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Toni Talks about PT Today

My New Pet Peeve

Published June 19, 2012 12:20 PM by Toni Patt

We all have things that annoy us. I have a new one at work, the assisted ergometer. It can be used for the UEs or LEs and programmed to provide either resistance or assistance to whoever is working the pedals. To me it is a glorified restorator. What annoys me so much isn't the machine but the individuals who put every patient on it every day under the guise of strengthening.

It used to be that restorators were the universal panacea at SNFs. When you didn't know what to do, you used one. Now the motorized version has that claim to fame. I have never understood how pedaling a stationary bicycle against no resistance with minimal or no supervision is a skilled service. The same is true of its more advanced reincarnation.

Certainly some patients benefit from it. The assisted function is nice for patients with cognitive impairments and some neurological deficits. Newer research is showing that unilateral pedaling actually inhibits motor activation of the weaker extremity if the stronger one is doing the majority of the work. Endless pedaling isn't all that helpful for restoring normal movement for stroke survivors and brain injuries.

No treatment is appropriate for everyone. Yet some of my coworkers put every patient on the darn thing. Some of those people are strong enough that other forms of exercise would be more beneficial. Performing the hands-on stuff takes time and energy, and dare I say, skill and clinical judgment. I don't think the assisted ergometer in our gym is still the entire day once things rev up.

There are only two reasons I can think of for putting every patient on one -- laziness or lack of knowledge/skill. Those two reasons top my list of pet peeves.


One of many examples of non-skilled therapy that is not evidence based and is billed for.  Manual therapy does require some special skills and knowledge and time!

Ed Scott June 22, 2012 1:48 PM

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