because you would know it doesn't just end in appointments, it's outside those appointments where they have your contact details. If they're having an episode, you're the most trusted person. What are you going to say in those conversations that's going to be relevant and help in that situation? That's the number one thing I recommend for anyone. When I have students, that's the number one thing I recommend. The second, because that's a yearly renewal which I have to also book in. It's just reminding me. So that would probably be the biggest thing. Is it?
[00:25:32] Speaker A: Yeah, it's in the last 12 months I did mine. Yeah. Because yeah one of my clients sparked me to do it. I realized there's something I need to do for you. I asked someone and they said to do mental health first aid. So I did. That might be about eight months now.
[00:25:47] Speaker B: The other one was a miniature course. I have to get the name of it. But the other thing that I would recommend to everyone is going through. I think it's like the. I don't know if it's my governing board or it's all overall but the NDIS like orientation because that's renewal. That's like new information. Same information but new every year. In the last couple of years they've added more information on mental health related things. That would be the other thing I recommend as non negotiables coming into the disability sector.
[00:26:18] Speaker A: Yeah, cool. That's cool to know about. Being updated.
[00:26:20] Speaker B: The module's updated. If there is anything that comes up they pop it in every year as a new thing. It'll be mostly the same but I've noticed the mental health side has been more updated.
[00:26:31] Speaker A: Sometimes when you go back even the same information you learn it differently because you're older, you've got more experience or you've got somebody that has made you look at something differently. Especially in this world. Oh yep. That would help them because of this and this. I heard that didn't discard it but haven't used it. Now I'm rehearing it. That's something I can apply specifically for We Johnny. There's no We Johnny's except for the jokes with fatigue management for myself I've got clients, a group of neurodiverse clients. Fatigue is probably more affected by anxiety and depression. With the guys I've got what would you apply in those circumstances?
[00:27:08] Speaker B: The first thing would be when is the fatigue? When are they noticing the fatigue the most? If this is something that they can't really communicate with you, asking the carers and non formal carers around them when are they noticing it the most? If that's the first thing you can get under control. For instance, if they say just after lunch because they've got a bit more energy with food in their tummy, then discussing their preferred exercise or physical activity, they might say I'd rather do some gardening or bounce the ball around at a park. So then that would be the probably the most prime Most. Yeah. Like you're going to encourage that over anything else because structured exercise is probably not going to work for your guys anyway. So what's Going to be activity that they're going to enjoy to do every single day. That's promoting movement. And then that third thing rolling into the third thing is trying to get them to do it as often as possible. We know that movement every day is the most effective. 30 minutes a day is the big consensus.
If we can get them moving for 30 minutes, doing an activity they love, that would be probably the major thing that we would work on, especially in those early days, trying to get them to move more. Yeah, that's how we would structure it.
[00:28:25] Speaker A: It's like anything. You adapt to the situation and find out what's going to work best. As you're saying that.
I just think if there's a couple of guys in the group and I'm like, oh, you know what I could do? I could bring a virtual reality down for the days I don't want to do it. But then I know everybody would just want to do that. The idea was there for a split second. I'm like, no, that would cause mayhem.
But they would do the movement. I've watched this one young fella, he doesn't like to exercise. We went to time Zone, and they've got this Olympics game. It's cartoony, like Mario Brothers. They stand on the pads, jump, run to a pat something. I'm looking at this kid like, dude, what the hell? Why do you never move like this in our exercise groups? And he's Mario. I have to. Oh, my God. All right, get some Mario down.
[00:29:11] Speaker B: Yeah. Virtual reality, things of that nature. That's such a big thing. Now, if that's something you can encourage him to do outside of your sessions, like if that's a possibility or something along, like, similar. The we and things of that nature. Like, that's. Yeah, that's. That's a really good way to get them moving without them feeling as if they're exercising. You're probably a step ahead into this area. We know that in a supervised group setting and they're at a convenient location for them to do an activity, it's 80% more adherence rate that we see for people. So having that social aspect, having someone there that knows what they're talking about in terms of movement, safe movement and being able to be a part of a community will bring more adherence. Even not even talking about fatigue levels. Right.
[00:30:02] Speaker A: Yeah, I see that directly. Funnily enough, I started doing against what I wanted to do. The guys encouraged me, and we started doing craft nights. I'm like, craft nights? I'm like, that's not pt, but you said you want to do it, we'll try it and then move on. It's now their favorite thing, watching the guys after starting craft night and getting camaraderie, community. And they care a little bit. They know the other boys more and try harder to compete with them. Those levels matter. I might fudge the rules to encourage one of them to win and they feel that sense of winning. I'll digress. I get excited about my stuff. This is about you.
[00:30:40] Speaker B: You probably notice if someone's away, they notice it as well. So they're onto that quickly, too. And that would bring encouragement and motivation for that individual that maybe missed a session so that when they come back, you're probably like you noticing that they're going up to that person and going, oh, why weren't you here? Being a bit more caring in that factor too. So that's going to help with adherence as well and keeping someone motivated to come back to that group.
