In this issue of eMS news, we talked with Kendra Greeney, Exercise Specialist at the King Adult Day Enrichment Program (KADEP) here at the Rocky Mountain MS Center. KADEP is an innovative, community-based and cost-effective day program for younger adults with MS, brain injury and other neurological conditions. Kendra has a bachelor’s degree in Integrative Physiology from the University of Colorado, Boulder. There, she took classes on Exercise Science, Biomechanics, and Exercise Physiology among others, integrating the systems of the body. Kendra talks about the Exercise Program offered for KADEP clients, including the special adaptive equipment that clients access in our fitness room. We also hear about what brought Kendra to KADEP and why she loves her job.
Kendra, could you please describe your role at KADEP?
I started last May as the Exercise Specialist at the Rocky Mountain MS Center’s King Adult Day Enrichment Program (KADEP). I coordinate the exercise programs at KADEP, oversee the fitness center to ensure the equipment is functioning correctly and safely for our clients, and set up our clients with personalized exercise programs. We also have specialized equipment that I run and oversee – either in a group setting or individualized programming.
Just like for any individual, the philosophy of exercise involves the added benefits it brings to a person’s life – improvement of life satisfaction, overall health benefits. The nice thing about our setting is a lot of the equipment is adapted or can be adapted to clients’ abilities. And our staff is there for support and to help them get on and off equipment safely.
Please tell us about some of the ways the different equipment is adapted in the exercise room.
We have a typical cable machine that you’ll find in a regular gym or fitness facility. This machine has “arms” which can be adjusted for different heights. So if a person can stand and do an exercise, we’re able to bring it up to their appropriate height so they can do the exercise standing. And for those who are doing the exercise in seated position (whether due to fatigue or because they are in a wheelchair) we can adjust to their heights for that. We also have a wheelchair accessible bow flex machine and a seated elliptical machine.
We have a couple of recumbent bikes which are the “sit back bikes” for someone to get on and off of. One of the bikes is adapted with pedals that have straps so that their feet can be secured and stabilized on the pedals. And then we have two more passive bikes. These provide more of a range of motion-type of exercise. One is strictly a passive bike and one will start passive and move into active when it feels that the client’s legs have started to engage. So it can kind of kick back and forth, depending on the client’s ability. If a client is on active mode, the bike has a monitor to show how much they are using their right leg vs. their left leg to give them real-time feedback. The bike can go back into passive mode any time they start to feel fatigued. You can also change the adjustment of the weight and resistance to vary the workout. The bike also allows for upper arm movement so it adds a cardiovascular element.
We also have an arm bike. So someone who doesn’t get a lot of activity in their legs, they can use the arm bike for some actual cardio. That arm bike can also be adjusted for wheelchairs and the resistance can be adjusted on that as well.
We also have a Power Plate machine. There is some science behind vibration being a positive technique for decreasing tone that often accompanies neurological diagnoses. So clients can put their feet onto it and push into it while it’s vibrating and get some tone response. There are other claims about the Power Plate that it increases circulation, flexibility, strength and decreases pain. All of which our clients can benefit from in some way or another.
We have an array of free weights ranging from one pound to sixty five pounds, so clients can do any kind of workouts using those. We also have adaptive mitts, so if someone has trouble holding on to a handle or to a hand weight because of their grip, we can attach the handle or hand weight with the glove to do that.
The largest machine we have is our LiteGait which is our suspension treadmill machine. It allows clients to do walking and standing exercises with support. This machine holds up the client while staff helps them to walk. We do a lot of activities with clients on the LiteGait. Just getting them to stand up in the harness and weight bear through their legs is so valuable. We can do things like marching or single leg stance activities instead of just walking, we even utilize the harness to help stretch client’s legs. With the LiteGait, they can either bear their own weight 100% or you can adjust the harness so they are only supporting a percentage of their body weight.
All of our clients get a choice of classes to sign up for every 16 weeks, including the exercise classes. We offer other ways to do exercise in our program. Every morning, we have a morning stretch session. So if someone isn’t as into group exercise settings, they can go in and do some stretching every morning. And in that same setting, they can get assistance with stretching if they need it – they just need to request that of a staff person.
Every afternoon we have 30 minutes of open fitness. The fitness room is open right after lunch and people can come in and work out. So if they don’t have a fitness group that day, but they still want to get a workout in, they can come in and do that. The only thing that isn’t available at that time is the LiteGait because of the demands for staff support and supervision.
