PTH 845 Advanced Therapeutics: Part 1 Task B – Implications for Physical Therapist Form

Name: Taylor Mills ADL A: Hobby Farmer (chickens)

Neuro Case #3 Ortho Case #2 ADL B: Loading & Unloading a Vehicle Trunk
Occupation A: Road Construction Worker
Occupation B: Store Manager at Walmart
Neuro Case ADL A: Hobby Farmer (with chickens)
How does the data you collected from your field observations impact your plan of care for this
patient? Consider all of the biopsychosocial factors.

The data I collected from my field observation helped me learn the tasks and specific movements
that the patient performs during this activity of farming with chickens. The person I observed was a 21-
year-old who viewed feeding and caring for her chickens as a hobby rather than a chore. Psychologically
I think this activity was good for her mental health and I could tell that she enjoyed her tasks with the
chickens. Because she was vocal toward her chickens and took selfies with them during my observation, I
am assuming that this was a social activity for her, despite not having much human contact present. These
psychological and social factors helped me see that this is not only an activity that she has to do almost
every day, but it is something she enjoys doing. These observations helped me see what activities she
participates in and I learned how important this activity is to her. The patient’s hobbies and goals are
always important to consider when forming their plan of care. An injury could be devastating to her, so it
is essential that I form a plan of care that is salient for her and includes movements that will help her
resume this daily activity because she thoroughly enjoys it.

Implications for Physical Therapist: Prescription & Execution of Interventions

Impairment Goals:
-Decrease generalized stiffness and rigidity
(improve flexibility in UEs, LEs, and trunk)
-Increase UE and LE strength, especially
shoulder, elbow, hip, knee, and trunk flexors
and extensors.
-Reduce number of falls by improving balance
strategies
-Gain control of tremor in hand to improve
fine motor skills.
-Increase bilateral hand grip strength
-Improve aerobic capacity and muscular
endurance
Functional Goals:
-Lift bag of chicken feed and pour it into bucket
-Independently move into developmental positions
like half kneel, tall kneeling, and quadruped on the
ground to fill water buckets and gather chicken eggs
-Safely ambulate community distances
independently with his walker or cane on even and
uneven ground to walk outside from house or garage
to the chicken pen
-Dual tasking of sprinkling feed on the ground while
walking in the chicken pen of uneven terrain
-Perform various hand grips to improve fine motor
tasks, such as gripping bucket handles, sprinkling
chicken feed, and picking up chicken eggs

What will you consider when selecting exercise to address impairments associated with the first
functional activity of daily living you observed for your neuro case patient?

I will consider that he has had Parkinson’s Disease for the past 5 years and I will want to ask him prior to
each exercise session if he is still taking Sinemet. This will help me know if some of his symptoms and
impairments are being adequately managed by these medications. If it was not working, I would speak
with his neurologist about my findings. I want to choose exercises that involve dynamic, whole-body
movements because of his classic symptoms of PD, such as bradykinesia and rigidity, and his hobby as a
chicken farmer involves these movements as well. He has an increased risk of falling outside while caring
for his chickens due to increased obstacles, performing dual tasking activities, and because he is walking
on uneven ground. Because of this, I want to incorporate balance exercises and gait training exercises.
1 DO NOT EXCEED 15 Pages for this Assignment in Total!
** Each group will be given a what if question to consider for the neuro pt and the ortho pt.
PTH 845 Advanced Therapeutics: Part 1 Task B – Implications for Physical Therapist Form

What will you consider when selecting functional exercise to work on toward independence for
your case patient for the first ADL activity?

It would be helpful to incorporate multiple developmental positions into the exercises because he needs to
perform these as a chicken farmer. I can instruct the patient how to do these and then give him tips on
how he can perform these positions at home and still remain safe. An example is having a stable chair at
his side to help him get onto the floor to position himself into the quadruped, tall kneel, and half kneel
positions. This will allow him to become more independent with his exercises at home and work on
improving his impairments. Then the ultimate goals is that he will safely and confidently resume
completing his activities of daily living, such as feeding his chickens and collecting eggs.

Neuro Case ADL B: Loading & Unloading a vehicle trunk

How does the data you collected from your field observations impact your plan of care for this
patient? Consider all of the biopsychosocial factors.