[00:31:07] Speaker A: Yeah, actually, yeah. One of every areas. Bro, I missed you. I haven't seen so long. Do you have a different model that you would apply to someone where it is physical fatigue versus the mental fatigue? Is that.
[00:31:22] Speaker B: Yeah, so same structure. So we want to make sure that we find the time of day specifically that's going to be best for that person. If we're talking about my spinal cord injury, guys, it's usually midday where they've got out of bed. Carers have got them out of bed. They've had a little bit of movement by getting up and then they can use that middle part of the day to have as much energy in their. Like the spoons. They've got their sort of more spoons than usual.
[00:31:53] Speaker A: Yeah.
[00:31:54] Speaker B: And then in the afternoon, there's a massive decline from about 2, 3 o'clock. That's where we see. It's just they've used their body to their highest capacity in that part of the day. Massive decline. So we would tailor it in terms of what we're trying to get information from them. What's the best time of day? What's your most preferred activity? Do you want a lever resistance band in the kitchen? So, you know you've got to do upper body exercises for 20 minutes. Or is it more about when a TV show comes on specifically and that triggers your mind to then be able to go through your exercises? Usually they would sit in front of the TV and watch the same sort of show. That's what I've noticed. Just finding those little things. Right. And then, yeah, we move into more individual approach. Like we Would with any client. Usually my spinal cord injury, guys, is maintaining upper body strength with secondary lower body strengthening exercises if they're in the chair or not. So, yeah, it's very similar. What information do we need? Obviously the prescription is different because it's physical disability focused.
[00:33:00] Speaker A: If it's spinal cord and they've lost use of their lower body, is manipulation still exercise.
If somebody else was moving Disney. And deflect. Like moving the leg around and getting muscles to move and do something even though they're not the.
[00:33:17] Speaker B: Yeah, absolutely. So it's still considered in that we don't recommend that for entire sessions if they're able to independently move in some capacity. But yes, if. If that person didn't have the ability to. Yeah. Actively move. So passively, we would then move them and use things like resistance bands and ankle weights and things in those sessions. But us passively moving them. So, yeah, that's all very much counts. If we're contracting muscles where we're moving and it probably doesn't look like 30 minutes straight, but it does count.
[00:33:51] Speaker A: Yes. And if you're looking at the metabolic potential problems and that's. Then that is still doing something because blood flow and muscles are getting used, moved and stretched.
[00:34:01] Speaker B: Yeah, absolutely. Using different ways of contracting muscles too. So concentric, eccentric, but also isometric with more than likely doing all three of them in a session.
[00:34:12] Speaker A: Passive was the word I was thinking of. Manipulation, popping backs and stuff, isn't it?
[00:34:16] Speaker B: Yeah.
[00:34:17] Speaker A: Okay, cool. What have we missed? What's something really important that you still need to get?
[00:34:23] Speaker B: The biggest thing was emphasizing movement as the biggest goal, improving movement capacity. I had a couple of notes written down just so I didn't stuff up either.
To sum up, the goal of fatigue management for adherence is to improve movement capacity and get them to meet guidelines of 150 minutes per week of exercise in their own way. Individualized to them and understanding that. Yeah, the.
I guess the psychology around it is that, yes, people will think to themselves, I'm already fatigued. Why am I going to exercise? But if we're doing a safe and structured program, individualized to that person over a long period, we say we have to give it three months to get the effect of the exercise program. And this is when we talk about structured exercise. Right. It takes three months for it to feel and see different results and achieve some of those goals.
[00:35:24] Speaker A: Yeah.
[00:35:24] Speaker B: So it's also about. Yeah. Just trying to get them motivated to stick there for the three months. Because a lot of people. And this is. In general, it's tenfold with people that have disabilities that fatigue is a primary symptom. But a lot of people will just give up because they're not seeing automatic results within the one to two weeks. A lot of that psychology and education to get them there to feel and see those results. And it's proven in our research that fatigue can be managed through exercise. As I mentioned with our cancer patients it's the only form of treatment that helps with fatigue management. There's no medication strong enough across a lot of our conditions and disabilities. Exercises and physical activity is the main form of treatment for fatigue management.
[00:36:15] Speaker A: Yep.
Is there a difference when the medication is the reason for the fatigue?
[00:36:23] Speaker B: That's why we talk about secondary fatigue management.
[00:36:26] Speaker A: What are some pearls of wisdom for viewers? Ex phys or people with disabilities doesn't have to be specific to sports. You think people need to know we.
[00:36:39] Speaker B: Have a high percentage of people not regularly exercising. Right. So I think that disability. No disability. Right. We know the benefit of exercise really quite forward to but I guess anyone has a disability and is wanting to start exercise is find the most enjoyable thing where you're moving your body and do it every day.
[00:37:12] Speaker A: Yep.
[00:37:12] Speaker B: If that. Yeah. If that's gardening or if that's doing.
