AA

Section 2: Interventions OFM Intervention • Remediate ability or restore performance through relearning and/or adaptation. • Occupation-as end to restore function • Occupation-as-means to optimize abilities. • Activities bring together abilities and skills within a functional context (e.g., wringing water from sponges as a component of washing dishes). Frames of References Biomechanical Frame of Reference: Focus: • Musculoskeletal problems and orthopedic conditions • Remedial approach • Directly addresses impairments in body functions • Appropriate when feasible to restore strength/ROM Intervention Approaches • Prevention o Orthotics, ergonomic principles, PROM, home exercise program. • Remediation/Correction o Edema management, PAMs, therapeutic exercises (resistance bands, putty), therapeutic activities, gradually increase repetitions/duration • Compensatory/Adaptive o Adaptive equipment, durable medical equipment, energy conservation. Rehabilition Frame of Reference: Focus: • Can be used with anyone and is focused on returning individuals to their hightest level of independence and function despite any residual impairments. • Modify approach • Promotes use of assistive technology, compensatory strategies, and environmental modifications. • Appropriate when remediating impairments is not possible or is not the immediate goal. Appropriate for: • Individuals with conditions that are considered chronic, permanent, or progressive o Arthritis, Parkinson disease, multiple sclerosis. • Individuals who have undergone remediation-focused treatment but still have residual impairments • Individuals who prefer a compensatory or adaptive approach • Individuals who lack access to remediation-focus treatment Mixed Approach: Adapt & Restore Activities of Daily Living (ADL) • ADL: an area of occupation defined as activities needed to care for one’s body o Also referred to as personal activities of daily living (PADLs) & basic activities of daily living (BADLs). • Include: o Bathing & showering. o Toileting & toilet hygiene. o Dressing. o Swallowing and eating, feeding. o Functional mobility o Personal device care. o Personal hygiene and grooming. o Sexual activity • Difficulties in ADL performance o Due to disability, illness or injury o Lead to activity limitations and participation restrictions. Skilled ADL Intervention • The use of a functional activity to help a patient regain or develop the skills needed to perform the task to become more independent. o For example, during an ADL treatment, we should be providing skilled intervention to: ▪ Improve strength and functional endurance ▪ Improve dynamic and static balance ▪ Improve AROM, gross and fine motor skills, eye-hand coordination ▪ Improve abilities to use sensation, vision, and cognition to safely perform an ADL ▪ Educate and train in modified and safety techniques Types of Interventions: Occupations and Activities Occupations: • ADLs: Client completes morning dressing and hygiene using adaptive devices Activities: • Components of occupations: client selects clothing and manipulates clothing fasteners in advance of dressing. Types of Interventions Interventions to Support Occupations • PAMs: practitioner administers PAMs to decrease pain, assist with wound healing or edema control, or prepare muscles for movement to enhance occupational performance. • Orthotics: practioner fabricates and issues a wrist orthosis to facilitate movement to enhance participation in household activities. • Assistive technology: practitioner uses Eyegaze software to communicate daily needs. • Wheeled mobility: practitioner recommends, in conjunction with the wheelchair team, a sip-and-puff switch to allow the client to maneuver the power wheelchair independently and interface with an environmental control unit in the home. • Self-regulation: client participates in a fabricated sensory environment (e.g., through movement, tactile sensations, scents) to promote alertness before engaging in a school-based activity. Education and Training • Education: practioner provides education regarding home and activity modifications to the spouse or family member of a person with dementia to support maximum independence. • Training: practitioner instructs the client in the use of coping skills such as deep breathing to address anxiety symptoms before engaging in social interaction. Advocacy • Practitioner collaborates with a client to procure reasonable accommodations at a work site. Group • Client participates in a group for adults with traumatic brain injury focused