Because most people afflicted with acquired brain injuries have been sedentary for long periods of time, physical activity may be primed with a stretching program. Many individuals with an acquired brain injury will suffer from ataxia, reduced range of motion, spasticity, incoordination, and altered tonus. For some of these participants, stretching may be a tremendously grueling experience, even at its most basic approach.

The three major types of stretching used in fitness and conditioning regimens are static, ballistic, and proprioceptive neuromuscular facilitation (PNF).

• Static stretching, the most popular method of gaining flexibility, involves slowly stretching a muscle to mild discomfort and holding that position for a period of 20 to 30 seconds.
• Ballistic stretching uses the momentum of bouncing to produce the stretching effect. This is a flexibility movement that produces a high risk of injury.
• PNF stretching refers to any of several post-isometric relaxation stretching techniques in which a muscle group is passively stretched, then contracts isometrically against resistance while in the stretched position, and then is passively stretched again through the resulting increased range of motion.

For participants who suffer from coordination problems and have difficulty completing stretches on their own, a knowledgeable trainer may administer PNF stretching. PNF was initially developed as a method of rehabilitating stroke survivors. Only a well-trained individual should administer this technique. Rob is very athletic and does have good coordination, but because of the extent of his limited range of motion, he benefits from this technique.

It is important in all aspects of exercise prescription with acquired brain injury not to push beyond excessive limits. The trainer must know his or her client. He must be aware of psychological limitations as well as physical limitations.

Although there are standards of time and intensity for all people involved in a fitness program, the trainer must relax these elements when working with individuals with a brain injury. For some individuals, completion of the simplest task can spell success. In time, by using accurate documentation and displaying patience, the coach can gradually increase the progression of exercises to avoid discouraging the participant.

A successful stretching program will incorporate flexibility exercises for all body parts and musculature by taking into account all restrictions that may apply. Flexibility exercises should be performed each day to provide optimum results, but the frequency will be determined by the level at which the participant can perform.

Using a multi-modal approach, the trainer should demonstrate each stretch and explain its effect on the area worked. It may be helpful to have the client identify a number of stretches he or she prefers doing and find pictures to correlate with each stretch. These may be posted where the client has access for reference and as a reminder.