Physical Therapy

How do you help patients stay motivated and engaged during their rehabilitation process?

Tailoring Treatment with Personal Goals and Education for Effective Rehabilitation

My name is Emily. I'm a physical therapist. I'm going to answer this from a slightly different position because I do work with a lot of chronic pain, chronic illness, and our clinic particularly serves a large portion of our homeless community. So how do I keep them motivated and engaged, especially when they've had pain for many years? I take the time to get to know my patient and really tailor their treatment plan toward their personal goals and things that they find valuable. I also spend a large amount of time in between exercises explaining why they need to do their exercises in terms that I know they'll understand. I'm not going to use textbook terms because I do realize that not everybody goes to school for physical therapy or athletic training. They're not going to understand the anatomical terms or scientific terms. So creating an environment where I'm educating them on this activity is going to help you for this reason and for them in particular. Like for a specific activity that they want to get back to doing or that they want to have less pain while they're doing. And then I just spend extra time each session, especially at the beginning and the end, explaining to them why it's important that they continue their plan of care even after they discharge from physical therapy. You know, sometimes I'm really straightforward and say if you're not willing to work in physical therapy, physical therapy might not work for you because that is the physical aspect of it. You are required to do a certain amount, a certain amount of movement with your body for it to help you.

I take the time to get to know my patient and their goals, and explain why they need to do exercises in terms they can understand. I then create a positive environment where I'm educating them on why it's important to continue with their plan of care, even after they discharge from physical therapy.

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As a physical therapist, my approach to helping patients stay motivated and engaged during their rehabilitation process is slightly different. I often work with individuals dealing with chronic pain, chronic illness, and even those from the homeless community. Here's how I approach it:

Firstly, I take the time to truly understand my patients and their personal goals. I tailor their treatment plan to align with what they find valuable and important.

I also make an effort to explain the reasons behind each exercise or activity in a way that is easily understandable to them. I avoid using complex anatomical or scientific terms that may not resonate with everyone. Instead, I focus on educating them about how a specific activity will benefit them, especially in relation to something they want to get back to or reducing pain during certain activities.

Additionally, I dedicate extra time during each session, particularly at the beginning and end, to emphasize the importance of continuing their plan of care even after they complete their physical therapy. I'm honest with them, explaining that their active participation is crucial for the success of their therapy. I may even say that if they're not willing to put in the effort, physical therapy may not be effective for them, as it requires a certain level of commitment and movement from their side.

By personalizing the treatment plan, providing clear explanations, and emphasizing the importance of their active involvement, I strive to keep my patients motivated and engaged throughout their rehabilitation journey.

How does neuromuscular reeducation improve coordination and motor control?

Neuromuscular reeducation: Retraining the brain for improved coordination

My name is Emily. I'm a physical therapist. So the trick to neuromuscular re-education first and foremost is high repetitions of the activity that you're trying to retrain. So let's speak to, you know, your question is about coordination and motor control. Let's speak to core strengthening. Sometimes you have to retrain somebody how to properly activate certain layers of musculature based on what your end goal is. So maybe their breathing patterns and their body mechanics with lifting, especially for something that I do on a regular basis, postpartum care. So once you retrain that movement, giving them different types of cues, verbal cues, visual cues, tactile cues with your hand, maybe you change their positioning. Once you figure out the right cue for them and they activate that muscle the way you want it to, then you perform it in high repetition. And then after you've kind of, you know, for lack of a better term, dumbed down that exercise so you get the proper activation in the proper position, then you get creative with changing the positions and adding more complexity to the task. So adding different limb movements, requiring them to use more joints. So you go from maybe laying down in different positions to half kneeling, tall kneeling, hands and knees, sitting, standing, so that their brain has to think about more joints moving in space. And then you add more repetition to that to retrain the brain how to connect with the body.

To retrain neuromuscular coordination and motor control, start with high repetitions of the activity to properly activate certain muscles based on the end goal. Use verbal, visual, and tactile cues to get the proper activation and position. Then add complexity by changing positions and adding limb movements, requiring more joints. Finally, add more repetition to retrain the brain.

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Neuromuscular reeducation improves coordination and motor control through high repetitions of the targeted activity. In the case of core strengthening, it may involve retraining the activation of specific muscle layers based on the desired outcome, such as proper breathing patterns and body mechanics during lifting. Different cues, such as verbal, visual, and tactile cues, can be used along with changes in positioning to achieve the desired muscle activation. Once the correct activation is achieved, the activity is repeated extensively. As progress is made, complexity is added by changing positions and incorporating additional limb movements and joints. This challenges the brain to coordinate multiple joints in space. The process involves continuous repetition to train the brain-body connection effectively.

What equipment is commonly used in an aquatic therapy session?

Aquatic Therapy: Get Creative with Simple Equipment!

