The first step in creating a wellness program is identifying the need to encourage and model physical activity and to provide a safe and motivating environment for exercise.

Our client population is generally in the severe to profound MR category. Our goal was to create a program that could include individuals who have seizures and behavior disorders that would otherwise exclude them from participation due to the threat of injury to themselves or caregivers. We needed a program that did not require a long and elaborate element of training but would have immediate success. For these reasons, we utilized the treadmill, where the surface would move and the participant would automatically need to walk. There are bicycles being tested that may provide an alternative exercise modality.

We found pain perception and communication of needs an ever-present issue. Many of our clients appear to have a very high pain tolerance and are unable to verbalize complaints or concerns. To overcome this potentially dangerous situation, we choose dedicated and skilled personnel familiar with this population. Staff training in disabilities and wellness is strongly advised before attempting to initiate a program of this nature. Here, physical therapists do the initial assessments, monitor programs, and make necessary adjustments while trained physical therapy assistants implemented the routine sessions.

All individuals in our facility are referred by the primary care who provided medical approval Since we are a medically-based practice, we require a medical reason for inclusion into the program such as improving cardiovascular health, weight control, high lipid panel, etc. While general conditioning is strongly encouraged and a worthy outcome, if there is no need for a skilled physical therapy intervention, we prefer the program to be a part of the home routine. We provide guidelines, give suggestions, and help with the initiation of such a program, but require home staff to monitor and encourage regular participation.

Each client is scheduled for at least three evaluation sessions. The rationale for repeated assessments is to: a) obtain a good baseline for parameters of the program, including target heart rate range, speed, and grade of treadmill; b) have an opportunity to determine if a client who is apprehensive about being on the apparatus can learn to overcome his or her fear and comply with the program. (Likewise, repeated trials may show reasons for exclusion due to emergent client maladaptive behaviors with anticipation of the exercise protocol.); and c) provide us with multiple opportunities to determine the least restrictive guarding technique, either gait belt or sling suspension (to be discussed later).