**5.1 Medical doctor/physician**

*Therapy Approaches in Neurological Disorders*

relationship [17, 21].

**cord injured patients**

iii.Van Straaten *et al* have documented that habitual physical activity and

iv.The need for regular flexibility training reduces stiff tight asymmetrical muscles, which allows for easier movement [17]. Many spinal injured individuals often have muscle contractures that limit their movement. Regular flexibility exercises decreases muscle contractures by increasing their muscle extensibility, joint range of motion and agonist-antagonist force couple

**4. Exercise prescription of physical activity and exercise for spinal** 

Both the World Health Organization and the American College of Sports Medicine (ACSM) have prescribed habitual physical activity and exercise for spinal cord injured individuals [10, 28]. However their frequency and intensities differ. The WHO suggests spinal cord injured individuals exercise at low to moderate intensity at least three times per week for approximately 30 min a day [28]. The exercise session can be solely strength resistance training or aerobic and/or a combination of both. Whilst Martin Ginis *et al* and the ACSM have prescribed that spinal cord injured adults should engage a minimum of 20 minutes of moderate to vigorous intensity aerobic activity at least twice a week, in addition to two strength training sessions per week [16, 28]. Jordaan disagrees with WHO, Martin Ginis *et al* and the ACSM aerobic exercise prescription because she feels that the aforementioned exercise prescription is insufficient [2, 10, 16, 28]. Jordaan rationale is based on the premise that spinal cord injured individuals are usually physically inactive; therefore, their metabolism is very low expending low amounts energy [2]. Jordaan recommends an aerobic exercise regime of 4 days a week to increase the individual's metabolism and consequently increase their energy expenditure [2]. The rationale for the aerobic exercise regime is based on the clinical fact that many spinal cord injured individuals have poor metabolic risk profiles, which increases their unfortunate campaign towards the onset of non-insulin diabetes mellitus, obesity and cardiovascular diseases [3, 4]. Therefore these individual should follow an analogous exercise rehabilitation prescription plan of cardiac patients, provided they don't have any further contra-indications. The aerobic exercise intensity should range between 11-14 on the rate of perceived effort (RPE) Borg Scale and/or 60-75% of heart reserve. Exercise duration should steadily increase from 10-40 minutes per session as per Ehrman *et al* prescription guidelines [29]. Strength training should be performed at least twice per week consisting of three sets with 8-10 repetitions per exercise for each major muscle group as per Martin Ginis *et al* strengthening exercise guidelines [16]. However the strength training should start at 40% of the incumbent's 1RM and steadily progress to 70% following Ehrman *et al* prescription [29]. Flexibility should further be included at least thrice weekly as recommended

**5. Members of an interprofessional clinical and therapeutic team** 

Spinal cord injured individuals have numerous diseases (neuro-musculoskeletal and non-communicable diseases) that are affecting their wellbeing simultaneously [2].

**strategy to manage spinal cord injuries**

exercise diminishes spinal cord injury inflammation and neuropathic pain, however the exercise-induced-physiological mechanisms are unclear [27].

**110**

by Tweedy *et al* [23].

The speciality of the physicians involved in the management of spinal cord injured individuals depends on the time post-injury (that being phase of management and type of injury). During the surgical phase the emergency medical surgeon, anaesthesiologist, neurosurgeon, orthopaedic surgeon is needed. Post-surgery during the rehabilitation phase a pulmonologist, physiatrist, urologist

and a rehabilitation medicine specialist is needed. The aforementioned medical doctors all have significant roles to play in the successful management of spinal cord injured individuals, who needs to comply with their directives [34]. The consulting medical doctor and/or physician general serves as the source of referrals for physiotherapy and exercise therapy (biokinetics and kinesiotherapy).
