Goals

Maximize efficiency & safety of functional movement

• Functional activity (ADLs, gait, transfers) improves ONLY when the underlying impairment is addressed
• Be specific with underlying impairments for each task
• Function not form: task analysis vs. rep/set & weight selection

Plan of action

Alignment–>Trunk Initiation–>How Muscle is Used–>Muscle Activation–>Re-education

Alignment:

• Pick one task at a time
• Assess for proper alignment
  • If not in proper alignment, remedial work needed on ROM, flexibility, soft tissue work, core strength & stability

Trunk Initiation:

• Where does the trunk initiate movement for the task?
• Is resident able to get in that position? If not, that is your exercise!
• If resident is able, then move on to analysis of how muscle is used

How Muscle is Used:

• Open chain
• Closed chain
• Slow or fast twitch fibers
• Speed vs endurance task

Muscle Activation:

• What joints are needed for the task?
• What muscles are responsible for action?
• Start activation:

• Single plane supported à unsupported
• Maintain proximal control
• Begin with low load, high reps (15-20) to build proximal stabilizers in prep for intensity

Re-Educate:

• Re-educate the muscles to work together
• Add the pieces together to get the whole
• Once the client gets the basics of the task, vary attributes to ensure mastery in daily living situations
• Improve the connection between the brain and body vs. hypertrophy only!

Training Seniors

Impact of age:

• Type I and II fibers lost with age in addition to disuse atrophy of type II
• Reduced conduction, especially type II
• After age 60, 1-2% decline in strength and 3-4% decrease in power per year
• Lower extremities show greater decline than upper extremities

Principals of Strength Training:

• Overload: providing a load that is new to the body to get positive training effect
• Specificity: work muscles in a specific way to get desired outcomes
• Progression: continually providing overload to get continued benefit without plateau
  • Doesn’t always mean – add weight
  • Can achieve overload by changing:
    • Support surface
    • Lever length
    • Speed of movement
    • Single plane à multi plane
    • Change height of surface

Mimic the Demands:

• Once you know how a muscle is used in a task, design exercise to mimic the demands
• Each exercise should relate directly to a missing piece of the task

Melissa Ward

Director of Clinical Services