Elements and Performance Criteria

The Range Statements provide advice to interpret the scope and context of this unit of competence, allowing for differences between enterprises and workplaces. The Range Statements relate to the unit as a whole and helps facilitate holistic assessment. In addition, the following variables may be present for this particular unit of competency:

Address factors affecting exercise adherence in clients with neurological impairment
barriers to participation and adherence
structural, eg, access
attitudinal, eg, other participants
programming
possibly initial low fitness level
preference and need to emphasise functional capacity and tasks of daily living
realistic, supportive and positive environment
non-judgmental
respect for individual client
appropriate level of instruction for age and cognitive ability, ie, do not always assume cognitive impairment
social interaction

Appropriate apparel and equipment
footwear
other aids including
strapping

Cardio-respiratory conditioning

choice of exercises and location

appropriate to impairment and health needs

within context of exercise prescription

emphasis on functional capacity and activities of daily living, eg, mobility

gait, coordination, balance limitations

low initial fitness level, easily fatigued

inefficient movement

possible cognitive impairments

integration with muscular training

may first need to improve strength, balance and range of motion

use of exercise machines and circuit training

low initial fitness level and need for gradual progression

Components of an exercise session

importance of warm-up and cool-down in context of client's health needs

incorporation of stretching

role of different conditions methods in health context

muscular conditioning

cardio-respiratory conditioning

balance of different methods

health justification of each components

time efficiency

Ensure client safety and to monitor client responses to exercise
equipment modification, set-up, maintenance
actions of able-bodied clients using facilities at same time
appropriate apparel and footwear
client instruction of safe practices
formal instruction
informal supervision
written materials and displays
spotting, strapping, supervision, assistance
alterations to standard monitoring methods (eg, heart rate) may be needed for some impairments, eg, spinal cord injury
direct observation of and communication with client
potential risks to client
differ according to impairment and age
may be similar or different from able-bodied
dehydration, heat stress, hyperthermia
shortness of breath
irregular heart beat, chest pain
fainting, dizziness
sudden loss of balance, muscular strength or coordination, eg, need for spotting
autonomic hyperreflexia in spinal cord injury

Exercise leadership and design of exercise sessions for clients with neurological impairment

individual and group instruction

clear instructions and demonstrations, especially for those with cognitive impairment

respect for client as individual

formal and informal instruction and supervision

possible need to educate able-bodied clients about impairments in other clients

importance of warm-up and cool-down

adaptation of exercise setting, equipment and program

role of different outcomes of physical conditioning

fitness needs

health needs

functional capacity needs

integration of various modes appropriate to needs and impairment, eg, importance of stretching

Exercise variables to be altered in an exercise prescription for clients with neurological impairment

appropriate modes for different types of impairment

emphasis on functional capacity related to tasks of daily living

duration

frequency

intensity

optimum combination for different types and severity of impairment and desired outcomes

Muscular conditioning
choice of apparatus and exercises
weight machines, dumbbells, elastic bands
appropriate to impairment
within context of exercise prescription
whole body, isolated muscles
posture, gait, coordination, balance
muscle tone, spasticity and stretching
emphasis on functional capacity and activities of daily living, eg, wheelchair transfer
safe and effective exercises
range of motion and limitation for certain movements
posture and body position control
spotting, strapping, direct supervision and assistance
moderate intensity, gradual progression
monitor for adverse reactions
integration with cardio-respiratory training

Professional behaviour in relationship and communication with clients and allied health professionals

confidentiality of client health and personal information

when to refer client who shows untoward response or requires alteration of exercise prescription

correspondence and communication with allied health professionals about clients with neurological impairment

Role of physical activity in managing neurological impairment and enhancing health in clients with neurological impairment

pathology, causes and impairments due to most common neurological impairments likely to be seen in exercise setting

Cerebral Palsy (CP)

Acquired Brain Injury (ABI)

Stroke

Parkinson's Disease (PD)

Multiple Sclerosis (MS)