on individual goals for reentering rh community after inpatient treatment Approaches Types of Approaches • Create + promote • Establish + restore • Maintain • Modify • Prevent Weakness Bed Mobility: ability to bridge in bed, roll from supine to side-lying, scoot up and down in bed, move from supine to sitting & sitting to supine & sit at edge of bed. • Teach bed mobility skills to clients with weakness promotes ADL participation • Therapy focuses on adaptive techniques and aids such as railing and other supports Bathing: clients with weakness may have difficulty transferring into bathtub or shower, standing or sitting in shower, grasping and holding onto items. • Therapy focuses on adaptive techniques, pre-planned placement of items and aids such as special bathing chairs, grab bars, and ways to ease grip demands. Toileting & Toilet Hygiene: it requires a person to be able to don & doff clothing, sit on and rise from toilet, reach and grasp toilet tissue, and clean perianal areas. • Clients with weakness may have difficulty grasping/holding onto clothes and cleaning supplies and transferring onto and off of toilets. Safe Patient Handling: Precautions and Transfers Tip Sheets • Always review policies and procedures, as additional precautions may be specified by the surgeon. Weight Bearing Precautions • Some patients may have restrictions on the amount of weight they are able to put through a limb. Weight-Bearing Status Description Full weight bearing (FWB)/ Weight bearing as tolerated (WBAT) No weight restrictions; patients may bear full weight. Partial weight bearing (PWB) Up to 50% body weight through the affected extremity, unless specified otherwise/ Toe-Touch weight bearing (TTWB) A minimum of 10% body weight through the affected extremity. Non-weight bearing (NWB) Hip Precautions No weight allowed on the affected extremity. • Hip precautions vary depending on the type of surgical approach used. Anterior Hip Precautions 1. No hip adduction (do not cross legs) 2. No external rotation (do not turn toes outward) 3. No extension past neutral (do not step the leg backward or bridge) Posterior Hip Precautions: 1. No bending past 90° 2. No internal rotation (turning toes in) 3. No hip adduction (crossing legs) Spinal or Back Precautions 1. No bending 2. No lifting ≤ 5lbs 3. No twisting • Tip: use phrase “No BLTs” (Bending, Lifting, Twisting) to remember these precaution Sternal Precautions • Precautions may vary based on physician protocol 1. Avoid overstretching the sternum area 2. Avoid bearing down through arms during transfers as much as possible Treatment Guide for Conditions Purpose: This worksheet organizes relevant information regarding the treatment of conditions and diagnoses discussed throughout the semester. In class, we will work to brainstorm potential equipment and interventions for spinal stenosis patients. The remaining charts are intended to be completed independently. Conditions & Diagnoses: • Spinal stenosis • Cardia • Stroke • THR • TKR • Hip fracture (consider weightbearing status – NWB, TTWB, PWB, WBAT) Instructions: For each condition or diagnosis, think about: 1. What you could suggest if a patient complains of pain. 2. Relevant precautions the patient should adhere to. 3. ADLs that a patient may have difficulty with due to their current condition/diagnosis. 4. Adaptive equipment (AE) the patient may need to function during ADLs. 5. Durable medical equipment (DME) the patient may need to function during ADLs. 6. Appropriate interventions a. What kills (e.g., weight shifting) can you assume you will need to work on based on the condition/diagnosis?  Wheelchair Mobility Areas of Functional Mobility Assessment Nervous system, vision, hearing, and structures related to movement Propulsion: ability to self-propel Environment of chosen activities Physical abilities, cognitive function, & social support Body mechanics & posture – important to maintain balance Ability to plan for and judge realities of real world movement Wheelchair Skills • Mobility training programs include: o Falling safety: first skill taught o Maneuvering on smooth surface, open spaces o Maneuvering on difficult surfaces (e.g., sand, gravel), tight spaces and obstacles (e.g., curbs, steps) o ADL training in home, grocery, and public environments, and mobility device care and maintenance. Manual Wheelchair Navigation • Most efficient – semicircular • Least efficient – arc • Wide turns made by “dragging hand” on push rim in direction person want to turn • Very tight turn – accomplished by