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Specialist PSI Exercise Module
DAYS 3 & 4 – OVERVIEW
• Programming, Theory and Practice I and II
• Teaching Practice Workshop
• Assessment Briefing
• Medical Conditions, Medications and Exercise
Management
• Health and Safety
• Progression and Adaptation Workshop
• Implementation in Community Programmes
Specialist PSI Exercise Module
PROGRAMMING THEORY & PRACTICE
• AIMS
- Making the case for PSIs
- Types of exercise sessions in falls exercise provision
- FaME
- Exercise programming theory
- Applying theory to practice
- Practical
Manual 2 Section 3
Specialist PSI Exercise Module
Making the case for PSIs
4 Types of Opportunities, Phase IV:
• PSI
• Exercise for the Older Person
• 1 to 1 Personal Training / Physiotherapist
• Active Lifestyle
4 4
Advantages Drawbacks
Specialist PSI Exercise Module
Types of exercise sessions in falls exercise provision: 3 Settings, 3 Session Structures
• Rehab
• Prehab
• Chair
3 Common
Activities
PSI Approaches Phase 3
PSI
Phase IV
“Holding Group”
Functional Strength
3 Distinct
Activities (one per session)
Manual 2 Section 3
Specialist PSI Exercise Module
FaME
PHASES 1. 2. 3.
Phase names and corresponding weeks
Content of each phase
Manual 2 Section 3
Your practical assessment is week 15 – 20 (training gains / phase 2) –
See Manual 2 Section 3 for session planner
Specialist PSI Exercise Module
SAFETY FIRST
PSI Session Structure + Content
Warm Up CIRCULATION BOOST; JOINT MOBILITY; STRETCH
Workout 5 (of 7) EVIDENCE-BASED ACTIVITIES
Cool Down CIRCULATION LOWERER; FLEXIBILITY; TAI CHI
Tea + Chat and re-energise
Manual 2 Section 3
Specialist PSI Exercise Module
EXERCISE PROGRAMMING THEORY
• Principles
Specificity
Progressive Overload
Rest & Recovery
Individual Difference
• Variables (recap)
FITTA
Manual 2 Section 3
Specialist PSI Exercise Module
PSI =
EXERCISE for OLDER PEOPLE – Best Practice Guidelines
+SPECIAL CONSIDERATIONS for
Older People with HIGH RISK OF FALLS –
Best Practice Guidelines Manual 2 Section 3
Specialist PSI Exercise Module
What
is it ?
Definition
Older Person
Guidelines
Special Considerations
For Fallers
Only 3 please!
Examples of exercises
EXERCISE GUIDELINESCOMPONENTS OF FITNESS WORKSHOP
BALANCE: STRENGTH: FLEXIBILITY: ENDURANCE
F
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T
A
Specialist PSI Exercise Module
STRENGTH
What
is it ?
Working
Muscle + Bones
Against
Resistance
To Gain
Stronger
Muscles
And Bones
To Make
Everyday
Activities
Easier
Older Person Guidelines
2 – 3 Times / week
12 –15 reps to begin
1 – 3 sets progress up to 70-80% 1RM
6-8 reps
20 mins –1hr
6-9 secs per Isotonic Rep
5 Secs Isometric
Body weight / Weights
Open/closed chain
Isometric / isotonic
Fun / Relaxed
Variety
Safe
Warm
Social
Special Considerations for
fallers
Functional abdominal work
Postural and bone-load for back extensors
Specific
Targeted
Muscles: Hip, Knee, Ankle
Examples of
Exercises
FaME: seated leg
press, seated upper
back strengthener, prone back extension
Otago: standing
knee flexion, standing hip abduction
F
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AManual 2
Specialist PSI Exercise Module
The Borg Scale
Rate of perceived exertion0 NOTHING AT ALL
0.5 VERY VERY LIGHT
1 VERY LIGHT
2 FAIRLY LIGHT
3 MODERATE
4 FAIRLY HARD
5 HARD
6
7 VERY HARD
8 VERY TIRING
9
10 VERY VERY HARD
EXHAUSTING
NB.
Community Session Evaluation 0 – 10 scale in Dynamic Endurance Component
Research 6 – 20 scale Endurance Component before mid point + post
Manual 2 Section 3
Specialist PSI Exercise Module
Resistance Training Continuum
15 12 10 8 6
30% 50% >60% >70% >80%of IRM of IRM of IRM of IRM of IRM
Low weight Heavy weightHigh Reps Low Reps
Manual 2 Section 3
Endurance Strength
Specialist PSI Exercise Module
What
is it ?
Stamina:
Work muscles harder & longer
(in order to increase the pulse rate, breathing rate)
Older Person Guidelines
3 – 5 days per wk
Moderate,
30-75 % VO2 Max
30 – 60 mins.
Aerobic
Fartlek
Longer build up and
build down
Avoid steps that
could cause a trip
Special Considerations for fallers
- Focus on coordination and balance
- Chair based initially then chair support
- Simple / repetitive / stable
Examples of Exercises
Marching
Side-stepping
Gait training
Toe taps
ENDURANCE
F
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A
Manual 2 Section 3
Specialist PSI Exercise Module
What
is it ?
Maintaining upright posture during position change
(eg. Standing up and to prevent falls)
Older Person Guidelines
3 x per week
Increase slowly –
graded to group
10 mins – building up to 1
hour.
