Body Brain FitnessTM (BBF) is a therapeutic enrichment program that has been developed by Rehab on the Move and has been successfully in use since 2007 to help people living with complex disability.
There is considerable evidence that people with complex disability are at increased risk of developing dementia as they age (Satz, Paul 1993) and the BBF Program, based on current research, was designed to slow this progression. It was not initially designed or expected to produce short or medium term improvements however this is what has been achieved.
Participants have improved their cognitive, social and/or physical skills within months of commencing the Program as well as improvements in behaviour, communication and fatigue levels.
A recent audit of the BBF Program showed 85% of participants demonstrated a marked improvement in quality of life and 31% also achieved an increased level of independence. More details of the results achieved are included in the Goals section below.
The BBF Program is based on:
- Neuroplasticity Theory, which is the ability of the brain to change by regrouping its neural pathways to adapt to new information. (Nundo,RJ 2013)
- Neurogenesis which is the birth of new brain cells. There is solid evidence that this occurs in adult mammalian brains and such changes can persist (Rakik 2002) (van Pragg et al 2002).
- Brain Reserve Theory which describes how the effects of dementia later in life can be minimised if cognitive reserves are built up. (Satz, Paul 1993)
The goals of the Program are:
- To slow down the aging process so people with complex disabilities can continue to live at home and participate in their community for as long as possible.
- Delay the need for additional care as the person with a disability ages.
- To improve the quality of life for the person living with a disability, their family and carers.
- To increase their level of independence and decrease their level of reliance on their carers.
These goals are achieved by improvement in:
- Communication and use of appropriate language
- Self-regulation of behaviours
- Fine motor control and performance in self-care activities
- Balance, transfers and mobility skills
- Memory, planning and problem solving skills
- Concentration, attention and fatigue levels
Body Brain FitnessTM Sessions
BBF is a three-hour program. The group session is run in combination with physiotherapists by occupational therapists and speech pathologists with experience in brain injury. Most participants attend a session weekly, but more regular attendance (twice per week) has resulted in more significant and sustainable improvements.
Before the first session each new participant in conjunction with their family and care worker undertakes an assessment to ensure suitability for the BBF Program. Assessment includes:
- Baseline physical, cognitive and behavioural skills including identification of strength areas.
- Risk identification to enable proper management and to ensure the safety of all group members and staff.
- Goal identification.
Following the assessment, specific activities that take into account the participant’s goals and the physical and cognitive abilities of the participant are agreed upon. The therapist will incorporate the individual goals and activities into the group program.
There are four components to the Program.
1. Physical Exercise
Each session commences with a 30 minute physical workout that is aerobically challenging and includes coordination, balance and strength exercises compiled by our physiotherapists. Apart from improving fitness, there is evidence that exercise assists to build the connections between brain cells which assists with cognitive function. Recent research including that from Dr Michael Valenzuela at The University of Sydney indicates greater cognitive function is seen when combined with exercise (Valenzuela 2006). Other research has supported the theory that higher cardiorespiratory fitness is related to higher cognitive function (Brown et al 2010).
It is important to stress that this is not a ‘physio-rehab’ session. The main focus is to increase the heart rate and the blood and oxygen flow to the brain before the cognitive component of the session. Whilst safety is paramount, exercises are designed to motivate and be fun in an environment which encourages participants to support each other and push their own limits.
2. Cognitive Exercise
A range of cognitive exercises that challenge different parts of the brain are provided. They include computer based activities, group games and puzzles and are designed to exercise attention, memory, problem solving, language and visual-spatial skills. Exercising the different parts of the brain responsible for these functions together, which is referred to as ‘cross training’, helps build new connections and results in better outcomes. Research reveals that doing this type of training in a group setting is of vital importance to achieve results (Valenzuela 2014).
This 30-minute session of cognitive exercises stimulates memory, processing speed, judgement skills, initiation, attention and perceptual skills. Participants learn new tasks and skills. Learning a new task is more critical for the brain to change its structure than continued training of an already learned task (Driemeyer et al 2008).
3. Social Interaction
A morning or afternoon tea is included in the BBF Program and organised to maximise interaction between the participants and to develop social and communication skills. When indicated, the therapist will facilitate behaviour modification and the use of appropriate language. Participants are encouraged to contribute to a topical conversation that improves their confidence and self-esteem. They are assisted to use their communication aids providing purposeful use of the skills that some of them are mastering with their speech pathologist. There is also an emphasis on fostering the development of friendships between participants and we often see them assisting each other in managing difficult behaviour. The social interaction continues into the final hour of the BBF Program when the participants pursue a creative activity.
4. Participation in purposeful activities
In the last hour a wide range of creative activities that foster new learning are provided. These include handicrafts, clay work, paper art, woodwork, photography, small pot gardening and painting. These are all designed to facilitate the development of their hand function, coordination, visual perceptual skills, motivation, initiation, attention, planning and cognitive skills. Activities are carefully selected to engage the participants in a social setting whilst they are producing something that builds on their self-esteem. Opportunities are provided to display their finished work in local and community shows.
BBF is a group program that allows participants to work together to achieve their individual goals in a social group setting. Evidence based practice has been used to develop this program to facilitate best results for the participants in the group. Through participation in physical exercise, cognitive activity, social interaction and purposeful activity, our participants have shown improvement in their overall functional abilities and participation.
Program developed by Caswell Health Care