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 PSI Exercise 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 PSI Exercise 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 PSI Exercise 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
3 Distinct
Activities
Activities (one per session)
Manual 2 Section 3
Specialist PSI Exercise Module
FaME
PHASES 1. 2. 3.
Phase names and corresponding weeks
Content of each phase
Manual 2 Section 3
Your practical assessment is week 15 – 20 (training gains / phase 2) –
See Manual 2 Section 3 for session planner
Specialist PSI Exercise Module
SAFETY FIRST
PSI Session Structure + Content
Warm Up
CIRCULATION BOOST; JOINT MOBILITY; STRETCH
Workout
5 (of 7) EVIDENCE-BASED ACTIVITIES
Cool Down
CIRCULATION LOWERER; FLEXIBILITY; TAI CHI
Tea + Chat and re-energise
Manual 2 Section 3
Specialist PSI Exercise Module
EXERCISE PROGRAMMING THEORY
•
Principles
Specificity
Progressive Overload
Rest & Recovery
Individual Difference
•
Variables (recap)
FITTA
Manual 2 Section 3
Specialist PSI Exercise 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
Specialist PSI Exercise Module
EXERCISE GUIDELINES
COMPONENTS OF FITNESS WORKSHOP
BALANCE: STRENGTH: FLEXIBILITY: ENDURANCE
What
is it ?
Older Person
Guidelines
Special Considerations
For Fallers
Examples of
exercises
F
Definition
I
Only 3 please!
T
T
A
Specialist PSI Exercise Module
STRENGTH
Older Person
Guidelines
What
is it ?
Working
F
Resistance
I
12 –15 reps to begin
1 – 3 sets
progress up to 70-80% 1RM
6-8 reps
Postural and bone-load for
back extensors
T
20 mins –1hr
6-9 secs per Isotonic Rep
5 Secs Isometric
Specific
Targeted
Muscles: Hip, Knee, Ankle
T
Body weight / Weights
Open/closed chain
Isometric / isotonic
To Gain
Stronger
Muscles
And Bones
To Make
Everyday
Activities
Examples
of
Exercises
2 – 3 Times / week
Functional abdominal work
Muscle + Bones
Against
Special
Considerations for
fallers
FaME:
seated leg
press, seated
upper back
strengthener,
prone back
extension
Otago:
standing
knee flexion,
standing hip
abduction
Easier
Fun / Relaxed
A
Variety
Safe
Warm
Social
Manual 2
Specialist PSI Exercise 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
E
v aluation 0 – 10 scale in
Dynamic Endurance
Component
5
HARD
 Research 6 – 20 scale
6
7
VERY HARD
8
VERY TIRING
 CommunityS ession
Endurance Component
before mid point + post
9
10
VERY VERY HARD
Manual 2 Section 3
EXHAUSTING
Specialist PSI Exercise 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
Specialist PSI Exercise Module
ENDURANCE
What
is it ?
Stamina:
Work muscles harder &
longer
(in order to increase the
pulse rate, breathing rate)
Older Person Guidelines
F
Special Considerations
for fallers
Marching
3 – 5 days per wk
- Focus on coordination
and balance
Moderate,
30-75 % VO2 Max
- Chair based initially then
chair support
T
30 – 60 mins.
- Simple / repetitive /
stable
T
Aerobic
Fartlek
A
Longer build up and
build down
Avoid steps that
could cause a trip
I
Examples of
Exercises
Side-stepping
Gait training
Toe taps
Manual 2 Section 3
Specialist PSI Exercise Module
BALANCE
What
is it ?
Maintaining upright
posture during position
change
(eg. Standing up and to
prevent falls)
Older Person
Guidelines
F
3 x per week
Special
Considerations for
fallers
Start with ‘win win’ tasks
(eg – seated ball games)
Examples of
Exercises
Functional reach while
sitting
Toe & heel walking
I
T
T
Increase slowly –
graded to group
10 mins – building up to 1
hour.