Based on my observations, it is important to consider how the patient’s age and general health condition
may influence how they can perform this task. This will impact my plan of care because I would have to
determine the patient’s difficulty with this task and determine at what exercise intensity the patient should
begin at. This will depend on the patient’s previous level of function and if they have comorbidities to
consider. The weather conditions, such as temperature, rain, sun, or snow, can also impact how the patient
will perform this activity of daily living. I could have him exercise when he’s more fatigued and has an
increased body temperature or perform this task on a friction reducer to simulate a snowy, slippery
environment. Lastly, a psychological and social factor to consider is that he seemed very experienced
with this ADL. It may be difficult to change his routine with this activity, so this should be considered
during the therapy session and the POC should focus ultimately on him gaining independence with this
ADL.

Implications for Physical Therapist: Prescription & Execution of Interventions

Impairment Goals:
-Improve postural strength and endurance to
reduce thoracic kyphosis
-Increase upper extremity, lower extremity,
and trunk strength to properly lift
objects/groceries
-Increase hand-eye coordination and speed to
sort grocery bags in trunk
-Increase shoulder flexion and abduction ROM
to at least 90 degrees
Functional Goals:
-Independently load and unload walker and
groceries from his vehicle
-Lift grocery bags to carry them into the house
-Safely ambulate community distances
independently with his walker on even and uneven
ground to complete IADLs such as grocery
shopping through parking lot and store
-Independently weight shift onto one LE while
reaching to successfully place groceries into car
trunk

2 DO NOT EXCEED 15 Pages for this Assignment in Total!

** Each group will be given a what if question to consider for the neuro pt and the ortho pt.
PTH 845 Advanced Therapeutics: Part 1 Task B – Implications for Physical Therapist Form

What will you consider when selecting exercise to address impairments associated with the first
functional activity of daily living you observed for your neuro case patient?

I want to choose exercises that involve lifting grocery bags and different weighted items to midline,
across midline, and away from midline while performing tri-planar, functional movements. During this
exercise, it’s also important that he lifts these objects from various heights because he has to gain the
strength and maintain his ROM to lift object from the ground up to waist height or even to shoulder
height during this ADL. Because the tasks are dynamic and involve multiple planes, the exercises I
choose should aim on improving multiple impairments at the same time, such as balance, strength, ROM,
and coordination. Focusing just on one exercise in one plane of motion will not allow for much
transference for this loading and unloading activity because that exercise would likely not be salient to the
patient.

What will you consider when selecting functional exercise to work on toward independence for
your case patient for the first ADL activity?

I will consider the environmental factors that he may have to work in. At first, I could have him start
these exercises and tasks in a neutral temperature environment with limited outside distractions, such as
no cars zooming around, limited outside noises, or people walking around talking. Then I can progress
him through this task by increasing the distractions I listed above. This will allow him to be independent
and successful with this activity of daily living, even when faced with these complex environmental
factors.

Identify one impairment level exercise for each functional activity of daily living observation you
were assigned for your neuro case patient. Provide a drawing or picture of the exercise as well as
the prescription including dosage, frequency, and instructions below. What impairment level goal
does this activity address toward the return of the functional activity of daily living?

3 DO NOT EXCEED 15 Pages for this Assignment in Total!

** Each group will be given a what if question to consider for the neuro pt and the ortho pt.
PTH 845 Advanced Therapeutics: Part 1 Task B – Implications for Physical Therapist Form

Impairment Level – Exercise for ADL #1

Sitting PWR! Up and Twist Moves to Standing UE Chop with a Squat to improve UE,
decrease stiffness and rigidity and LE, and core strength during a functional lift.
improve UE and trunk mobility.

Start standing while holding a free weight in both

Sit at the edge of your chair with your feet
on the floor with a wide base of support.
Bring your arms out to your sides with
your hands facing forward. Bring your
right hand to your left hand and clap
hands together. Follow your hand with
your eyes. Return to the center and repeat
with left hand. This is one repetition.
Perform 2 sets of 10 repetitions, 2x per
day. 1-minute rest between sets.
hands and then draw in your belly button (ab set).
While maintaining this, squat down and bring
weight near your knee. Lift weight up in a diagonal
pattern toward opposite shoulder and follow your
hands with your eyes. Then bring weight back
down toward your knee. That is one repetition.
Perform 3 sets of 10 repetitions with 1-minute rest
between sets. Perform 1x per day, 3 times per
week.

