Techniques of a PTA
Working in a variety of settings has helped me develop some simple tools to get patients motivated and moving in an efficient manner. Once they are up and moving, I try to maximize my time with them and get them to do as much as possible to increase their functional mobility and LE stability.
For starters, I encourage them to reposition their legs and hands for comfort and safety before getting up out of a chair. Yes, I know, push from the wheelchair arm rests with both hands, but most people will not have a wheelchair at home while watching TV. Is it wrong for a patient to grab hold of the assistive device and stand up? As long as the device does not slip and the patient is safe, there is not a right or wrong way to get up. It is either safe or unsafe.
There may be circumstances when I will cue a patient to push up, but in general I do not. This can irritate other therapists who strive for continuity with sequencing. I do cue patients to reach back for the armrest before sitting down, but again this is only for them to ensure the wheelchair is locked or secured and will not slip - safe and unsafe transfers.
For leg exercises, I like to maximize time with patients and will have them combine standing exercises. Beginning with abduction/adduction, I then demonstrate to bring that same leg into hip flexion after the legs are together. It takes a bit of coordination to do this and some patients tend to hip flex while they are abducting/adducting. I cue it like this, "Out, in, up, down." I emphasize they are two separate movements.
Another combo is toe raises, then bilateral knee flexion. Watch the patients who try to stay up on their toes while bending both knees. The cue for this is, "Up, down, bend." Again, I emphasize the two distinct movements.
When I have patients rest, I tell them to move their ankles up and down or do LAQs while they "rest." The key is functional mobility, getting the patients up and moving to their tolerance at an acceptable level of performance. I would rather have a patient stand and do balance activity for a session than go through the motions of AP, HS, QS, Ab/Ad and GS - which, by the way, can be grouped like the standing exercises.