There were two common themes at CSM this year: dosage and intensity. Every clinical presentation I attended mentioned one or the other. Intensity was defined as how hard the patient is working. Dosage referred to the number or reps or duration in the case of a static activity. In both cases, more is considered better.
Last weekend I worked at a SNF. One of my patient's treatment notes indicated he was doing 100 reps of his exercises. Given the concept that more is better in a population that often needs encouragement to do anything, this sounds wonderful. The problem is the patient was doing 100 reps of the wrong exercises.
Yes, his legs were getting stronger but weakness wasn't the problem. It's a motor recruitment issue with compensatory movements. Unless someone corrects his gait pattern, he isn't going to improve. He doesn't need strengthening. He needs motor training. I didn't know whether to laugh or cry. More of the wrong thing isn't better. It might even be worse.
The reason the therapist was doing the wrong thing is the topic of another blog. Suffice to say that unless it's more of the correct activity, nothing will be accomplished. Obviously the treating therapist was listening to the message. He just didn't hear all of it.