Spinal Cord Injury (SCI)

effects of exercise in enhancing functional capacity and managing impairment

health benefits of exercise in neurological impairment

answer client questions about effects of exercise

Understand and apply physical activity recommendations for clients with neurological impairment

limitation to exercise capacity imposed by each type of impairment

modification of standard exercise prescription for each type of impairment

modification of exercise prescription according to grade of impairment, eg, SCI, CP, or stage of condition, eg, MS

examples of appropriate activities for each type of impairment and for each grade within particular impairments, eg, SCI, CP

cerebral palsy international sports and recreation association, eg CP-ISRA, classification of impairment

influence of cognitive impairment in some conditions, eg, CP, ABI

The Evidence Guide identifies the critical aspects, knowledge and skills to be demonstrated to confirm competence for this unit. This is an integral part of the assessment of competence and should be read in conjunction with the Range Statements.
Critical aspects of evidence to be considered
Assessment must confirm integrated demonstration of all elements of competency and their performance criteria, in particular, assessment must confirm the ability to
translate exercise prescription for clients with neurological impairment into the practical exercise setting
explain and discuss with the client all aspects of the exercise prescription and reasons for inclusion of specific components in the context of the client's impairment
lead and instruct exercise for clients with neurological impairment, both individuals and groups
monitor safe exercise practices and make corrections when appropriate
maintain exercise equipment, exercise aids and the exercise setting to ensure client safety
apply risk assessment procedures in exercise settings serving clients with neurological impairment
recognise and act on evidence that a client with neurological impairment is not coping with exercise, is showing signs or symptoms requiring referral, or is experiencing an untoward event during exercise
demonstrate appropriate emergency procedures for a client with neurological impairment experiencing an untoward event during exercise
demonstrate appropriate manner, attitude, empathy and patience when working with clients with neurological impairment

Interdependent assessment of units
This unit must be assessed after attainment of competency in the following unit(s)
SRFAHN001A Make referrals and work collaboratively with allied health professionals where appropriate
SRFAHN002A Receive and respond to rehabilitation referrals from allied health professionals
SRFFIT010B Utilise a broad range of fitness equipment
SRFFIT016A Apply information from postural appraisals to fitness programs for moderate risk clients
SRFFIT018A Apply anatomy and physiology to fitness programs for moderate risk clients
SRFFSP003A Plan and deliver exercise to promote physical and psychological well-being in low and moderate risk clients
SRFFSP005A Deliver exercise for people with a disability
This unit must be assessed in conjunction with the following unit(s)
Nil
For the purpose of integrated assessment, this unit may be assessed in conjunction with the following unit(s)
SRFFSP004A Plan and deliver exercise for moderate risk children and young adolescents
SRFFSP006A Plan and deliver exercise strategies for musculoskeletal rehabilitation
SRFFSP009A Plan and deliver exercise for moderate risk clients with musculoskeletal needs

Required knowledge and skills
Required knowledge
Common neurological impairments likely to be encountered in the exercise setting, eg, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, acquired brain injury, stroke
Causes and consequences of each disorder with regards to physical and cognitive impairments likely to affect exercise capacity
Benefits of physical activity for each type of impairment
Modification of standard exercise prescription for each type of impairment
Physiological responses to exercise associated with neurological impairment, and how these differ from responses in able-bodied
Structure of an exercise session for clients with neurological impairment
Expected fitness level and progress in clients with different types of neurological impairment
Barriers to exercise and strategies to address these in clients with neurological impairment
Signs and symptoms of untoward events that may occur during exercise in clients with various neurological impairments
Limitations to gait and movement, and role of stretching (active and assisted) in enhancing range of movement
Neurological impairments associated with cognitive impairment that may affect the client's ability to communicate
Association of neurological impairment with major health risk factors, eg, cardiovascular disease, and role of exercise in managing these
Different roles of cardio-respiratory and muscular conditioning for different types of impairment
Required skills
Exercise leadership for individuals and groups of clients with neurological impairment
Exercise instruction using a wide range of modes including dumbbells; weight machines; Theraband; Swiss balls; water, floor and chair exercises; core stability
Exercise equipment set-up and maintenance
First aid
Safe exercise procedures specifically for clients with neurological impairment
Strapping and other stability techniques when needed for clients with neurological impairment
Gait, coordination and balance assessment and exercises
Range of motion and stretching techniques (active, assisted)
Various methods to monitor client's responses to exercise, especially when these may differ from responses expected in able-bodied
Structure of exercise session to meet needs of client with neurological impairment
Education of client about role of exercise in enhancing functional capacity and addressing needs of client with neurological impairment