pushing forward on one rim while pushing backward on other Ramps and Slopes Leaning into hill (ascending or descending) helps to avoid tipping Skilled users may descend ramps in a wheelie to prevent falling forward Wheelies allow propulsion over uneven ground Changes in Level Assistant helps by slowing movement Assistant helps when moving up step(s) Stairs Using wheelie to descending deep platform stairs Using “bump up (down)” method Power Wheelchair Navigation • Training – similar to manual wheelchair o Begin in open, barrier – free environment o Arrange environment and equipment so person is successful o Set speed of power wheelchair at slow setting o Give single-step directions o Grading tasks can build client confidence Ramps and Slopes • ADA guidelines state - any change in level over ½” should be ramped at 5° or less o For every 1 inch or rise, ramp must have 12” of length (1:12 slope) • Ramps in public have: o Surface with detectable texture for persons with visual impairments o Railings and curb to prevent rolling over edge o 4-feet level landing at top of ramp Documentation for Wheelchair Use • Wheelchair used • Method of propulsion • Speed and accuracy of navigation in each environment • Training of assistants and wheelchair rider’s ability to direct care during navigation • Safety in performance of each skill • Safety, or safe navigation, is most important aspect to document Overview of Interventions for Balance Impairment • The approach(s) used to address balance impairment can be determined by underlying deficit and would be more appropriate if there is potential to improve the deficit through remediation, compensation, or adaptation. • May begin with a compensatory and/or adaptive approach to increase safety independence. • Remedial techniques include: o Increasing ROM o Strength and/or endurance when motor dysfunction effected on balance o Fall prevention Specific Interventions for Balance Impairment • Remediation of balance impairments o If indicated that client factors can be improved, a remediation (biomechanical) approach is appropriate o Exercises and occupation-based activities can be used to improve core, UE, and lower extremity strength or activity tolerance, by gradually increasing weight/repetition. o Reaching can be improved by gradually increasing activity demands for reaching during training or rote exercises, while seated unsupported as long as it is safe. o Therapist starts by ensuring that client achieves postural alignment having: ▪ Pelvis in neutral to anterior tilt with equal weight bearing on the ischial tuberosities ▪ Trunk extended in a midline orientation ▪ Shoulders symmetrical and positioned anterior to the hips ▪ Hips and knees flexed and neutrally rotated ▪ Both feet securely on floor o Occupation-based challenges requiring active weight shift include: ▪ Incorporating tasks that demand movement on variety of planes ▪ Any combination of movements plus upward or downward directions. Compensating for Balance Impairments • Safe weight shifting • Bracing with contralateral UE • Getting dressed in bed • Alternate methods of lower body dressing • Toileting hygiene while sitting • Pants over knees before standing • Standing activities in front of chair in case of balance lost • Pull pants over knees before standing from toilet • Position directly in front to avoid reaching outside of base of support • Making bed while lying in it • Wear terry cloth bathrobe to dry instead of towel Adapting for Balance Impairments Supports Added to Home Environments Grab bars Stair railings Electronic Life Chairs Stair lifts Toilet safety handles Nonslip floor surfaces Cane, walker, wheelchair Reacher Pant clip for toilet clothing management Positioning Functional Transfers Interventions for Transfers • Intervention for improving transfers – two approaches: o Remediation o Adaptation • May address underlying impairments and direct transfer training • Each underlying impairment can be addressed alone or in combination • Addressed in several activities while practicing actual transfers • Environmental attributes also varied during training – different heights of transfer surfaces. Standing up and Sitting Down • Transition from standing and sitting – essential for daily occupations. • Sit-to-stand transfer requires intact balance with the integration of adequate mobility at pelvis, hips, postural alignment, postural adjustments, weight shifting, and strength in core and lower extremities. Interventions for Visual Field and Binocular Impairments Visual Fields • Visual field deficits (VFD) are associated with CVA or TBI and include hemianopsia or quadrantanopia. • It occurs due to lesions along the visual pathway between the optic nerve and visual cortex. • The right hemisphere of the brain processes information from the left half of the visual field (VF) in both eyes, while the left hemisphere processes the right half of the VF. • Prevalence: o 36% of individuals with right-hemisphere stroke experience VFD. o 25% of individuals with left-hemisphere stroke experience VFD. • Central Vision: Responsible for acuity, recognizing features and details of objects such as color, shape, motion and depth. • Peripheral vision: Attention to the environment. • Peripheral Field Cut: o Visual field loss occurs contralateral to the lesion o Clinical presentation: ▪ Reading difficulties (missing portions of a page) ▪ Objects or people suddenly appearing from the affected side ▪ Difficulty with environmental navigation and locating items during ADLs ▪ Compensatory behaviors like head turning or tilting during vision screen and ADLs o Prognosis: ▪ Some natural recovery occurs in the first few months, but most individuals will not fully recover. Treatment Strategies for Visual Field Deficits (VFD) Compensation: Finding strategies or techniques that work around limitations Adaptation: Modifying the setting or demands of a task to facilitate performance Remediation Compensation VFD are not effectively remediated Adaptation Use organized scanning strategies (e.g. lighthouse) Use line of guides High contrast visual anchors placed on affected side Use anchors Frenel prism glasses Increased contrast Increase awareness Place items on unaffected side Increased organization of client’s environment Visual Field Cut Interventions • Education & training on compensatory strategies • Lighthouse strategy: encouraging head turning • Environmental scanning (large saccadic eye movement) o Saccadic Fixator o BITS (Bioness Integrated Therapy System) o Dynavision o Split Hart Chart (targeted scanning exercises) • Caregiver education: modifying the environment and home set up • Neuro-optometry referral: prescription of prism lenses, which shift the impaired visual field to the central area of the retina. Binocular Vision Disorders • Binocular vision disorders are characterized as either strabismus or nonstrabismic, can occur after stroke; common vision problem following TBI. • Binocular vision disorders may be caused by damage to: o Cranial nerves 3, 4, or 6. o Midbrain injury o Oculomotor nuclei injury • Prime symptom is double vision or diplopia; can interfere with a client’s ability to participate in functional tasks. Types of Strabismus Description Type Esotropia Exotropia Inward tuning of the eye Outward turning of the eye Hypertropia Hypotropia Upward turning of the eye Downward turning of the eye Binocular Vision Challenges Skills required for binocular vision: • Alignment • Stereopsis (depth perception) • Convergence Clinical Presentation: • Diplopia (double vision) or blurry vision • Seeing shadows or misaligned images • Squinting or closing one eye to compensate • Overshooting/undershooting when reaching for objects • Difficulty reading or avoiding tasks at near point Convergence Insufficiency • Difficulty converging eyes on a near object. • Symptoms include: o Headaches o Eye strain o Avoidance of near tasks • Brock String Exercise: o Uses a 6’ or 12’ string with different color beads/ o The client changes gaze from one bead to another to improve convergence and divergence skills. Treatment for Oculomotor Dysfunction Remediation Compensation Scanning exercises Adaptation Tracking exercises Visual anchors & guide lines Large print materials Pacing strategies Range of motion (ROM) exercises Prism glasses Increase awareness of deficit Increase lighting Computer programs Head movements Increase contrast Teach systematic scanning Eliminate visual clutter Dynavision Brock String Exercises Oculomotor Weakness Interventions • Oculomotor Skills Training (ROM) o Pursuits: ▪ Letter tracking ▪ Marsden ball ▪ Flashlight exercises ▪ Ball bouncing tasks o Saccades: ▪ Split Hart Chart ▪ Saccadic fixator ▪ BITS/Dynavision Interventions for Diplopia: Patching • Total occlusion: eliminates double vision when other treatments fail. • Considerations: o Overuse can limit chances of recovery o Follow neuro-optometrist recommendations (change sides every two hours) o Allow time without the patch if tolerable o Downside: ▪ no light enters the retina, resulting in loss of peripheral vision