Transcript 1-Practical_Theory-and-Assessment-Guidelin

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
Specialist Postural Stability Instructor Module
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
Specialist Postural Stability Instructor Module
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
Advantages
4
Drawbacks
Specialist Postural Stability Instructor Module
Types of exercise sessions in falls exercise
provision: 3 Settings, 3 Session Structures
• Rehab
PSI Approaches Phase 3
• Prehab
PSI
Phase IV
• Chair
“Holding Group”
Functional Strength
3 Common
Activities
3 Distinct
Activities (one per session)
Manual 2 Section 3 Page 49 - 53
Specialist Postural Stability Instructor Module
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
Specialist Postural Stability Instructor Module
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 Page 60
Specialist Postural Stability Instructor Module
EXERCISE PROGRAMMING THEORY
•
Principles
Specificity
Progressive Overload
Rest & Recovery
Individual Difference
•
Variables (recap)
FITTA
Manual 2 Section 3 Page 58 - 59
Specialist Postural Stability Instructor Module
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
Specialist Postural Stability Instructor Module
EXERCISE GUIDELINES
COMPONENTS OF FITNESS WORKSHOP
BALANCE: STRENGTH: FLEXIBILITY: ENDURANCE
What
is it ?
Definition
Older Person Guidelines
F
Special Considerations
For Fallers
Examples of exercises
Only 3 please!
I
T
T
A
Specialist Postural Stability Instructor Module
STRENGTH
What
is it ?
Older Person Guidelines
F 2 – 3 Times
Working
Against
I
To Gain
Stronger
Muscles
And Bones
Examples of
Exercises
Functional abdominal work
FaME:
seated leg
press,
seated
upper back
strengthene
r, prone
back
extension
Week
Muscle + Bones
Resistance
Special Considerations
for fallers
12 –15 reps to begin
1 – 3 sets
progress up to 70 – 80% IRM
6-8 reps
T 206 ––1hr
9 secs per Isotonic Rep
Postural and bone-load for
back extensors
Specific
Targeted
Muscles: Hip, Knee, Ankle
Otago:
standing
knee
flexion,
standing hip
abduction
5 Secs Isometric
To Make
Everyday
Activities
Easier
T
Body weight / Weights
Open/closed chain
Isometric/isotonic
Fun / Relaxed
A Variety
Safe
Warm
Social
Manual 2 pg 71-72
Specialist Postural Stability Instructor Module
The Borg Scale
Rate of perceived exertion
0
0.5
NOTHING AT ALL
VERY VERY LIGHT
NB.
1
VERY LIGHT
2
FAIRLY LIGHT
3
MODERATE
4
FAIRLY HARD
Evaluation 0 – 10 scale in
Dynamic Endurance
Component
5
HARD
 Research 6 – 20 scale
6
7
VERY HARD
8
VERY TIRING
 Community Session
Endurance Component
before mid point + post
9
10
VERY VERY HARD
EXHAUSTING
Manual 2 Section 3 page
101
Specialist Postural Stability Instructor Module
Resistance Training Continuum
Endurance
15
Strength
12
10
8
6
30%
50%
>60%
>70%
of IRM
of IRM
of IRM
of IRM
Low weight
High Reps
>80%
of IRM
Heavy weight
Low Reps
Manual 2 Section 3 Page 70 -71
Specialist Postural Stability Instructor Module
ENDURANCE
What
is it ?
Older Person Guidelines
Stamina:
Work muscles harder &
longer
(in order to increase the
pulse rate, breathing rate)
F
Special Considerations
for fallers
Marching
3 – 5 days per wk
-Focus on coordination and
balance
I
Moderate,
30-75 % VO2 Max
Examples of
Exercises
-Chair based initially then
chair support
Side-stepping
Gait training
Toe taps
T
30 – 60 mins.
T
Aerobic
Fartlek
-Simple / repetitive / stable
Longer build up and
Abuild down
Avoid steps that
could cause a trip
Manual 2 Section 3 page 83 – 84
Specialist Postural Stability Instructor Module
BALANCE
What
is it ?
Older Person Guidelines
Maintaining upright
posture during position
change
(eg. Standing up and to
prevent falls)
F
I
for fallers
Examples of
Exercises
3 x per week
Start with ‘win win’ tasks
(eg – seated ball games)
Functional reach while
sitting
Increase slowly –
graded to group
Ensure appropriate ratio
of supervision for each
task
Toe & heel walking
Explain benefits
Method of using support
calf raises
mins – building up to 1
T 10hour.
balance
T Dynamic
i.e weight transference
Special Considerations
Tandem walks
Flamingo swings
Picking objects off the
floor
Backward walking
A
.