Ensure appropriate ratio
of supervision for each
task
Explain benefits
Method of using support
Tandem walks
calf raises
Flamingo swings
Picking objects off the
floor
Dynamic balance
i.e weight transference
Backward walking
.
A
Varying activities &
weaning off support
slowly – vary positions
Manual 2 Section 3
Specialist PSI Exercise Module
FLEXIBILITY
What
is it ?
Best optimal range of
movement available at
a joint or joints
Older Person
Guidelines
F
I
Special
Considerations for
fallers
Examples of
exercises
2 – 7 days a week
Mild muscular tension
No Pain
T
Maintenance:
1 x 8 – 10 secs
Developmental:
2-3 x 11-40 secs
T
Static and active
Developmental +
Maintenance
A
“Reward”
Relaxing
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
Manual 2 Section 3
Specialist PSI Exercise Module
BACKWARD CHAINING
FLOOR WORK
• Strength
• Balance / Co – ordination
• Flexibility
• Coping strategies
TAI CHI
Manual 3
Specialist PSI Exercise Module
EDUCATION and PREPARATION OF
PARTICIPANTS
INDUCTION SESSION
Manual 2
WHEN EXERCISE SHOULD
Manual 2
- NOT HAPPEN
- BE DISCONTINUED
- BE CONTINUED
FALL
S S PECIFIC EDUCA
T IO
N / COPIN GS TRA
T EGY
Manual 2
MONITORING
BORG, TALK TEST, observing co-ordination & technique
Manual 2
= comfortably challenged
Specialist PSI Exercise 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
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 PSI Exercise 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 PSI Exercise 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
Specialist PSI Exercise Module
Exercise Management of Patients with Chronic
Illness / Conditions
STEP 2
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•
•
•
•
•
•
•
•
•
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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 PSI Exercise Module
DISEASE
Do’s
Don’ts
Adapts
Benefits
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 PSI Exercise Module
HEALTH & SAFETY
1. The Environment / Facility
2. The Equipment
3. The People
Specialist PSI Exercise Module
ASSESSMENT INSTRUCTIONS
Formative Assessment of Tai Chi:
On Day 5 (afternoon) you will have your teaching skills for
delivering the Tai Chi section of a class formatively assessed.
1. THEORY PAPER
• ON DAY 5
• 2 Hours
• 5 short answer questions and 30 multiple choice
• 70% pass mark
• 5 mins reading time
• Let us know before if special needs requiring additional support
Specialist PSI Exercise 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 PSI Exercise Module
ASSESSMENT INSTRUCTIONS
2. PRACTICAL
• On Day 6 or 7 (whichever you signed up for)
• Plan 1 hour week 15-20 PSI Session – bring 2 copies of plan - ie.
assessed on planning
Refer to Manual 2 Session Planner;
Use sesson plan proformas provided;
Only teaching points necessary ie. not instructions
• Approx 30 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 used by assessor;
Consider lifting technique e.g. for mats. Chair alternatives but Not Chair focus;
Notes can be used if necessary – or assessor prompt
Specialist PSI Exercise Module
ASSESSMENT INSTRUCTIONS
2. PRACTICAL cont’d
• No Pass Mark for Practical delivery, only Pass/Refer and
action points given
• Receive peer evaluation
• Write up self- evaluation – ie. assessed on evaluation
Practice with people - not just in front room!
Specialist PSI Exercise Module
ASSESSMENT INSTRUCTIONS
3. CASE STUDY
Ensure meets Criteria for PSI intervention and is at risk of falls
•
Complete all paperwork - (questionnaires + functional grid) in
assessment pack
•
Complete 1500 word ‘write up’ – see case study guidelines in
Summative Assessment Pack
•
Submit on day 6/7
•
Pass mark 70%
All results (case study, practical and theory paper) in post
(8-10 weeks later)
Specialist PSI Exercise 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 PSI Exercise 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 PSI Exercise Module