Impairment Level – Exercise for ADL #2

Describe a progression (above was too easy):

Perform PWR! Up and Twist in a standing Deepen the squat and increase intensity of the
position with feet shoulder width apart. exercise by using the UEs that are holding the
Can perform a sequence of PWR! Moves. weight as a driver. Increase weight of the free
Example: PWR! Up 10x, PWR! Twist 10x, weight to build more UE strength.
PWR! Up 10x, and PWR! Twist 10x. Can
allow less rests to improve endurance as
well.
Describe a progression (above was too easy):

Describe a modification towards lower level
(initial exs too hard or provoked s/s):
Perform PWR! Up and Twist in a four-point
quadruped position so that gravity has less
effect on the patient. This is also a functional
position for him as a hobby farmer because
he gets into this position to reach for chicken
eggs in the coop. Increase the rest time or
decrease the repetitions or sets can also
regress this exercise.
Describe a modification towards a lower level:
(initial exs too hard or provoked s/s):
Perform this diagonal motion in a standing
position without a free weight and have the
patient perform a mini squat rather than a full,
deep squat. Decrease sets or reps as needed.
If this is still difficult, have the patient perform a
sit to stand from a high-seated position using the
UE motion without a free weight.

4 DO NOT EXCEED 15 Pages for this Assignment in Total!

** Each group will be given a what if question to consider for the neuro pt and the ortho pt.
Could not fit next section
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PTH 845 Advanced Therapeutics: Part 1 Task B – Implications for Physical Therapist Form

Identify one functional task/exercise that will allow for progression/return to the functional activity
of daily living you were assigned for your neuro case patient. Provide a drawing or picture of the
task/exercise as well as the prescription including dosage, frequency, and instructions below. What
impairment level goal does this activity address toward the return of the functional activity of daily
living?

Functional Activity – ADL #1 Functional Activity – ADL #2

Carrying a bucket of chicken feed in
dominant hand while walking on an uneven
surface with a walking stick or cane in the
non-dominant hand. This activity improves
balance reactions, improves ambulation
distance, UE strength, and challenges
ability to dual task.
Standing facing wall with a waist high bench on
right side and a large bucket or basket at waist
height on his left side to simulate a car trunk.
Unload grocery items from right side to left side.
Maintain an ab set by drawing in belly button
toward spine during activity to reduce strain on low
back and use cane in non-dominant hand. Addresses
impairments involving hand dexterity, ability to
weight shift and balance, UE coordination, trunk
mobility, and UE strength.

Walk 50 feet at a rate of perceived exertion

of 12-14 (exercise should feel somewhat
hard) while carrying the bucket of chicken
Load 20 groceries of different weights from your
feed. PT could also use Karvonen Formula
right to your left into the “trunk” and then move
in the clinic to assure that the pt is working
groceries back from left to right. This is one set.
in his target heart rate zone (intensity 60%-
Before beginning exercise, tighten core muscles by
70%).
making an ab set (as if you were trying to put on a
tight pair of pants, but do not hold your breath) and
Perform 3x’s with 2-minute rest in between.
maintain this during the activity.
Perform 3-4 times per week.
Perform 3 sets with 2-minute rest in between.
Perform this activity 2 times per week.

Describe a progression (above was too easy): Describe a progression (above was too easy):

Increase walking distance to 100 feet or
more and decrease rest breaks. Could also
increase the weight he has to carry in the
bucket. This exercise can also be
progressed by making an obstacle course
that includes variable stepping. This is
salient because he may have to maneuver
around objects to get from his house out to
the chicken pen.
Lower the height of the bench to simulate grabbing
items for the bottom of the cart and lower the
surface that the bucket/basket sits on. The trunk
may sit lower in some cars compared to others.
Increase the weight of the grocery objects or
increase the number of items that he has to load and
unload. Increase the environmental distractions (car
horns, people talking, small space to work in)

