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


  • 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 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