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

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 by Tweedy *et al* [23].

## **5. Members of an interprofessional clinical and therapeutic team strategy to manage spinal cord injuries**

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

**111**

**Figure 1.**

*The Interprofessional Clinical and Therapeutic Team Strategy to Manage Spinal Cord Injuries*

As such these individuals require an interprofessional team of clinical and medical practitioners to manage their health and wellbeing [30]. The medical and clinical management of a spinal cord injured individuals begins as soon as the injury occurs and persist throughout the person's life; pre-hospital immobilization, surgery and post-surgery rehabilitation and aftercare. Generally the interprofessional clinical and therapeutic team includes a physician (medical doctor), pharmacist, physiotherapist, occupational therapist, kinesiotherapist (United States of America) or biokineticist (South Africa and Namibia), rehabilitation nurse, psychologist and nutritionist [2, 31] (**Figure 1**). The medical doctor is the primary healthcare giver who serves as a referral source to the other practitioners [32]. Grogery stated that each member of the interprofessional team must acknowledge and respect each profession's scope of expertise to ensure success [33]. Due to focus of this book being on the effects of physical therapy on neurological pathology, this sub-section will concentrate on contributions of physical and exercise therapy to management of spinal cord injured individuals.

The speciality of the physicians involved in the management of spinal cord

management and type of injury). During the surgical phase the emergency medical

Post-surgery during the rehabilitation phase a pulmonologist, physiatrist, urologist

injured individuals depends on the time post-injury (that being phase of

surgeon, anaesthesiologist, neurosurgeon, orthopaedic surgeon is needed.

*The interprofessional clinical and therapeutic team supporting a spinal cord injured individual*

*DOI: http://dx.doi.org/10.5772/intechopen.94850*

**5.1 Medical doctor/physician**

### *The Interprofessional Clinical and Therapeutic Team Strategy to Manage Spinal Cord Injuries DOI: http://dx.doi.org/10.5772/intechopen.94850*

As such these individuals require an interprofessional team of clinical and medical practitioners to manage their health and wellbeing [30]. The medical and clinical management of a spinal cord injured individuals begins as soon as the injury occurs and persist throughout the person's life; pre-hospital immobilization, surgery and post-surgery rehabilitation and aftercare. Generally the interprofessional clinical and therapeutic team includes a physician (medical doctor), pharmacist, physiotherapist, occupational therapist, kinesiotherapist (United States of America) or biokineticist (South Africa and Namibia), rehabilitation nurse, psychologist and nutritionist [2, 31] (**Figure 1**). The medical doctor is the primary healthcare giver who serves as a referral source to the other practitioners [32]. Grogery stated that each member of the interprofessional team must acknowledge and respect each profession's scope of expertise to ensure success [33]. Due to focus of this book being on the effects of physical therapy on neurological pathology, this sub-section will concentrate on contributions of physical and exercise therapy to management of spinal cord injured individuals.