5 DO NOT EXCEED 15 Pages for this Assignment in Total!

** Each group will be given a what if question to consider for the neuro pt and the ortho pt.
PTH 845 Advanced Therapeutics: Part 1 Task B – Implications for Physical Therapist Form

Describe a modification towards lower level Describe a modification towards a lower level:
(initial exs too hard or provoked s/s): (initial exs too hard or provoked s/s):

Decrease the weight of the bucket or have him
carry an empty bucket to start. Decrease the
distance walked or have him walk on a flat,
even surface. If he could not perform this task
with one cane, you could have him use his
walker and trial attaching the bucket handle to
the walker or place the bucket on the seat of
the walker.
Use cane or walker, if needed, rather than no
assistive device. Decrease grocery items or the
weight of them. Increase the height of the
surfaces where the groceries and bucket/basket
sit, so he can perform less trunk flexion, SB,
and rotation.
If this is still too difficult, have the pt sit on his
walker seat to take more rest breaks. This
activity could also be broken down into smaller
components, such as standing to sort groceries
once they are in his trunk.

Mock Case Occupation A: Road construction

worker

How does the data you collected from your field observations impact your plan of care for this
patient? Consider all of the biopsychosocial factors.

For this occupation, it is important to consider the environmental elements that a road construction
worker goes through on a daily basis. The weather (extremely hot or raining), rush hour of traffic, and the
multiple outside distractions are important factors to consider. Within my plan of care, I need to consider
how fatigued this worker will feel during different times of their shift. The intensity of the job likely
increases near the end of the day as the workers are trying to finish their tasks before heading home for
the day. There also seemed to be a social factor because road construction workers work in groups and as
a team. Based on my personal observations at this particular construction site, most of the workers were
smoking cigarettes while taking a standing break from their work or they were multi-tasking by smoking
while working. Although I won’t promote smoking, I need to give adequate breaks that they would take
during their typical shift and also incorporate multi-tasking into the exercises and activities I choose.

Implications for Physical Therapist: Prescription & Execution of Interventions

Impairment Goals: Functional Goals:
-Decrease low back pain to 5/10 (moderate -Independently dig and shovel at work
pain) or less intermittently for 8-10 hours
-Decrease lumbosacral spine spasms while -Improve tolerance to coupled spine movements
bending and rotating spine for ADLs such as donning shoes, socks, and pants
-Improve trunk mobility and ROM (flexion, to get ready for his workdays
extension, SB, rotation, and coupled -Standing independently for prolonged period of
movements) time on even and uneven surfaces
-Increase tolerance to sitting for over 30 -Improve static and dynamic sitting and standing to
minutes to be
DO able
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sit in a machine
15 Pagesatforwork
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Assignment Total! full-time as a road construction
6 trucks
drive dump ** workerto consider for the neuro pt and the ortho pt.
Each group will be given a what if question
-Strengthen abdominal muscles, paraspinals, -Improve tolerance to performing sit to stands from
core chair
-Increase hamstring flexibility to reduce LBP -Improve tolerance to perform car transfers of
-Increase standing and sitting endurance to various seat heights that he may see at work
PTH 845 Advanced Therapeutics: Part 1 Task B – Implications for Physical Therapist Form

What will you consider when selecting exercise to address impairments associated with the
occupation you observed for your musculoskeletal case patient?

After observing a road construction worker for a short period of time, I saw a wide variety of tasks and
movements being performed on site. The exercises that I choose for this patient should involve tri-planar
movements and be functional for him. Although a lot of strength needs to be present to fulfill these work
duties, it is important to get a stable base to avoid provocation of his spine. I want to focus on spinal
stabilization to calm down the tissues surrounding his low back and then improve functional strength and
ROM.

What will you consider when selecting a functional exercise task to work on toward participation in
work following your observation for your case patient?

The best way to exercise this patient is to gradually increase his work demands. He can continue to
perform a variety of work-related movements, but this prolonged time of repetitive movements without
proper stabilization may be causing him to have pain and spasms. First focusing on spinal stabilization
and then strength will be key for this patient. Then once he has this, he will be able to independently
return to participating in half workdays and then progress to returning to full workdays.

Mock Case Occupation B: Store Manager at Walmart

How does the data you collected from your field observations impact your plan of care for this
patient? Consider all of the biopsychosocial factors.

