1) What is the ARNI Trust?

First of all, please read about what ARNI is, and then below, why we exist.

The ARNI is designed by a successful stroke survivor as a working structure to help people with partial paralysis who want to make as full recovery as possible. We support the work done by the NHS by training cohorts of professional Instructors around the UK who wish to work (or are already working) in the area of rehabilitating stroke survivors. It is a unique professional devleopment programme, based on our direct and practical experience of stroke recovery and is fully in line with new neurological research perspectives. It encompasses:

• Task-related functional movement training
• Intensive resistance training
• Energy training and nutritional care
• Motivational counselling

The ARNI programme offers a uniquely tailored training regime for the individual, which revolves around functional movement with task-related exercises. Stroke survivors can tend to avoid using impaired limbs, a behavior called learned non-use, which is why task-related training is so important for real-life function return, which encourages brain plasticity.

It is the first comprehensive collection of reality-based techniques grounded in comtemporary neurological research perspectives.

It relies on the holistic effects of a combination of neurologically complementary strategies that aim to hit targets for individual cases.

Importantly, it is presumed that each case will be different and thus will require a different emphasis. As the training is so personalised it offers a unique chance to benefit from training that is normally absolutely inaccessible to the average stroke survivor. Indeed, this dedicated approach is completely unique; it has been designed specifically for the needs of the stroke survivor with partial paralysis who feels that they cannot find any way to recuperate further using more traditional approaches.

The ARNI Trust exists for YOU. We know that, by accessing our UK Instructors, you should expect to:

• Correct your balance and posture
• Improve your co-ordination and timing
• Increase your flexibility and stamina
• Increase your muscular, tendon and ligament strength
• Increase your confidence and remove your fear of the consequences of exercising
• Increase your ability to perform everyday tasks and progressively more self-sufficient
• Become productive in an occupation or past-time
• Increase your self-esteem and be happy with life

2) How does ARNI work?

Current neurological scientific research supports the premise that your brain has the ability to positively adapt to assist recovery of lost function after stroke.

The notion of brain plasticity, also known as ‘neuroplasticity’ is one of the most extraordinary discoveries of the twentieth century. It suggests that the location of a given function in the brain (for example, speech) can move to another area of the brain. In the case of stroke, brain plasticity refers to healthy brain cells taking over the functions of damaged brain cells. This means that certain lost functions, such as speech and language, may re-emerge as the result of intensive rehabilitation. The idea of the brain being able to ‘adapt’ to a traumatic event is new and optimistic.

So, why is that more people are not getting their movement back again after stroke? The number one reason is physiological: stroke causes a number of changes with the body that must be tackled incrementally because stroke survivors frequently have insufficient underlying motor activity to start the kind of task related practice they need to do. This system contains an abundance of techniques which are designed to prime the body for task-related practice.

With your ARNI Instructor:

The system you are about to learn has been rigorously tested over a period of 10 years with stroke survivors of varying ages, difference of type, severity and of time from injury and it WORKS. With your trainer, the application of individual trial and error is required in order to see what can be done using the specialised ARNI techniques and to understand what goals can be reached. All training given will be appropriate to the individual, even though you may be working in a group class.

With your trainer, the application of individual trial and error is required in order to seewhat can be done using the specialised ARNI techniques and to understand what goals can be reached. You need to be working 'on the edges' of your current ability to stimulate maximum neuroplasticity.

Your Instructor will show you progressively more advanced exercises including an introduction concerning how you can prepare your body for rigorous weight training, if that is a further goal of yours. Usually only body-weight resistance work is used by Instructors, although the ARNI training syllabus incorporates just 2 highly effective techniques for compound resistance training (the deadlift and squat). Both are variations of the usual techniques, as we have adapted them for stroke survivors' limitations.

Your training will finish when you find you no longer need the help of our specialists, but you can continue to use their gyms or training areas, or find another outlet in your own area, however old you are, to continually be active in order to maintain and add to your gains in terms of movement, stability, strength and conditioning.

HARD WORK? Well, yes...