and depth perception • Partial occlusion: allow some light to enter while reducing diplopia • Strategies: o Apply translucent tape over the affected visual field o Positioning techniques to encourage eye alignment (remediation) • Benefits: o Light enters the retina which preserves depth perception o Maintain some peripheral vision Interventions for Diplopia: Stereopsis Training • Utilizing red/green glasses • Red lens can only see green portion of the image • Green lens can only see red portion of the image • Requires the client to keep both eyes open Guidelines and Vision Therapy Activities • Principles of Vision Therapy: o Identify the patient’s easies level of performance o Be aware of frustration levels o Maintain an appropriate training level o Make the patient aware of the therapy process o Set clear therapy objectives o Remain flexible in treatment approaches • Vision Therapy Activities: o Hart chart saccades o Symbol tracking o Letter tracking o Visual tracing o Rotator-type instruments o Flashing tag General Considerations • Remedial vs. Compensatory approaches • Monocular vs. Binocular activities • Prevent head movement during oculomotor strengthening activities • Incorporate learned strategies during ADLs and IADLs for carryover • Add balance component to upgrade visual demands • In-room exercises or home exercise program (HEP) • Include caregivers to promote home safely, following up with neuro-optometry, and completion of HEP Cognitive Interventions (Suero, 2024) Cognitive Impairment & Occupational Therapy • Occupational therapy practitioners have a key role in assessing functional cognition. Occupational therapists use everyday task performance to identify cognitive impairment and inform the plan of care (AOTA, 2021). Mental Functions 1. Arousal and orientation 2. Attention and processing 3. Various types of memory 4. Executive functions 5. Self-awareness Assessing Cognition • Coma Recovery Scale • Agitated Behavior Scale • Orientation Log • Mini Mental State Exam • Montreal Cognitive Assessment (MoCA) • KF-MSA Hopkins Medication Schedule • Safe at Home Assessment • Modified Mini Errands Test • Quick cognitive screens alone cannot demonstrate a relationship to world performance. (Hartman-Maier et. al., 2009) Approaches to Cognitive Intervention • Current research supports use of functional tasks, improving participation despite functional impairments, and compensation/strategy training over remediation. (Gillen, 2009) o Skill habit training o Cognitive strategy training o Environmental modification/adaptation Skill Habit Training • Two systems for behavior: o Controlled, effortful, deliberate o Rapid, effortless, automatic • Training through task practice Cognitive Strategy Training • External strategies o Checklists o Alarms o Smart phone • Internal strategies o Self-talk o Mental imagery Communication & Cognition • Expressive aphasia • Receptive aphasia • Global aphasia Low Level Cognition • Arousal • Alertness • Consciousness • Attention • Processing Low Level Cognition • Auditory function • Visual function • Motor function • Oromotor – verbal function • Communication scale • Arousal scale High Level Cognition • Addressing multiple subsets of cognition • Multiple Errands Task • Cognitive tool kits • KF-MSA Hopkins Medication Schedule • Safe At Home Assessment • Community Skills Outing Safe at Home Assessment • Uses a simulated unsafe environment to assess how well patient can recognize and fix potentially unsafe situations • Functionally based assessment of cognitive abilities related to detecting and correcting home safety hazards. • Identify potential barriers to safety in the home environment to guide interventions and prepare for discharge Cognitive Tool Kits • Filling cabinet • Wrapping a gift • Microwave cooking • Table setting • Tool box • Medication management • Money management • Planning a trip • Orientation Grading Cognitive Tasks • Concrete ↔ Abstract • Simple ↔ Complex • Quiet ↔ Distracting Setting Goals for Cognition • Initiation • Sequencing • Organization / planning • Safety awareness • Working memory • Self-awareness • Sustained attention • Error detection Documentation • SOAP notes • Describing task • Measuring accuracy • Describing assistance provided o Did you upgrade or downgrade the task? Motor Interventions • Neuroplasticity: the brain’s ability to reorganize and regenerate neural connections • Motor learning: the ability to develop a relatively permanent change in motor skills from novice to skilled performance through practice or