Because the person I viewed was a store manager of a big store (Walmart), she was never alone. There
was always a staff member or customer talking to her in person or through her headset. She constantly
had to leave the tasks she was trying to do at the counter to go help others. She seemed tired and fatigued
from all the walking and standing tasks that she had to do, so it would be helpful to get her on an aerobic
exercise program.

Implications for Physical Therapist: Prescription & Execution of Interventions

Impairment Goals: Functional Goals:
-Improve muscular endurance and - Improve ambulation distances of hard even
cardiorespiratory endurance to ambulate through surfaces, such as the tile floors in Walmart
Walmart and may also improve his HTN -Standing at fabric counter organizing fabrics
-Improve bilateral shoulder ROM into bins
-Increase hip abductor strength to reduce - Pointing to objects for customers and reach
compensated Trendelenburg gait deviation items on shelves
-Improve static and dynamic standing tolerance -Standing at counter using box cutter and scissors
-Improve bilateral hand coordination and to cut boxes and fabrics
dexterity to open store items and sort them -Able to bend down to look for items or stack
-Improve DO NOT
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with for this Assignment
cervical lowerinshelves
Total!
** Each group will be
rotation while walking and talking given a what if question to
-Improveconsider for for
tolerance the squatting
neuro pt and the
down toortho
grab pt.
-Increase trunk ROM, especially rotation items on lower shelves
-Strengthen UEs, LEs, core, and back extensors
PTH 845 Advanced Therapeutics: Part 1 Task B – Implications for Physical Therapist Form

What will you consider when selecting exercise to address impairments associated with the
occupation you observed for your musculoskeletal case patient?

For this patient, his primary impairment seems to be decreased endurance. This was causing him to look
fatigued and have gait deviations, which could contribute to him LBP. Another group of exercises to
focus on with him is spinal stabilization to get a solid platform and base to allow for controlled mobility
on stability. His work demands include being on his feet all day, lifting, reaching, and squatting, so
incorporating a whole-body strengthening program may be beneficial for him too.

What will you consider when selecting a functional exercise task to work on toward participation in
work following your observation for your case patient?

His functional exercises should incorporate multi-tasking and changing activities quickly. He would
benefit from a circuit training activity that simulates multiple work tasks. It would also be helpful for this
patient if the PT approaches him to ask questions as a customer or if the PT tells the patient to move to a
different station to simulate an employee asking for help somewhere else in the store. Having distractions
and keeping the patient on their feet will help the patient return to his work environment.

Identify one exercise to address an impairment for the patient with Occupation A and one for the
patient with Occupation B that you would select as part of your intervention plan. Provide a
drawing or picture of the activity as well as the exercise prescription including dosage, frequency,
and instructions below. What impairment level goal does this activity address toward the return of
function to that occupation?

Impairment Level – Exercise for Occupation #1 Impairment Level – Exercise for Occupation #2

Repeated Sit to Stand to a Metronome with UE Spinal Stabilization Exercises in Supine with
Drivers: This exercise helps to improve sitting alternating arm lifts. This exercise works on
and standing endurance while strengthening his improving the patient’s abdominal weakness
lower extremities. This exercise is salient for and this will hopefully decrease the patient’s
this patient because he will have to get in and back pain and spasms.
out of different seat heights in trucks and
I could not fit all of the content here.
machines at work.
Please scroll down to the next page.

Lie on your back. Perform the ab set where you

8 DO NOT EXCEED 15 Pages for this Assignment draw in Total!
your belly button toward your spine as if
** Each group will be given a what
Begin by sitting at the edge of your chair. Set if question to
you were consider forput
trying to theonneuro ptpair
a tight andof
thepants.
ortho pt.
the metronome at 30 beats per minute. Follow Do not hold your breath during this exercise. In
the beat of the metronome. On the first beat, picture, PT is feeling for muscle contraction.
stand up and bring both arms straight up in front While maintaining the ab set, lift your R arm up
PTH 845 Advanced Therapeutics: Part 1 Task B – Implications for Physical Therapist Form

Describe a progression (above was too easy): Describe a progression (above was too easy):

Decrease chair height so that there is a deeper
squat that the patient has to perform. This will
be helpful for this patient as a construction
worker because some of the smaller machines
have very low seats to get into. Also progress
this exercise by increasing the metronome beat,
so that the patient has to perform this at a higher
intensity. Patient can also incorporate UE
drivers going into diagonal patterns rather than
just sagittal plane movements.
Progress by increasing the length of time that
the patient performs this exercise. Can also
progress by performing leg lifts with an ab set,
performing alternating arms and legs, or
incorporating spinal stabilization with other
positions. Progress to sitting and standing for
this patient because these are functional
positions he uses for his occupation.