You might find yourself wondering by now whether you could even think about doing something like this especially as we will tell you it requires a lot of hard work. Actually it is progressive hard work. There is a big difference. We will surely push you, but within your own limitations, which are of course going to be moving targets. The rehabilitative movements are done at a very basic and recuperative level, designed especially for the trainee. Likewise, essential resistance training is carried out at a low level with great care in exercise selection and attention to form. For example, see this feedback from 2 day training (June 2009).

3) Why is ARNI Exercise after Stroke needed in the UK? According to the research:

a) Traditional physiotherapy can become unavailable and may not support your more active needs after a while

Physiotherapy is essential in the acute, chronic and rehabilitative phases of stroke. But it is a sad fact that continuation of effective rehabilitation is generally unavailable from the Health Services once sufficient movement to move around has been achieved. In the UK, NHS neurophysiotherapists and ocupational therapists are simply stretched too thin. Physiotherapy cannot go on forever, and the work they do often is undermined by issues like 'learned non-use of limbs' and confidence issues.

Yet the degree to which brain repair, neurogenesis and neural rewiring happens can be enhanced very significantly long after the short therapeutic window after stroke, where most return of function is seen. The regain of quality movement with control, strength, flexibility, stability and essential physical coping strategies are highly individual, relying as they do on your own genetics, status of accompanying medical problems and attitude (drive, persistence, desire and motivation).

Great physiotherapists don’t want to 'keep' you for longer than you need to have them take care of you. They need you to rehabilitate in the community, and do more of the same kind of work that they have been doing with them (but by yourself, in a structured way) so that you can be creative, adapt and grow. In fact, some of the 37% of senior physiotherapists in the UK, who are using an eclectic mix of their own hybrid nature to help stroke survivors, find that they can identify a clear point when they find themselves needing to advise clients to move on (ie, their job is done)

You need support long after neurophysiotherapy has finished. Many stroke survivors report that they are left with photocopies of training 'exercises' to do, many of which they may have plateaued on anyway. These concerns have been echoed in the research for some time. Many physiotherapsists feel strongly that there is a certain point where it is the patient who must take charge and self-rehabilitate.

i) RESEARCH shows: Both home-based visits and outpatient exercise programmes can improve gait speed but declines by three months after intervention ceases. In other words, gains do not stay.

ii) RESEARCH shows: The effects of physiotherapy programmes on social participation and quality of life are inconsistent – which may be because these issues are complex or that later therapy does not always integrate underlying problems with day to day functioning in the real world.

iii) RESEARCH shows: Much physiotherapy in the rehabilitative stages still results in the stroke survivor doing too little, for fear of ‘doing it wrong’ or developing abnormal compensatory strategies.

iii) RESEARCH shows: Stretching muscles to prevent contractures does not work for long term neuroplastic change.

This is all important information to know, for it highlights a possible failing at the end of the physiotherapy process (through no fault of the hospitals) where patients are not only left in limbo, but are left sliding backwards. This may well result in a classic vicious circle (particularly when trying to conquer spasticity), where you end up back in hospital due to a fall, because you tried to take risks. Yet you MUST take risks in order to attempt to rewire your brain. Remember that increased movement, capability and decreased spasticity are two sides of the same coin. Clearly, a rehabilitation programme after the chronic stages MUST not only examine how increase function but also how to maintain any gains achieved.

b) The newest studies are showing that neither effortful activities nor strength training, per se, exacerbate spasticity.

Traditionally, high exertion activities were considered inappropriate for persons with post-stroke hemiparesis because excessive effort was thought to exacerbate spasticity. However, this perception is increasingly being challenged in the contemporary neurological research literature.

In a systematic review of 151 studies by (Van Peppen et al., 2004) there was found insufficient evidence that traditional neurological treatment methods were effective in improving muscle strength, synergies, muscle tone, dexterity, or ADLs after stroke.

Dutch researchers Kollen, Kwakkel & Lindeman in 2006 reviewed ALL available published (clinical) stroke rehabilitation trials, of which at the time of writing there existed 735. They selected 151 studies including 123 randomized controlled trials and 28 controlled clinical trials. The rest did not in their consideration meet the inclusion criteria or lacked statistical and internal validity, reflecting the poor methodological quality of many clinical intervention studies. This does not concern us too much - I’m just giving you the background picture to let you know how comprehensive the review is.