I don't know if you enjoy doing 10 squats every hour. That's the main thing to encourage. It's finding what you enjoy and movement shouldn't be feared. Unfortunately exercise is a scary word but if we change the perspective of movement for life and movement for. For you to go and go to the movies without pain or whatever it's going to be that's where we can get those statistics down of non adherence to the guidelines of exercise which is what we want for the health of the person for the burden of disease for we want it. It benefits everyone in the community when you're a healthier version of yourself.
[00:38:04] Speaker A: I sing when I exercise. I don't know if that's better for everyone else but once the endorphins kick in I'm. I don't care. I'm singing my songs. That's just how it is. I get some weird looks.
[00:38:14] Speaker B: Yeah. If that's what makes you happy. And that's going to keep you walking that lake or running that lake. Just go for comes together.
[00:38:22] Speaker A: Why are you doing that Jason? Oh, it's for my lung capacity. Yeah. Did you have any special deals or offers that if anyone drops vicarious insights you might be able to help them out with?
[00:38:34] Speaker B: Absolutely. For anyone new to rehab aids no matter what you're coming in for if you're. It doesn't matter if you're underfunding for the ndis or whatever it might be, every person that comes through will get a free initial assessment. That's 60 minute, saving about $250. It's really just to make sure that we're the right fit for you and you're the right fit for us. Because it doesn't make any sense. When I hear of people going to practitioners and they're spending so much money because we do cost a bit to come and see because we are specialists in our area, they have no connection with that person. It's a win for everyone. If we do the free initial assessment for everybody, then we know we're the right person for the job and they feel comfortable with us. It's just going to help with all of that motivation and yeah, everything at the start. That's a little bit scary for people. If you're comfortable with us, you get a free initial assessment in the home, at a pool, for hydrotherapy, at a park, wherever is convenient for that person. That's the luxury that we have. We're mobile based. We go wherever the person would like to meet us.
[00:39:40] Speaker A: Joe, I like that for a few reasons. It's not just come to me and it's free. You go to them, it's free, they can come to you. You can meet in different areas. But I also like that you're treating people on the NDIS the same as you're treating people that are not on the ndis, which is.
[00:39:53] Speaker B: Yeah, everybody.
[00:39:55] Speaker A: You hear horrible things about that. I hear some funny ones.
[00:39:58] Speaker B: Yeah.
[00:39:58] Speaker A: Cool. I know you've got a bit of a network. I met you at one of your networking events. If you feel they're not the right fit or somebody's better, you can refer out to them.
Sorry, you just completely cut out then.
[00:40:12] Speaker B: That's okay. Can you hear me?
[00:40:13] Speaker A: I can hear you now.
[00:40:15] Speaker B: Can you hear me? Yeah. That's the reason I started that Facebook group. It's for ndis providers and small businesses in southeast Queensland. So it was to connect providers. We have a private directory within that space too. So if I meet someone specifically and they would like to go on that private directory, it just allows. That's a big area, Southeast Queensland. So if any clients are coming to us and we're not in that location or there's someone that might specialize a little bit more with what they're trying to achieve, we. Yeah, we've got that sort of networking there where we refer them to the right ep, nurse, pt, ot, whatever they need.
[00:40:58] Speaker A: I meant to email you about that too. I will email you about that. Yeah. Awesome. And so contacts for you. What's the best? So if anybody's heard what you've talked about, likes what you've said, wants to get in contact with you, what is the best way to contact you? I'll write this down. See it, not just hear it. I'll put it in.
[00:41:16] Speaker B: Yep. I'll start like website. So it's www.rehabaidx. just let it x physiology.com.
that's where they can book the free assessment as well. So I'll start with that. But also Phone number is 041-067-6057. An email, we might pop that in the description. But yeah, either phone or email, they can call anytime. Always happy to answer questions over the phone.
[00:41:42] Speaker A: First links will be below on YouTube and Spotify. Any final thoughts? Anything else you want to say that I've missed?
[00:41:51] Speaker B: I think final thoughts are we're both trying to get people to move their bodies. I'm super passionate about getting people to move but continue to move as well and adhering to that physical activity they want in their life. Sometimes it's easier to have someone on your side like us along for the ride. The biggest thing to take home from today's conversation is that people like myself that can help to navigate those really difficult sort of challenging things that they're facing with fatigue and the discrepancies around exercise when they have fatigue. Yeah, cool.
[00:42:28] Speaker A: Cool. Awesome. I've enjoyed our chat. I've definitely me too few things there and it's yeah, I love this stuff. Any anything that's going to share information, make everyone a little bit better I think is always going to be a bit of a win.
Thank you for joining us at Vicarious Insights. We are all about learning and growing together. So if you have any questions, topics you'd like us to cover or guests you'd love to hear from, feel free to reach out.
[00:42:52] Speaker B: Thanks Jay.
Thanks for having me.
[00:42:55] Speaker A: Thank you for tuning in. We'll catch you on the next episode. Keep learning, stay inspired and let's make a positive impact together.