Describe a modification towards lower level Describe a modification towards a lower level:
(initial exs too hard or provoked s/s): (initial exs too hard or provoked s/s):

Increase the chair height to allow for a smaller
squat to occur. Also, the metronome beat can be
decreased, or the metronome can be removed if
this cognitive task is too difficult for the patient
when starting out.
This exercise can be regressed by having the
patient only focus on performing the ab set. The
patient could also just focus on moving their
right arm for one set and then focus on moving
only their left arm for a separate set. The patient
could also count reps rather than time.

Identify one functional activity that will allow for progression/return to each occupation you were
assigned for your musculoskeletal case patient. Provide a drawing or picture of the functional
activities as well as the prescription including dosage, frequency, and instructions below. What
impairment level goal does this activity address toward the return of the functional activity of daily
living?

Functional Activity – Occupation #1 Functional Activity – Occupation #2

Shoveling objects off the ground and into a
bucket (wheelbarrow). This activity aims to
improve the patient’s tolerance to coupled
trunk movements, standing endurance, and
strengthens his core.
Circuit Training Activity: Spread out multiple
stations around a large room so the patient has to
walk at a fast pace from station to station:
Station1: standing at waist height counter and
sorting fabrics into bins. Station 2: Chop lifts
with a free weight.

9 DO NOT EXCEED 15 Pages for this Assignment in Total!

** Each group will be given a what if question to consider for the neuro pt and the ortho pt.
Station 3: D2 PNF flexion and extension with a
Grab onto your shovel and perform an ab set to reach and weight shift to put items away. Take
stabilize your spine. Then bend with your legs item on the floor and place it on a high shelf.
PTH 845 Advanced Therapeutics: Part 1 Task B – Implications for Physical Therapist Form

Describe a progression (above was too easy): Describe a progression (above was too easy)

Increase the weight of the items being lifted or Incorporate distractions and outside
have the patient shovel multiple items at once environmental factors that simulate the patient’s
to fill the shovel. Can make this more work environment. PT can call out different
challenging by having the patient walk holding station numbers so that the patient has to react
the filled shovel and then dumping it into the by changing directions and move to the next
bucket that is a further distance away. Can task.
further challenge the patient by having them
stand on an unstable surface while performing
this activity, such as an Airex pad. The PT can
also have the patient perform this activity when
they are fatigued to simulate their work
environment.

Describe a modification towards lower level
(initial exs too hard or provoked s/s):
Decrease the sets and repetitions that the patient
is performing this activity. Regress this activity
by having the patient shovel the items from a
higher surface rather than off the ground so that
the patient doesn’t have to bend their back as
much or squat as low.
Describe a modification towards a lower level:
(initial exs too hard or provoked s/s):
The best way to regress this exercise is to
decrease the time of performing this exercise
and by allowing the patient to have increased
rest breaks between stations.

Summarize the different considerations you took into account in your clinical reasoning for the
plan you identified for the two ADL situations for the patient with the neurological condition.

I viewed the hobby farming ADL as something that the patient enjoyed doing, whereas loading and
unloading his car trunk was seen more as a chore. I think the exercises and activities that involve the ADL
that's considered a chore may need education on why this is important, and the patient may need more
external motivation from the PT. Using the fact that he wants to return to caring for his pet chickens can
act as an internal motivator. The activity of daily living involving farming for his chickens also involves
more dual tasking and physical exertion to complete, but the patient can work in solitude and focus on his
tasks. Loading and unloading his trunk, however; involves one main task, but there are more external,
environmental factors to consider. The exercise progressions that I made incorporate elements, such as
the being in busy, loud environment for the loading and unloading ADL and involves uneven terrain for
the chicken farming ADL. I wanted the exercises to be transferable and as salient to the patient as
possible.

