It starts with the level of function the client is seeking. Again, for those who have been part of the movement professional community, this can be an abrupt change from the typical seek and destroy mission that is organized around what problem to get rid of. Pain and loss of function will certainly be addressed; however without the context of an overall desired level of function, something specific, the change effort is likely to end when the pain or problem intensity subsides. Identifying patient’s true aspirations is done through a survey of the in regards to activities the patient or client wants to be involved in. A quick assessment of the life categories helps to identify where the focus will be, as areas that are deemed adequate can be reviewed but not assessed specifically. After the client has chosen a few of the specific activities that interest them, they are asked to self asses their current abilities by choosing similar tasks that are associated with varying levels of difficulty. These levels may be defined as a different performance skill that is required, a different energy level required of both.
This first action is asking the patient or client what really matters to them may seem trivial, a nicety, and window dressing to the real work to come. The purpose of this exercise in identifying true aspirations is to generate the momentum and interest in the work to come. Frequently in a problem solving structure in which the expert is the provider and giver of the solution, the patient or client becomes passive. It’s not their fault, as they are simply reacting to the implied expectations that it is their job to be a passive participant. By asking for what is desired, the foundation for true involvement is set. However it is not enough to know where they want to go. We also need to know where they are now. This observation and recording of where the patient status is now in relation to the desired outcome is the work to be done. It begins with the client taking the first steps.
The client then performs an assessment of their general mobility capabilities. This is done through the client being instructed to perform a series of motions in different BOS. Supine, seated, squatting, standing in a stride stance, and standing on one leg are progressively requested depending on the prior, simpler levels answers to the question. The client selects from 5-7 different descriptions of the action performed and asked to select that description that most closely describes their ability at that time. This progression is for safety as it is reasonable to conclude that a person who cannot sit unassisted is unlikely to be able to stand without significant need of assistance. In addition, it is reasonable to conclude that client with this scoring would be in danger if asked to perform a stride stance balance test or a single limb balance test. As a result those tests are only offered to those who are able to demonstrate an acceptable lower level score.
After the conclusion of the mobility test, a self-test of aerobic capacity is performed. For those with low mobility scores, the aerobic survey is presented for completion. This self-survey provides a reasonable approximation of aerobic function. Starting with this allows those with potential for unsafe movement to provide data but not be at risk. For those with higher level scores on the mobility screen, both the aerobic survey and a 6 minute walk test is performed. Both forms are presented to the user and the appropriate check boxes are made for the aerobic survey and data added to the requested text boxes. The program then calculates the scores and presents the MET levels.
After this is completed a report is presented that demonstrates the results of the mobility test and what are the percentiles for that movement pattern. Also the MET scores are presented. A separate report is presented with a clickable list of acceptable activities for the person to perform based on both their mobility scores and MET levels. This list is life area specific. This list is provided in response to the question “What can I do now, given my current functional capacity.” This offering is a direct expression of the value of involvement that our company holds as an organizing principle. Why wait to encourage involvement? Regardless of the level of capacity, many life activities can be presented as reasonable ways to get involved.
The report also presents the comparison of the desired level of function as identified by the client and the current levels of ability. The general mobility and MET level is compared to the tasks and energy requirements of the function and a recommendation regarding current ability is presented. If the general mobility and MET levels are lower than the desired levels, the change effort will include remediation of lower levels. If the current levels are greater than the desired levels then the user is exempted from those lower level activities. At this point the specific desire results can be investigated for physical capacity to perform and a change effort presented for the user to develop maximal capacity. An example of a user with higher level of current ability still requiring education on lower levels would look like the following. A user wants to be able to sit and work at the computer for extended periods of time and is currently able to pass all components of the general mobility and 6 minute walk test indicates a MET level of 10.5. The seated activity requires a MET level of 2.3 for example. The lesson presented would include supine chop lift, seated hip hinge with core integration and squat progressions all to assist in maximizing seated postural ability.
Why use these exercises…Structured Motion is about intensification of functional movements. With this approach a strong foundation of actions on behalf of the patient or clients goals are initiated. The upcoming installments will describe how the change effort progresses and the focus on creating a specific outcome.