Focus on Home Exercise Programs

Great piece from distinguished ERI faculty member:

Jacqueline Grimenstein, PT, C/NDT, Jackie Grimenstein - ERI

As a working mother of 4 kids I always dreaded homework.  My husband and I would get home from work, do afterschool activities or carpools, make dinner and then deal with homework.  I found so much of homework to be more about getting it done that actually learning something from it or reinforcing a skill.  I keep this in mind as I design home programs and activities for the children I treat.  How meaningful are those activities and just what am I trying to have the child accomplish through them. 

Over my 40 plus years as a PT I have given this a lot of thought and try to focus on what does the child actually need for my next session.  Because isn’t that what home programs are for.  Along those same lines I find I need to match what is needed with something the child will practice and be willing to participate in.  When my children were going up I wanted them each to play the piano, but no one really wanted play the piano so every night was a struggle to get them to sit at the piano and practice.  I remember being in the kitchen and yelling into the family room that I did not hear any music coming from that piano.

So I have found the challenge to be what motivates the children we treat and how do we get them to be actively engaged and practice the skills they need.  The purpose of the home exercise program should be to build in repetitions of the components they need to advance a skill. So what is fun?  Finding those activities that the child actually likes to do is often the key to getting them to willingly do their home program.  Of course this then requires investigation and innovation on our part to tailor the activities to that child. 

Which brings us to, whose home program is this – mom’s or the child’s.  Many times when the child comes in for a therapy session and I ask how the child made out with the home program; mom answers she didn’t have time for them to do it.  Once the child is able to follow directions, if the program is meaningful and fun then it should not be a struggle.  So I start digging into what does the child like.  Is it sports, playing video games, imaginative play or something in the arts field?  Taking that interest can I build an exercise program around something that relates to that interest?  When doing an arts project can I build in some weight shifts and squats by placing objects at different levels.  For video games can they play an active game that requires them to move rather than just sit or can they sit on a dynamic surface to make their base more active. I try to find people they admire in their desired area of interest and look at what type of physical activities or work out program that person does.  Children are surprised to find that people in the arts field and even the video game world need to work out to have the posture and stamina to perform.   I have found that giving the child activities that work into play time to be more successful that setting them apart as a separate activity.  I may recommend the child do their home program during TV commercials.  These are timed to about 15-30 seconds per commercial and about two and a half minutes for a set.  It is amazing how many repetitions of an activity can get done in this time frame.

Having spent the majority of my career treating children with severe disabilities presents challenges in that the child often cannot do activities independently.  Helping the family find what is meaningful to them and what works in their time schedule become a separate challenge.  Parents often need guidance as to what skills the child can accomplish to assist with everyday activities such as transfers and ADL’s.  Being able to assist with the everyday becomes vital for the future as the child grows and parents age.  I have found that once parents understand why and what of programs they generally become your partner and willingly work toward the goal outside the therapy session.

The longer you stay in the therapy field the better perspective you have on what it to come in the future of the children we treat.  I have had the pleasure of following several children across the lifespan and have developed an appreciation of components of movement that are needed to have the child develop to prevent future issues with misalignment, pain and even decreased respiration.  Therapy is every day, all day to build in enough motor learning to get and keep functional patterns and skills. But first we have to get it so the child can use it every day and that only happens with consistent practice in hopefully a fun and meaningful program.

Being an NDT instructor and therapist has enhanced my assessment and creativity skills.  As I teach and encounter so many therapists we talk about the children we treat and problem solve how to get to the next level or sometimes even where to start.  But regardless if we are just starting to develop a skill or trying to refine an existing one, practice is essential and working with them to figure out how to build in practice while having fun is one of the things I enjoy the most. 

Don’t miss these great opportunities to learn from Jackie

Taping to Improve Alignment, Strength and Function in Children
March 23-24, 2018 Cedar Knolls, NJ
September 15-16, 2018 Washington, DC
November 2-3, 2018 – Indianapolis, IN

Utilizing NDT in Pediatric Practice
April 14-15, 2018 Minneapolis, MN
September 29-30, 2018 Pueblo, CO