On the Front Lines But Not Engaged in the Battle

Abstract

Physical inactivity and its related health conditions have reached pandemic proportions.1 Because of its greater prevalence, inactivity in the general population now may account for more disease burden and mortality than smoking.2,3 In persons with neurologic health conditions, physical inactivity and its inherent risks are often compounded by physical and/or cognitive impairments that limit balance and mobility. Indeed, the statistics are alarming regarding the extent of inactivity and the sequelae of immobility in persons with neurologic deficits.4–7 In 2005, the US Department of Health and Human Services issued “The Surgeon General's Call to Action to Improve Health and Wellness in Persons with Disabilities.” This call to action challenges health care providers to forge partnerships to provide more effective treatment, better education of future providers, and the implementation of health promotion programs.8,9 Although barriers to implementing such programs certainly exist, the neurologic physical therapy community has been too passive on this issue. Ironically, neurologic physical therapists are on the front lines of the battle to promote physical activity and exercise. Physical therapists are trained to understand that sedentary behavior is not an inevitable consequence of most neurologic conditions.10 Physical therapists are uniquely positioned to intervene at the primary and secondary prevention levels in those living with neurologic conditions.11 Unfortunately, the majority of our care is delivered in response to the onset of disability rather than in an effort to prevent it. Many of our clients are discharged from insurance-reimbursed care and left to fend for themselves in search for health, reduction of disability, and options for physical activity and exercise. Rather than leading the charge to answer the Surgeon General's call, the physical therapy community appears willing to tacitly accept as inevitable the pervasiveness of the sedentary lifestyle due to neurologic dysfunction and its deleterious consequences. Our commitment to these individuals is incomplete unless we directly provide or advocate for access to prevention and wellness care. This special topic issue of the Journal of Neurologic Physical Therapy was designed to illustrate ongoing efforts to raise our standard of prevention and wellness care. Rimmer and Yamamato outline a plan for the prevention of postrehabilitation health decline in acquired neurologic conditions (cerebrovascular accident, traumatic brain injury, or spinal cord injury) through efforts to minimize extrinsic barriers to prevention and wellness programs. To provide an explicit example of the implementation of such a wellness program poststroke, Rose and colleagues outline their partnership with the community in delivering secondary prevention services. Ellis and Motl use Parkinson disease and Multiple Sclerosis as the context for addressing intrinsic barriers to participation, such as self-efficacy and outcomes expectations. As part of this discussion, they outline novel ways of encouraging participation through virtual coaches and online support. Mulligan and colleagues provide an explicit example of partnership with persons with Multiple Sclerosis to deliver interventions designed to minimize barriers to physical activity. The remaining two articles provide explicit examples of clinical application. Rather than focus just on mobility outcomes, in a case series of persons with Parkinson disease, Tabak and colleagues outline the potential cognitive benefits of consistent exercise. Finally, Sasso and colleagues provide an example of the successful application of efficacious interventions to a home program for an individual with a long-standing spinal cord injury. It is our hope that this special topic issue will motivate readers to consider their role in prevention and wellness in neurologic physical therapy. As stated previously, there are substantial barriers to the regular provision of prevention and wellness services to our clients. However, these barriers also represent a spectrum of opportunities for contributing to the solution. Physical therapists should be engaged in determining policy, in community advocacy with stakeholders, and in the provision of resources, infrastructure, and expertise to persons with neurologic disability in the community.11