Strength vs. Function
I have worked with a plethora of PTs and PTAs who all have the perfect solution to get patients better. And each one insists that their way is the best way. Some therapists will tell me to do only strengthening exercises with the patients, while others say that function is more important than strength. Then I remember my pediatric days and what the therapists always told me there, "Stability before mobility."
Treating adults and more specifically geriatric adults can be challenging. After doing LE or UE weighted exercises, they will tell me they are not Charles Atlas and then they remind me of how old they are. I explain why we are doing strengthening exercises but I don't think they quite understand. When I have the same patient do balance activity or transfer training they seem to "get it." Maybe it is the perceived notion that because they are sitting, moving one limb at a time and not going anywhere, they think it is not beneficial. For some of these patients I will do a floor transfer to show how strength can be beneficial with function. At this point they usual ask for another therapist.
I have worked with therapists that focus all their attention on the strengthening aspects of treatment but fail to notice the patient is not able to transfer supine to sit or get on and off the toilet without extensive help. Pure strengthening activity has a place but most of the geriatric people I see have a decrease in functional mobility and balance instability. The time spent with each patient needs to be maximized for function. I could spend 20 minutes going over LE exercises or I could use that time to improve independence with transfers and ADL skills or work on fall prevention and recovery. At the same time, I do not want to hand a patient a list of LE exercises and say, "Do this," then move on to other activity.
Circuit training has become popular in the SNF setting, where the patients will do a variety of UE and LE exercises on certain days and on other days they can work on functional deficits that need to be addressed. Sometimes it is hard to strike a balance between strength and function but once it is found the blend is perfect.