Varying activities & weaning
off support slowly – vary
positions
Manual 2 Section 3 Page 75 – 76
Specialist Postural Stability Instructor Module
FLEXIBILITY
What
is it ?
Older Person Guidelines
Special Considerations
Examples of
exercises
for fallers
F
Best optimal range of
movement available at
a joint or joints
2 – 7 days a week
I
Mild muscular tension
No Pain
T Maintenance: 1 x 8 – 10 secs
Developmental: 2-3 x 11-40
secs
Remain seated 2 – 3
mins following work
(stretches) in lying
Targeted stretches
Alignment is paramount
Tai Chi
Precise instructions –
step by step
Functional Activities
Yoga
T
Static and active
Developmental +
Maintenance
A “Reward”
Relaxing
Manual 2 Section 3 Page 80-81
Specialist Postural Stability Instructor Module
BACKWARD CHAINING
Manual 3 Page 84
FLOOR WORK
Manual 3 Page 85
•Strength
•Balance / Co – ordination
•Flexibility
•Coping strategies
TAI CHI
Manual 3 Page 85
Specialist Postural Stability Instructor Module
EDUCATION and PREPARATION OF
PARTICIPANTS
INDUCTION SESSION
Manual 2 p.97
WHEN EXERCISE SHOULD
- NOT HAPPEN
Manual 2 p.95
- BE DISCONTINUED
- BE CONTINUED
FALLS SPECIFIC EDUCATION / COPING STRATEGY
MONITORING
Manual 2 p.98-99
Manual 2 p.100
BORG, TALK TEST, observing co-ordination & technique
= comfortably challenged
Specialist Postural Stability Instructor Module
How To Avoid Spending A Long Time On The Floor After
A Fall
FALL OVER
Remain still. Avoid panic and wasting
energy on ineffective struggling.
NO
Have any serious injury?
Any movements limited?
Any pain?
Will help arrive soon and this person
will summon help or use a lifting
cushion
Can you get up
without help?
NO
OK
YES
NO
YES
YES
OK
Plan how to summon help
OK
YES
If you are wearing an alarm button
or you can reach one – then do so!
NO
Simpson J. 1998
Manual 2 p.99
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.
Specialist Postural Stability Instructor Module
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
Specialist Postural Stability Instructor Module
Exercise Management of Patients with Chronic
Illness / Conditions
STEP 1 The Individual Difference Principle
• Liaison with Health Professionals
• Liaison with Patient
• Liaison with Leisure Professionals
Manual 1 page74 - 75
Specialist Postural Stability Instructor Module
Exercise Management of Patients with Chronic
Illness / Conditions
STEP 2
•
•
•
•
•
•
•
•
•
•
•
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.
Specialist Postural Stability Instructor Module
DISEASE
Do’s
Don’ts
Adapts
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)
Specialist Postural Stability Instructor Module
Benefits
HEALTH & SAFETY
1. The Environment / Facility
2. The Equipment
3. The People
Specialist Postural Stability Instructor Module
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
Specialist Postural Stability Instructor Module
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
Specialist Postural Stability Instructor Module
ASSESSMENT INSTRUCTIONS
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 / Order
Use proformas provided
Use stick drawings for stretch & MSE if preferred
Only teaching points necessary
• Approx 40 mins. teaching to your peers - ie assessed on teaching
Equipment 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!
Specialist Postural Stability Instructor Module
ASSESSMENT INSTRUCTIONS
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
Specialist Postural Stability Instructor Module
PSI Workshop
Warm Up
1. Circulation Exercise
2. Mobility
3. Stretch
Workout
5. Dynamic Endurance
6. Dynamic Balance
7. Resistance Bands
8. Backward Chaining
9. Floorwork
Cool Down
10. Circulation Lowerer
11. Flexibility
12. Tai Chi
Specialist Postural Stability Instructor Module
Teaching Workshop Feedback Guidelines
1. Content
2. Teaching
pace
Appropriate to
component and
evidence-based
transitions
What
Where
When
- Position
- T. Instruction
- T. Points
How
- 1 - 1 observing
analysing,
solution,
communicating
3. Personal Performance - Attire, Organised, Technique, Voice,
Communication
Specialist Postural Stability Instructor Module