Summarize the different considerations you took into account in your clinical reasoning for the
plan you identified for the orthopedic patient given the two different occupations the patient may
have.

10 DO NOT EXCEED 15 Pages for this Assignment in Total!

** Each group will be given a what if question to consider for the neuro pt and the ortho pt.
PTH 845 Advanced Therapeutics: Part 1 Task B – Implications for Physical Therapist Form

For both of these occupations, I observed the workers getting fatigued, but they still had to continue
working. The road construction worker worked in a small area and the Walmart manager had to walk all
over the store. Because of this, I had the store manager complete a widespread circuit activites. The road
construction worker only interacted with other construction employees and he was focusing on one task at
a time. Once he finished it, he moved on to the next one. The store manager, however; kept getting
interrupted by other staff members and customers, so she had to do more multitasking. This is primarily
why for the exercise progressions that I had the construction worker's physical work demands and the
exercise repetitions increase. For the store manager, the exercise progression involved more external
distractions and having to leave one task to move onto a different one when the PT called out for the
activity to switch.

**How does the “What if. . . “ question impact your neurological patient? Your orthopedic patient?

The “what if” question impacts my neurological patient primarily in the way that the PT would have to
motivate the patient. If the patient was hobby farming, they may have more internal motivation to return
to something that they love rather than returning to an ADL that’s a chore, such as loading and unloading
a car with groceries. For example, if I had to choose between doing the dishes or being able to play
basketball, I would be more motivated to get back to basketball. Incorporating overlapping tasks that both
ADLs required could help the patient improve both activities. An example of this is lifting a bucket of
feed for his chickens may strengthen the muscles that I was hoping to strengthen by lifting grocery items.

The “what if” question impacts my orthopedic patient primarily by the environmental factors. The road
construction worker will likely get fatigued by the weather and physical exertion that his tasks demand,
whereas the store manager may get fatigued mentally by the outside distractions and social situations
going on. For both occupations, the patient still had LBP and they both likely need spinal stabilization
exercises and strengthening, but each occupation had different intensities of work demands.

In 2-3 sentences, summarize the application of your understanding and/or use of biopsychosocial
principles and evidence from the literature to each of the four situations you were assigned.

Neuro Patient ADL #1: This patient had PD, so I wanted to use the neuroplastic principles such as
transference, saliency, and repetition within my plan of care. I applied these principles to his ADL of
hobby farming and hoped this would motivate him during therapy. I also chose an exercise using the
PWR! Moves because these exercises were originally created for individuals with PD and they target the
cardinal symptoms of PD that this patient was having, such as bradykinesia, rigidity, and possibly
freezing of gait that is leading to falls.

Neuro Patient ADL #2: I chose exercises that would specifically target his impairments, such as
decreased UE strength and trunk stiffness. These exercises involved using applied functional science to
train our bodies in multiple planes and add in drivers to improve the intensity of this exercise. Also, I tried
to incorporate principles within PNF techniques, such as moving in diagonal, functional patterns and
having the visual system follow the patient’s hands to facilitate further motion.

Ortho Patient Occupation #1: The first exercise I chose involved sit to stands because the patient had to
get in and out of machines at work and drive different trucks as a road construction worker. This exercise
can easily be progressed with a metronome to improve intensity and I incorporated drivers, which are a

11 DO NOT EXCEED 15 Pages for this Assignment in Total!

** Each group will be given a what if question to consider for the neuro pt and the ortho pt.
PTH 845 Advanced Therapeutics: Part 1 Task B – Implications for Physical Therapist Form

part of applied functional science. I wanted to add a spinal stabilization element for each of these
exercises as well because it may help to have a stable platform (the spine) to reduce the stress on his low
back.

Ortho Patient Occupation #2: I wanted to incorporate circuit training to maintain the intensity of this
activity, but also to add the environmental elements of changing directions and moving onto different
tasks quickly to simulate his job as a store manager of Walmart. For these exercises, I also added a spinal
stabilization component for the same reasons as listed above.

12 DO NOT EXCEED 15 Pages for this Assignment in Total!

** Each group will be given a what if question to consider for the neuro pt and the ortho pt.