They say that such traditional treatment approaches induce improvements that are confined to impairment level only and do not generalize to a functional improvement level.In contrast, they stated that: ‘more recently developed treatment strategies that incorporate compensation strategies with a strong emphasis on functional training, may hold the key to optimal stroke rehabilitation’. In summing up their findings, they reported that ‘intensity and task-specific exercise therapy are important components of such an approach’.

The ARNI system was grown instinctively over ten years ago using this principle of hard work and strength training, combined with functional task-related movement training as a fundamental tenet.

Medical professionals and stroke researchers around the world are currently highlighting a necessity for you to rehabilitate in the manner you will find in this programme. This is cutting edge 'experimental', aligned with the current theories of brain plasticity. ARNI has a whole new manual of innovative techniques for working at the edges of your current ability, which, allied with hard work, will transform you. You can learn to cope with falls (the most dangerous part of the off-balanceness that stroke causes). You can learn to get down to, and up from, the floor. You can learn to turn 90 and 180 degrees quickly and safely etc. You can learn to pick up a book and turn its pages. So how is this all done?

c) Stroke survivors in the UK find it very hard to locate stroke classes which promote active task-related functional movement and resistance training.

Most after-stroke classes that do exist are unable to provide people with the tools to effectively cope with the rigours of daily life, let alone the overwhelming sense of physical inadequacy that keeps people firmly inside their comfort zones. This is particularly difficult if extra problems persist such as epilepsy or aphasia. This is because such classes normally place great emphasis on meeting/socialising. This is great, these meetings are very valuable. However, the impression can easily and frustratingly be given that post re-hab, you have do just do the best you can with what you have. But this is not so.

There are very few accessible sources from which to find out how to go about regaining actual movement. There exist exercise classes in the UK for stroke survivors, but they routinely play safe, focus on socialising, don't push you hard and don't show you how to push yourself hard.

The switched-on stroke survivor knows that no improvements in function are going to come easy, and is prepared to work hard. But, given the serious paucity of innovative approaches towards stroke rehab in this country, begins to wonder if nothing is out there which is really going to really work. Intuition tells you that there is more that you can do than just trying to wiggle your hands and feet round in little circles, whilst sitting in a comfy chair!

So what do you do, and which of the sources do you assess to be worthwhile? How do you know what is effective? If you see something that looks effective in another domain, how do you evaluate whether it will work for stroke rehab, or just be a waste of time? Basically, there is so much misinformation out there and most of it is not worth a jot for real-life transformation. Many of you will be aware of the mass of partial information and anecdotal evidence floating about, especially on internet sites. How do you weed though all of it?

How are you going to make the choice to try something new when most of it is so costly and there are no guarantees of success? We appreciate that it's very difficult. But the human brain is an absolutely extraordinary self-healing mechanism that once activated in the right ways, with the right attitude, can perform miracles. Neuroplasticity is on your side already!

4) What to do now:
I encourage you to do the research for yourself if you like, and find out for yourself that traditional approaches to stroke rehabilitation are becoming outmoded right now as we are finding out more and more about the brain's capacity for plasticity. Then, you need to consider aligning yourself with instruction that encourages a hands off approach - encouraging YOU to do the techniques to yourself, positively reinforcing the neurological messages. Remember: cells that fire together, wire together.

Then, make a note that ARNI Instructors are full time professional personal trainers and therapists carefully selected by the ARNI Trust. Many have MA or PhD degrees in neurorehabilitation and all have a wide degree of experience working with diverse populations. They have all gone through the ARNI Trust Exercise After Stroke Course and regularly keep up their professional development training with ARNI, which we give for all trainers 6 times per year, for free. They now must charge nominally for their services simply to cover costs. However, this way, you will have dedicated trainer come and train you in your house or you may decide to travel to their area. You will also have the option of working in a stroke group when your ARNI Trainer has enough stroke survivors to create a group class.

Please look further into our site, and especially at the testimonials from past and existing ARNI clients and their carers/family and testimonials from the Instructors who have been through our courses.

If you feel that you could benefit from contact with our team or know someone else who would, then please contact us for consideration and evaluation.

WHAT IS A STROKE?

THEARNI TRUST........working for st

THE ARNI TRUST

...working for the active recovery of stroke survivors