specialist postural stability instructor module days 3 & 4 – overview programming, theory and...

Specialist Postural Stability Instructor Module

DAYS 3 & 4 – OVERVIEW

• Programming, Theory and Practice I and II

• Teaching Practice Workshop

• Assessment Briefing

• Medical Conditions, Medications and Exercise

Management

• Health and Safety

• Progression and Adaptation Workshop

• Implementation in Community Programmes


PROGRAMMING THEORY & PRACTICE

• AIMS

- Making the case for PSIs

- Types of exercise sessions in falls exercise provision

- FaME

- Exercise programming theory

- Applying theory to practice

- Practical

Manual 2 Section 3


Making the case for PSIs

4 Types of Opportunities, Phase IV:

• PSI

• Exercise for the Older Person

• 1 to 1 Personal Training / Physiotherapist

• Active Lifestyle

4 4

Advantages Drawbacks


Types of exercise sessions in falls exercise provision: 3 Settings, 3 Session Structures

• Rehab

• Prehab

• Chair

3 Common Activities

PSI Approaches Phase 3

PSI

Phase IV

“Holding Group”

Functional Strength

3 Distinct Activities (one per session)

Manual 2 Section 3 9 - 53


FaME

PHASES 1. 2. 3.

Phase names and corresponding weeks

Content of each phase

Manual 2 Section 3 Page 65-67

Your practical assessment is week 15 – 20 (training gains / phase 2) –

See Manual 2 Section 3 Page 93 for session planner


SAFETY FIRST

PSI Session Structure + Content

Warm Up CIRCULATION BOOST; JOINT MOBILITY; STRETCH

Workout 5 (of 7) EVIDENCE-BASED (page 57) ACTIVITIES

Cool Down CIRCULATION LOWERER; FLEXIBILITY; TAI CHI

Tea + Chat and re-energise

Manual 2 Section 3 0


EXERCISE PROGRAMMING THEORY

• Principles

Specificity

Progressive Overload

Rest & Recovery

Individual Difference

• Variables (recap)

FITTA

Manual 2 Section 3 Page 58 - 59


PSI =

EXERCISE for OLDER PEOPLE – Best Practice Guidelines

+SPECIAL CONSIDERATIONS for

Older People with HIGH RISK OF FALLS –

Best Practice Guidelines Manual 2 Section 3 page 61-63


What

is it ?

Definition

Older Person Guidelines Special Considerations

For Fallers

Only 3 please!

Examples of exercises

EXERCISE GUIDELINESCOMPONENTS OF FITNESS WORKSHOP

BALANCE: STRENGTH: FLEXIBILITY: ENDURANCE

F

I

T

T

A


STRENGTH

What

is it ?

Working

Muscle + Bones

Against

Resistance

To Gain

Stronger

Muscles

And Bones

To Make

Everyday

Activities

Easier

Older Person Guidelines

2 – 3 Times

Week

12 –15 reps to begin

1 – 3 setsprogress up to 70 – 80% IRM

6-8 reps

20 –1hr

6 – 9 secs per Isotonic Rep

5 Secs Isometric

Body weight / Weights

Open/closed chain

Isometric/isotonic

Fun / Relaxed

Variety

Safe

Warm

Social

Special Considerations for fallers

Functional abdominal work

Postural and bone-load for back extensors

Specific

Targeted

Muscles: Hip, Knee, Ankle

Examples of Exercises

FaME: seated leg

press, seated

upper back strengthene

r, prone back

extension

Otago: standing

knee flexion,

standing hip abduction

F

I

T

T

AManual 2 pg 71-72


The Borg Scale

Rate of perceived exertion0 NOTHING AT ALL

0.5 VERY VERY LIGHT

1 VERY LIGHT

2 FAIRLY LIGHT

3 MODERATE

4 FAIRLY HARD

5 HARD

6

7 VERY HARD

8 VERY TIRING

9

10 VERY VERY HARD

EXHAUSTING

NB.

Community Session Evaluation 0 – 10 scale in Dynamic Endurance Component

Research 6 – 20 scale Endurance Component before mid point + post

Manual 2 Section 3 page 101


Resistance Training Continuum

15 12 10 8 6

30% 50% >60% >70% >80%of IRM of IRM of IRM of IRM of IRM

Low weight Heavy weightHigh Reps Low Reps

Manual 2 Section 3 Page 70 -71

Endurance Strength


What

is it ?

Stamina:

Work muscles harder & longer

(in order to increase the pulse rate, breathing rate)


3 – 5 days per wk

Moderate,

30-75 % VO2 Max

30 – 60 mins.

Aerobic

Fartlek

Longer build up and build down

Avoid steps that could cause a trip


-Focus on coordination and balance

-Chair based initially then chair support

-Simple / repetitive / stable


Marching

Side-stepping

Gait training

Toe taps

ENDURANCE

F

I

T

T

A

Manual 2 Section 3 page 83 – 84


What

is it ?

Maintaining upright posture during position change

(eg. Standing up and to prevent falls)


3 x per week

Increase slowly – graded to group

10 mins – building up to 1 hour.

Dynamic balance i.e weight transference

Varying activities & weaning off support slowly – vary positions


Start with ‘win win’ tasks

(eg – seated ball games)

Ensure appropriate ratio of supervision for each task

Explain benefits

Method of using support


Functional reach while sitting

Toe & heel walking

Tandem walks

calf raises

Flamingo swings

Picking objects off the floor

Backward walking

BALANCE

F

I

T

T

A.

Manual 2 Section 3 Page 75 – 76


What

is it ?