experience. • Motor control: the process of initiating, directing, and grading purposeful voluntary movement. Motor Recovery Approaches • Traditional: o Based on reflex hierarchy model with motor control as the focus o Bottom-up approach → focused on impairments. o Promoted passive interventions – techniques a therapist performed “on” a client ▪ Examples: • Neurodevelopmental Treatment (NDT) • Proprioceptive Neuromuscular Facilitation (PNF) • Brunnstrom Approach • Contemporary: o Movement emerges from dynamic interactions of multiple systems o Focus on restoring functional movements through task-specific training ▪ Examples: • Task-Oriented Approach (TOA) • Motor learning-based interventions • Best Practice Approach? o Traditional motor control theories are no longer considered best practice. The field has moved towards Dynamic Systems Theory (DST), which emphasizes interactions between systems to promote movement. Motor Learning Stages & Principles Stages of Motor Learning 1. Cognitive stage: high attention, frequent errors, external feedback needed. 2. Associative stage: refining movements, errors decrease, increased self-correction. 3. Autonomous stage: movements become automatic, requiring minimal effort. Motor Learning Principles • Stage of learner: o Early stages: identify effective strategies to accomplish task goals (high cognitive demands) o Later stages: adjust and refine skill execution (lower cognitive demands) • Task specificity: learning depends on the type of task being learned: o Discrete tasks: recognizable beginning and end (e.g., kicking a ball) o Continuous tasks: repetitive and rhythmical (e.g., walking) o Serial tasks: a sequence of movements forming a whole functional activity (e.g., dressing). o Closed vs. Open tasks o Stable motionless task vs. Consistent motion task • Feedback: Enhances learning through: o Intrinsic feedback: naturally occurring from task performance o Extrinsic feedback: supplemented by verbal/nonverbal cues. • Practice conditions: learning is contingent on amount/type of practice: o External vs. Internal focus (environmental goals vs. Body movement) o Massed vs. Distributed practice o Blocked vs. Random practice o Whole vs. Part practice o Motivational influence Task-Oriented Training Approach (TOT) • Practicing common daily-life skills to acquire/relearn motor skills. • Key components: o Consistent with motor learning principles o High-intensity repetitive practice of functional tasks based on patient goals. o Designed to challenge motor ability (just-right challenge) o Leads to experience-dependent neuroplasticity • Principles: o Use it or lose it o Use it or improve it o Specificity matters o Repetition matters o Intensity matters o Time matters o Salience matters Assumptions of OT Task-Oriented Approach (OT-TOT) • Functional tasks organize behavior • Occupational performance results from interactions of person and environment • Experimentation with various strategies leads to optimal motor solutions • Recovery is variable, dependent on patient and environmental factors • Behavioral change reflects an attempt to compensate and improve performance OT-TOT Intervention Principles • Client-centered occupation-based interventions • Keeps clients active during treatment • Use natural environments and objects in therapy • Adjust to role and task limitations • Provide real-world practice opportunities • Promote motor learning via structured practice • Reduce ineffective movement patterns • Modify the task, environemt, or use assistive tech • Constraint degrees of freedom for patients with poor control • Use constraint-induced movement therapy (CIMT) for non-use of affected limb OT-TOT Upper Extremity Interventions • Used to improve upper extremity (UE) function, balance, and mobility, and performance of activities of daily living (ADLs). • Repetitive movements with functional components Constraint induced movement therapy (CIMT) • Developed for hemiparesis to counteract learned nonuse • Two main principles: o Forced use of impaired UE (restraining the non-impaired limb 90% of waking hours) o Massed practice (6-8 hours/day) with shaping (progressively harder tasks) • Evidence: improves UE motor skill performance in post-stroke patients with some residual function, through ADL improvements may be limited. Augmenting Task-Oriented Approaches • Combine TOT with technology or cognitive strategies • Effective for brain injury rehabilitation • Used for patients with severe motor impairments • Approaches include: o Mental practice o Mirror therapy o