Resource implications
Physical resources - assessment of this competency requires access to
interaction with moderate risk clients with neurological impairment under direct supervision of a supervisor who is experienced working with clients with neurological impairment. This interaction should occur in appropriate exercise settings, such as a fitness centre, community fitness program, or health care setting, eg, aged home, rehabilitation centre. Assessment should include work with a variety of exercise modes and equipment appropriate for use with clients with neurological impairment, eg, exercise machines, weight machines, exercise mats. Material for strapping parts of the body if needed for resistance exercise must be readily available
appropriate documentation and resources normally used in the workplace, such as client progress forms, correspondence with referring health professionals, and instructional materials, eg, brochures, displays, specifically for clients with neurological impairment
Human resources - assessment of this competency will require human resources consistent with those outlined in the Assessment Guidelines. That is, assessors (or persons within the assessment team) should
be competent in this unit
be current in their knowledge and understanding of the industry through provision of evidence of professional activity in the relevant area
have attained the National Competency Standards for Assessment: BSZ401A, BSZ402A and BSZ403A

Consistency in performance
There is a wide range of potential clients with neurological impairment. Thus, assessment should include clients of different ages with different types and severity of impairment. Due to issues such as safety requirements and deliver of appropriate techniques, this unit of competency should be assessed over at least three (3) and preferably up to five (5) different occasions to ensure consistency of performance over the Range Statements and contexts reflecting the diverse range of neurological impairments that a fitness specialist might encounter in the work environment

Context for assessment
This unit of competency must be assessed in the context of health, functional capacity and physical activity for clients who have some type of physical and/or cognitive impairment due to a neurological condition. This often requires adjustment of the standard exercise prescription and client approach to focus on functional capacity and health rather than physical fitness
This unit of competency should be assessed through observation of processes and procedures demonstrated by dealing with real clients, oral and written questioning on required knowledge and skills (especially how each neurological impairment influences exercise capacity), and the manner and attitude when working directly with clients with neurological impairment
Where performance is not directly observed or is required to be demonstrated over time or in different locations, evidence may be authenticated by supervisors or clients or other qualified individuals, provided that the person authenticating this evidence has directly witnessed his/her interactions with clients and is experienced working with clients with neurological impairment, and that this authentication addresses issues specifically relating to delivery of exercise for clients with neurological impairment

These levels do not relate to the Australian Qualifications Framework. They relate to the seven areas of generic competency that underpin effective workplace practices.

The three levels of performance (1, 2 and 3) denote the level of competency required to perform the task:



1. Use routine approaches

2. Select from routine approaches

3. Establish new approaches

Please refer to the Assessment Guidelines for advice on how to use the Key Competencies.
Communicating ideas and information
Discuss with client the role of physical activity in managing impairment, explain the different components of the exercise session and program, and explain reasons for inclusion of these in context of client's health needs and physical and/or cognitive impairment(s) (3)

Collecting analysing and organising information
Incorporate exercise prescription and information about client's health and impairment into planning and delivery of exercise session, instruction and discussion with client (2)

Planning and organising activities
Major responsibility for organising, leading and instructing exercise sessions in a safe and effective manner that addresses client's physical and/or cognitive impairment(s) and needs (3)

Working with others and in teams
Liaise with allied health professionals providing exercise prescription about client progress, responses and adaptations to exercise program (3)

Using mathematical ideas and techniques
Use of some quantitative techniques such as monitoring heart rate and rating of perceived exertion (2)

Solving problems
Monitor client's response to exercise and make adjustments appropriate to the client's needs, responses and impairment within the context of the exercise prescription (2)

Using technology
Use of exercise equipment (eg, free weights, weight machines, exercise machines), heart rate monitors (possibly), various exercise techniques, eg, Pilates, Theraband, Swiss ball, use of strapping when appropriate (2)