Best optimal range of movement available at a joint or joints


2 – 7 days a week

Mild muscular tensionNo Pain

Maintenance: 1 x 8 – 10 secs

Developmental: 2-3 x 11-40 secs

Static and active

Developmental + Maintenance

“Reward”

Relaxing


Remain seated 2 – 3 mins following work (stretches) in lying

Alignment is paramount

Precise instructions – step by step

Examples of exercises

Targeted stretches

Yoga

Tai Chi

Functional Activities

FLEXIBILITY

F

I

T

T

A

Manual 2 Section 3 Page 80-81


BACKWARD CHAININGManual 3 Page 84

FLOOR WORKManual 3 Page 85

•Strength

•Balance / Co – ordination

•Flexibility

•Coping strategies

TAI CHIManual 3 Page 85


EDUCATION and PREPARATION OF PARTICIPANTS

INDUCTION SESSION

WHEN EXERCISE SHOULD

- NOT HAPPEN

- BE DISCONTINUED

- BE CONTINUED

FALLS SPECIFIC EDUCATION / COPING STRATEGY

MONITORING

BORG, TALK TEST, observing co-ordination & technique

= comfortably challenged

Manual 2 p.97

Manual 2 p.95

Manual 2 p.98-99

Manual 2 p.100


FALL OVER

Remain still. Avoid panic and wasting energy on ineffective struggling.

Have any serious injury? Any movements limited?

Any pain?Will help arrive soon and this person

will summon help or use a lifting cushion

Plan how to summon help

If you are wearing an alarm button or you can reach one – then do so!

Can you get up without help?

YESYES

YES

YESNO

NO NO

NO

OK

OK OK

Carry out your previously worked out plan to summon help by alternative methods and while waiting for help to arrive carry out your plan to avoid any consequences of being on the floor for a

long time.

How To Avoid Spending A Long Time On The Floor After A Fall

Simpson J. 1998

Manual 2 p.99


PROGRESSION + ADAPTATION

• Seated Adaptations for:– Trunk rotation, calf stretch, upward side stretch– Double side step, wide-based sway, march– Heel raise and toe walk, toe raise and heel walk,

flamingo swing, tandem stand– Backward chaining– Prone back extension, side lying leg raise, prone

hip extension– Working the oar


Exercise Management of Patients with Chronic Illness / Conditions

The Individual Difference Principle

• Liaison with Health Professionals

• Liaison with Patient

• Liaison with Leisure Professionals

Manual 1 page74 - 75

STEP 1


Exercise Management of Patients with Chronic Illness / Conditions

• Type of condition• Site of condition• Stage of condition• Functional Limitations• Disease Specific Effects• Disease Specific Effects to the individual• Medication Effects• Exercise performance limitations• Risk stratification• Prognosis• SMART goals – Specific; Measurable; Agreed; Realistic; Timed

N.B. SMART - Not in manual / not assessed but an important tool.

STEP 2


Do’s

FREQUENCY(How Often)

INTENSITY(How Hard)

TIME(How Long)

TYPE

(+ Activities)‘Which type’ eg Strength / Endurance Isometric / Isotonic Continuous/Interval

APPROACH/ ADHERENCE(Variety, Individual interests etc)

Don’ts Adapts Benefits

DISEASE


HEALTH & SAFETY

1. The Environment / Facility

2. The Equipment

3. The People

Manual 2


ASSESSMENT INSTRUCTIONS

1. THEORY PAPER

• ON STUDY DAY

• 2 Hours - 7 Sections

• 80% multiple choice / 20% bullets or short answer

• 75% pass mark

• Can refer in 1 of 6 sections but must get at least 50% in referred section (must pass Exercise Section with 75%)

• 15 mins. read through

• Let us know before if special needs required


TIPS for Theory Paper

• LEARN YOUR PPTs!

• In the Manual

• If its in bold its important

•If its in a box its VERY IMPORTANT

•If its in a box + bold its VERY IMPORTANT


2. PRACTICAL• Plan 1 hour PSI Session – 2 copies - ie assessed on planning

Refer Manual 3 Appendix 5.3 p.165 for Session Plan Guide / OrderUse proformas providedUse stick drawings for stretch & MSE if preferredOnly teaching points necessary

• Approx 40 mins. teaching to your peers - ie assessed on teachingEquipment provided = therabands, chairs, mats

Moved on by assessor – plenty of time / prompts

Assessment checklist will be monitored/prompted

eg lifting mats. Chair alternatives but Not Chair focus

Notes can be used if necessary but is not recommended – assessor prompt is often better

• Receive peer evaluation

• Write up self- evaluation – ie assessed on evaluation

Practice with people - not just in front room!



3. CASE STUDY

Ensure meets Criteria for “Prehab” class and is at risk of falls

• Complete all paperwork - 2 copies (questionnaires +

functional grid) in assessment pack

• Complete 500 (max 700 words) Summary; AND Short &

long term goals; Adaptation of FAME Phases. 2 copies.

• Know your case study and refer to Summary / Assessments if

necessary

• Assessed on Completed paperwork and an oral viva of your

case study (approx. 20 – 30 mins) – see criteria in your pack



PSI WorkshopWarm Up

1. Circulation Exercise

2. Mobility

3. Stretch

Workout

5. Dynamic Endurance

6. Dynamic Balance

7. Resistance Bands

8. Backward Chaining

9. Floorwork

Cool Down10. Circulation Lowerer

11. Flexibility

12. Tai Chi


Teaching Workshop Feedback Guidelines

1. Content

2. Teaching

3. Personal Performance

pace

Appropriate to component and evidence-based

transitions

- Position

- T. Instruction

- T. Points

- 1 - 1

WhatWhereWhen

- Attire, Organised, Technique, Voice, Communication

Howobservinganalysing,solution,communicating

specialist postural stability instructor module days 3 & 4 – overview programming, theory and...

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