Action observation o Robotics Mental Practice (MP) • Rehearsing an action cognitively without physical movement • Activates similar brain regions as physical practice • Typically combined with TOT: o Audio-taped scripts for guided mental imagery o Visual prompts and verbal cues • Evidence: o Improves motor function and ADLs in stroke patients o Helps MS & Parkinson’s patients with mobility and cognitive fatigue Use of Technology – Robotics • Robotic devices support shoulder, elbow, or hand movements. • Can provide: o Passive movement o Resistance training o Assistance for multi-joint movements • Therapy progresses by: o Increasing/decreasing resistance o Adjusting force parameters and movement • Often combined with virtual reality (VR) for engagement Flaccid UE Treatments • TOT improves motor skills, but therapists may need to target neurological impairments to improve engagement in occupations. • Typically requires a combined approach. Neuromuscular Electrical Stimulation (NMES) • Assists with recruiting weak muscle groups during TOT • Electrical current is delivered through electrodes, causing muscle contraction. Mirror Therapy (MT) • Intervention based on visual feedback • Mirror is placed in the midsagittal plane, with the impaired limb hidden from view • The patient moves the unimpaired limb, focusing on its mirror reflection. • Protocol: o 30-45 minutes per session, 5 days per week. o Three 10-minute segments: ▪ Moving the arm/hand ▪ Functional tasks with objects ▪ Object manipulation Weightbearing • Improves weight transfer and loading • Enhances proprioceptive input • Reduces degrees of freedom, simplifying movement patterns Edema Management Acute Edema Interventions: • Elevation: limb positioned above heart to promote fluid return • Compression: light-form fitting garments Subacute Edema Interventions • AROM, PROM, Light isometric exercises • Kinesiotaping & MEM techniques Therapeutic Interventions for Limited ROM • Passive Range of Motion (PROM): maintains joint health and elasticity • Active-Assisted Range of Motion (AAROM): uses gravity-eliminated exercises • Active Range of Motion (AROM): strengthens through movement Passive Range of Motion (PROM) • Not the same as stretching • Involves taking a joint through available ROM without overpressure • Performed by therapist, caregiver, or the client’s other arm • 5-10 repetitions in all directions are recommended • PROM should never be forced or cause pain Intervention for Muscle Shortness or Passive Insufficiency • Short/stiff muscles can limit AROM • Stretching is the primary option for lengthening a muscle-tendon unit • To stretch a joint, the muscle-tendon unit is held in the opposition position of its typical movement Active Assistive Range of Motion (AAROM) • Client moves the joint as far as possible on their own (actively), then therapist or client assist to complete the ROM • Usually consists of gravity eliminated therapeutic exercises • Scapular mobilization • Typically targeting proximal muscle groups: scapula elevation, horizontal shoulder adduction. Active Range of Motion (AROM) • Utilizing: biomechanical FOR-bottom-up approach o Therapeutic exercises • Targeting: muscle demands to improve occupational performance 1. Types of Exercises • Static (isometric) exercise: o Used when joint motion is painful or contraindicated due to joint instability o Can remediate weakness at a particular point in the ROM o More effective with deconditioned individuals • Dynamic exercise (concentric and eccentric movements) o Used to promote strength throughout the arc of motion o Concentric activation: internal torque produced by the muscle is greater than external torque produced by the resistance (muscle “wins”) o Eccentric activation: external torque is greater than the internal torque, causing the muscle to lengthen under tension 2. Exercise Equipment and Techniques • Free weights: provides resistance where the weight moves up when the muscle wins and moves down when the muscle loses • Elastic exercise bands: o Pull toward their anchor point, creating resistance o When the band is lengthened, the muscle wins o When the band is shortened, the muscle loses 3. Strength Training vs. Endurance Training • Both are done at similar exercise volumes o Strengthening: higher resistance, fewer repetitions. o Endurance: Lower resistance, more repetitions. 4. Education on Positioning and Home Exercise Program • Positioning o Bed o Wheelchair o Standing • Home Exercise Program o Self-directed PROM o Caregiver-directed PROM o AAROM o AROM