There's a lot of different equipment you can use in aquatic therapy sessions. I like to keep it simple because I do realize that not every clinic is going to have top of the line equipment. You could be as simple as a pool noodle. You could cut up that pool noodle. You could tie that pool noodle in a knot to make it a little bit more dense. Kick boards, pull buoys, yoga blocks, empty water bottles, empty jugs. You know, I've used basketballs. I've used bands, TheraBands. You can tie those and use those in the water. There's a lot, like little hand that you would use for swimming training to give resistance, like the webbed gloves or the ones that are like paddles on the wrists. You can put those on the hands. You can tie them around the feet. There's so many different things that you can use. You just have to become creative. So look at an object. If it's buoyant, it's going to give you resistance pushing it down into the water, holding it in the water. I've even gotten as creative as using the top of a Tupperware container for resistance and pushing and pulling water for somebody that was working on balance.

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In aquatic therapy sessions, a variety of equipment can be used, but it's possible to keep it simple and work with what's available. Common items include pool noodles, which can be cut or knotted to adjust density. Kick boards, pull buoys, yoga blocks, empty water bottles, and empty jugs can also be utilized. Other options include basketballs, TheraBands (which can be tied for use in the water), webbed gloves for resistance training, and wrist paddles. Being creative is key in finding suitable objects - if an object is buoyant, it can provide resistance when pushed or held underwater. For instance, the top of a Tupperware container can even be used for resistance exercises in balance training.

How long should an aquatic therapy session typically last?

The Variable Duration of Aquatic Therapy Sessions

Just like with anything in medicine, the answer to this is very gray. With my chronic pain patients or my patients that are struggling with chronic fatigue, maybe they have fibromyalgia or lupus or multiple sclerosis, I may only start with 20 or 30 minutes of exercise in the aquatic environment because when you are consistently exercising or moving in the aquatic environment, it does actually utilize more energy than on land. So I always warn my patients, even though it feels like you're doing less physically because of the buoyancy, you are actually utilizing more energy. So I tell them they'll probably feel tired later in the day. With my more advanced patients, it really depends on their goals, their functional goals and their personal goals. And that may look more like 45 minutes to an hour and then the intensity is going to be a little bit higher with less rest breaks, more resistive objects, more buoyant objects, because that's what they need to progress. So the answer is it's variable.

The answer is variable, but for chronic pain patients, I may start with 20-30 minutes of exercise in the Aquatic environment which utilizes more energy than on land. With more advanced patients, it may look more like 45 minutes to an hour with higher intensity and less rest breaks.

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The duration of an aquatic therapy session typically varies and depends on individual circumstances. For patients dealing with chronic pain or fatigue conditions like fibromyalgia, lupus, or multiple sclerosis, I may start with shorter sessions of 20 to 30 minutes. It's important to note that exercising in water actually requires more energy compared to land exercises, despite the sensation of decreased physical exertion due to buoyancy. I caution patients that they may feel tired later in the day. For more advanced patients, session length depends on their functional and personal goals. It may range from 45 minutes to an hour, with higher intensity and fewer rest breaks. We incorporate more resistive and buoyant objects to facilitate progression. In summary, the duration of aquatic therapy sessions is variable and tailored to each individual's needs and objectives.

What equipment is used to measure progress during neuromuscular reeducation sessions?

Innovative Equipment for Measuring Progress in Neuromuscular Reeducation

As far as equipment goes, it really depends on what activities you're measuring. Are you doing a Berg or a DGI, a two or six minute walk test, a five time or 30 second sit to stand? In most cases, you're just going to need a chair, maybe a piece of foam, let's say you're doing a modified cat-sib, some cones, a shoebox, and a big space because a lot of neuromuscular re-education tests are performed in patients that have neurologic conditions or a more geriatric population, falls risk population, and you want to make that as functional as possible so you want to look as, you know, maybe a set of stairs as close to their home environment as you can.

Depending on the activity, you may need a chair, foam, cones, a shoe box and a big space with stairs that are close to the patient's home environment.

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The equipment used to measure progress during neuromuscular reeducation sessions depends on the specific activities being measured. Some common equipment includes a chair, foam pad, cones, a shoebox, and a spacious area. These tests are often conducted with patients who have neurologic conditions or are at risk of falls, so creating a functional environment that closely resembles their home setting is important. The choice of equipment will depend on the specific tests being performed, such as the Berg or DGI (Dynamic Gait Index), two or six-minute walk test, five-time or 30-second sit-to-stand, and modified cat-sib.

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Emily Hill, DPT answers your Physical Therapy questions. See all the advice Emily Hill, DPT has and get answers to your own Physical Therapy questions.

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Physical therapist specializing in sports medicine, women's health, orthopedics, Parkinson disease/Parkinsonism and multiple sclerosis.