Bridging the Gap: Using Elite Athlete Principles for Neurological Rehabilitation

In this first article in the “Bridging the Gap” series of articles, I want to encourage you and I to start thinking about motor training for physical rehabilitation as if we were training an elite athlete. The resources applied in modern sport training are immense and I think there are many insights here that we can usefully apply in rehabilitation. In future articles we will expand on each of the topic lines introduced here including:-

• the importance of goal setting

• Individualised Training Programs

• Progressive Overload and Adaptation

• Recovery and Rest

• Nutrition for Optimal Performance and Recovery

In addition, we will look in more detail in future articles about what we know of neuroplasticity and it’s consequences, the energy systems of the body, management of fatigue and what types of expertise are needed to exploit all this knowledge.

The basic problem

If you are a professional involved in rehabilitation you have heard this type of story lots of times. A client wants to recover as much independence and quality of life as they can following a stroke or spinal cord injury. So what do they do? Where do they go?

They survived thanks to the NHS, but as the weeks turn to months an arm or leg still doesn’t work they way it did and they are seeking answers.
Intensive rehabilitation sessions are now offered by a number of (generally private) providers who can bring to bear various technologies and skills to encourage functional recovery despite a neurological condition. These facilities are offering something we instinctively recognise to be potentially valuable. At the very least they offer hope and focused action but do they always meet client expectations? Both the client and the therapy provider will have to commit to a personal rehabilitation journey with some uncertainty about the outcome.

Uncertainty of outcome

In medicine, uncertainty of outcome and things generally “unknown” are very common. I always remember learning the meaning of “idiopathic” (as in idiopathic scoliosis) thanks to the late Bob Salter, who described the term as meaning that “the doctor is an idiot and the patient pathetic”.
He was a great man who could be somewhat irreverent as Chairman of Orthopaedics in Toronto, but we understood that uncertainty was never a reason for inaction when it came to treatment. In many walks of life, we never have complete information and we must manage the uncertainty as best we can.
We try to balance the risk and reward. We avoid a high stakes gamble and at least understand what could be the worst case outcome.
Having spent some decades in a research environment I understood that the journey to learn more never ends - there is always room for more research. In the business of rehabilitation though, our clients are hungry for progress and want progress today - not after another decade of research.
It is important to apply the best of what we know now. Of course we also must strive to grow our knowledge of how to tailor motor function training to the individual. Imperfect knowledge means we must manage client expectations in the face of uncertainty.
I like to think of this process as akin to training individuals for elite sports performance. I believe there is value in adopting some of the same ways of thinking that we might use in training elite athletes and this is the overall purpose of this article and others in the “Bridging the Gap” series. I will explain why and lets cover some of the basics first.

Bridging the gap

The journey to recovery from a neurological condition, such as spinal cord injury or stroke, can be a challenging and demanding process. Intensive motor training plays a vital role in helping patients regain as much physical ability as possible. Elite athletes, on the other hand, undergo rigorous training and adhere to strict nutrition plans to achieve peak performance. This first article aims to introduce the potential benefits of applying the principles of elite athlete training and nutrition to help individuals recover from neurological conditions.

Unlike rehabilitation, sport at the highest level attracts significant finance and as a consequence has enjoyed research and development as elite teams and individuals search for that elusive peak performance. This effort has spanned areas such as athlete health, nutrition, training, recovery and mindset in an attempt to secure an advantage over the competition.  There is a vast literature and a plethora of equipment emerging from this work. In fact, looking from outside of the field, this commercial activity has to some extent raised the level of confusion about what works and what doesn’t. Social media is full of noise about technique, nutrition, wearable devices and theories, so often, the majority of athletes don’t really benefit from the research. There is too much confusion.
Beneath all the noise though, there is the inescapable fact that

elite athletes place a heavy emphasis on some fundamental issues and ignore the fads. They understand the benefits of consistent rather than extreme effort and the fact that transformation takes time.

The Importance of Goal Setting
Elite athletes and their coaches set clear, measurable, and attainable goals to track progress and maintain motivation. Similarly, incorporating goal setting in the rehabilitation process can provide patients with a sense of purpose, direction, and a clear path to recovery. Collaborative goal setting between patients and therapists can be challenging, but it aims to ensure that the targets are realistic and tailored to the individual's needs. Achieving smaller milestones that are meanigful to an individual can boost motivation and promote a more positive attitude towards rehabilitation.

Individualised Training Programs
Elite athletes follow personalised training programs to optimise their performance. These programs are designed to address specific weaknesses, strengths, and individual goals in a timely fashion. Applying this principle to neurological rehabilitation, therapists can develop customised training programs that target the unique needs of each patient, promoting better outcomes and faster progress. Individualised programs can also help in identifying the most effective exercises, technologies and training methods for a particular patient, ensuring efficient use of time and resources. It is difficult for organisations such as the NHS to deliver truly individualised approaches and remain efficient.

Progressive Overload and Adaptation
In elite athletic training, the concept of progressive overload is essential for continuous improvement. For example, by gradually increasing the intensity, duration, or frequency of training, athletes stimulate their bodies to adapt and grow stronger. This natural principle can also be applied to neurological rehabilitation, where gradual progression in motor training can help patients to rebuild neural connections, improve motor function, and enhance overall physical ability. As the patient's abilities and physical health improves, therapists can adjust the intensity and complexity of the exercises to ensure continued progress.

Recovery and Rest
Rest and recovery are integral components of elite athlete training, allowing the body to repair and adapt to the stresses imposed by exercise. Similarly, incorporating rest periods and a focus on recovery in neurological rehabilitation can prevent burnout, reduce the risk of injury, and optimise the benefits of motor training. Adequate sleep, stress management, and relaxation techniques can also contribute to better recovery and improved overall well-being.

Nutrition for Optimal Performance and Recovery
Nutrition is a complex and multifactorial issue and we have far from complete information about it. Just about the only thing we can agree on is its relative importance. Elite athletes follow precise nutrition plans to fuel their bodies for peak performance and recovery. In the context of neurological rehabilitation, a well-balanced diet can provide patients with the essential nutrients to support the healing process, boost energy levels, and enhance cognitive function. Consulting with a registered dietitian can help patients develop a personalised nutrition plan that meets their specific needs and promotes optimal recovery.

Conclusion

Adopting the principles of elite athlete training and nutrition in neurological rehabilitation can provide patients with a comprehensive and holistic approach to recovery. By setting clear goals, individualising training programs, applying progressive overload, prioritising rest and recovery, and focusing on optimal nutrition, patients with neurological conditions can maximize their potential for regaining physical abilities and improving their overall quality of life. In this series of Bridging the Gap articles we will examine various aspects of elite performance training to see what we can usefully apply in the domain of physical rehabilitation.