If someone signs up for the exercise class elective what does that involve?
They are all different and offer various opportunities for the clients. We have some classes that are circuits where we post up pictures at every station and clients rotate very few minutes. Assistants help them get set up at each station. I run an open fitness group if someone has more of an idea of what exercises they want to do, they have an opportunity to come in and do that. I run a core group because the more someone is wheelchair bound, the more their core muscles decrease in strength. So we do a lot of seated core exercises. We also have a specific LiteGait group where we rotate clients onto the LiteGait during the 75 minute group time. Usually each client has about 20 minutes on the LiteGait. When it’s not their week to be on the LiteGait, they can work on other exercises and stretching.
We also have a balance group which involves clients who are ambulatory (able to walk). And we work on balance, games, and exercises. We had one group called “Extreme Extremities” where they would focus on arms one week and legs the next. So it really varies from class to class.
Over your year at KADEP, what are your biggest takeaways on the impact that the exercise program has had on clients’ lives?
I think the LiteGait has definitely helped us to incorporate a more individualized approach with our clients. Especially because once they are in that harness you can see some of the areas they might be weaker in a bit better than if they were just standing on their own. So we have been able to focus more on strengthening clients’ hamstrings, gluets, adductors and abductors in particular. When someone is in a wheelchair for an extended length of time, the muscles in your legs and pelvic area get really tight and so being able to stand people upright and get them to stretch out really helps.
We have one client in particular that has an interesting postural stance. He stands more posterior to his left side. When we put him in the LiteGait, we can adjust his stance using the harness. And his gait really changes pretty drastically.
We’ve done some preliminary tests on LiteGait. Before we put each client in LiteGait we do some functional tests. With these tests we can measure things like their balance and risk for falls and safety. When we tested this particular client again, his score jumped eight points which is a big change. Overall, he has increased his strength. I also notice that he seems more stable. His posture in the LiteGait is still similar to the way it was before. But I think he has gained some strength and balance with the activities he’s done. And he also really enjoys it so we continue to work with him in the LiteGait.
We have another client that we tested this week and his personal long term goal is walking. He’s currently in a wheelchair. In the LiteGait, we noticed that his calves and hamstrings were very tight. So we’ve set up an area at the parallel bars to allow him to stretch those muscles out more in a standing position. Whether he’ll be able to walk over time, I can’t say. But he has improved his time. His test is what’s called the TUG (Timed Up and Go). So we time how long it takes to get up from a seated position, walk a distance, turn around and come back and sit in the chair. We modified it for him and used the distance of the parallel bars. I think the first time he did it before using LiteGait, it took him 5 minutes 45 seconds to do the whole lap. When we retested him last week, his time was just under 4 minutes. So he’s made significant progress in his pace, we’ve noticed an increase in his balance and especially his safety with turning.
How did you get interested in this work and what brought you to KADEP?
I have a bachelor’s degree in Integrative Physiology from the University of Colorado, Boulder where I took classes on Exercise Science, Biomechanics, and Exercise Physiology among others, integrating the systems of the body. I also have a degree in Occupational Therapy as an Occupational Therapy Assistant. I worked just under two years at St. Anthony’s Hospital in their Rehab unit. And my interest and focus has always been neurological disabilities. I think the brain is extremely fascinating and everyone presents differently as we see on a daily basis with individuals in general.
In the hospital setting, the one thing I felt I was missing was that community and long-term connection with my clients. In the hospital you might see them for a total of three to ten days, and short sessions at that. I really wanted to get to know clients better and work more long-term with them.
When I was in school, I wrote out what my dream job would be and it was very similar to the job posting at the Rocky Mountain MS Center’s King Adult Day Enrichment Center that I responded to. I really enjoy it here – it has been a great experience working with the clients, they are all fantastic. I also very much enjoy the structure of KADEP, the staff support and open communication regarding client’s well-being.
At the end of each day, what are biggest rewards of your role here at KADEP?
The clients enjoying their workouts and feeling they can work out in a facility that is set up for them and for their friends. It’s a great moment when you are working with a client and they have an “A-ha” moment – when they’ve learned an exercise and know that they are doing it correctly and safely and they are happy. That is incredibly rewarding.