Dynamic balance
i.e weight transference
Varying activities &
weaning off support
slowly – vary positions
Special Considerations for
fallers
Start with ‘win win’ tasks
(eg – seated ball games)
Ensure appropriate ratio of supervision for each task
Explain benefits
Method of using support
Examples of Exercises
Functional reach while sitting
Toe & heel walking
Tandem walks
calf raises
Flamingo swings
Picking objects off the floor
Backward walking
BALANCE
F
I
T
T
A.Manual 2 Section 3
Specialist PSI Exercise Module
What
is it ?
Best optimal range of movement available at a joint or joints
Older Person Guidelines
2 – 7 days a week
Mild muscular tension No Pain
Maintenance:
1 x 8 – 10 secs
Developmental:
2-3 x 11-40 secs
Static and active
Developmental +
Maintenance
“Reward”
Relaxing
Special Considerations for
fallers
Remain seated 2 – 3 mins following work (stretches) in lying
Alignment is paramount
Precise instructions – step by step
Examples of exercises
Targeted stretches
Yoga
Tai Chi
Functional Activities
FLEXIBILITY
F
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AManual 2 Section 3
Specialist PSI Exercise Module
BACKWARD CHAINING
FLOOR WORK
• Strength
• Balance / Co – ordination
• Flexibility
• Coping strategies
TAI CHI
Manual 3
Specialist PSI Exercise Module
EDUCATION and PREPARATION OF PARTICIPANTS
INDUCTION SESSION
WHEN EXERCISE SHOULD
- NOT HAPPEN
- BE DISCONTINUED
- BE CONTINUED
FALLS SPECIFIC EDUCATION / COPING STRATEGY
MONITORING
BORG, TALK TEST, observing co-ordination & technique
= comfortably challenged
Manual 2
Manual 2
Manual 2
Manual 2
Specialist PSI Exercise Module
FALL OVER
Remain still. Avoid panic and wasting energy on ineffective struggling.
Have any serious injury? Any movements limited?
Any pain?Will help arrive soon and this person
will summon help or use a lifting cushion
Plan how to summon help
If you are wearing an alarm button or you can reach one – then do so!
Can you get up without help?
YESYES
YES
YESNO
NO NO
NO
OK
OKOK
Carry out your previously worked out plan to summon help by alternative methods and while waiting for help to arrive carry out your plan to avoid any consequences of being on the floor for a long time.
How To Avoid Spending A Long Time On The Floor After A Fall
Simpson J. 1998
Manual 2
Specialist PSI Exercise Module
PROGRESSION + ADAPTATION
• Seated Adaptations for:– Trunk rotation, calf stretch, upward side stretch– Double side step, wide-based sway, march– Heel raise and toe walk, toe raise and heel walk,
flamingo swing, tandem stand– Backward chaining– Prone back extension, side lying leg raise, prone
hip extension– Working the oar
Specialist PSI Exercise Module
Exercise Management of Patients with Chronic Illness / Conditions
The Individual Difference Principle
• Liaison with Health Professionals
• Liaison with Patient
• Liaison with Leisure Professionals
Manual 1
STEP 1
Specialist PSI Exercise Module
Exercise Management of Patients with Chronic Illness / Conditions
• Type of condition• Site of condition• Stage of condition• Functional Limitations• Disease Specific Effects• Disease Specific Effects to the individual• Medication Effects• Exercise performance limitations• Risk stratification• Prognosis• SMART goals – Specific; Measurable; Agreed; Realistic; Timed
N.B. SMART - Not in manual / not assessed but an important tool.
STEP 2
Specialist PSI Exercise Module
Do’s
FREQUENCY(How Often)
INTENSITY(How Hard)
TIME(How Long)
TYPE
(+ Activities)‘Which type’ eg Strength / Endurance Isometric / Isotonic Continuous/Interval
APPROACH/ ADHERENCE(Variety, Individual interests etc)
Don’ts Adapts Benefits
DISEASE
Specialist PSI Exercise Module
HEALTH & SAFETY
1. The Environment / Facility
2. The Equipment
3. The People
Manual 2
Specialist PSI Exercise Module
ASSESSMENT INSTRUCTIONS
1. THEORY PAPER
• ON DAY 5
• 2 Hours
• 5 short answer questions and 30 multiple choice
• 70% pass mark
• 5 mins reading time
• Let us know before if special needs requiring additional support
Formative Assessment of Tai Chi:
On Day 5 (afternoon) you will have your teaching skills for delivering the Tai Chi section of a class formatively assessed.
Specialist PSI Exercise Module
TIPS for Theory Paper
• LEARN YOUR PPTs!
• In the Manual• If its in bold its important
• If its in a box its VERY IMPORTANT
• If its in a box + bold its VERY IMPORTANT
Specialist PSI Exercise Module
2. PRACTICAL
• On Day 6 or 7 (whichever you signed up for)
• Plan 1 hour week 15-20 PSI Session – bring 2 copies of plan - ie. assessed on planning
Refer to Manual 2 Session Planner;
Use sesson plan proformas provided;
Only teaching points necessary ie. not instructions
• Approx 30 mins teaching to your peers – ie. assessed on teachingEquipment provided = therabands, chairs, mats;
Moved on by assessor – plenty of time / prompts;
Assessment checklist will be used by assessor;
Consider lifting technique e.g. for mats. Chair alternatives but Not Chair focus;
Notes can be used if necessary – or assessor prompt
ASSESSMENT INSTRUCTIONS
Specialist PSI Exercise Module
• No Pass Mark for Practical delivery, only Pass/Refer and action points given
• Receive peer evaluation
• Write up self- evaluation – ie. assessed on evaluation
Practice with people - not just in front room!
ASSESSMENT INSTRUCTIONS
2. PRACTICAL cont’d
Specialist PSI Exercise Module
3. CASE STUDY
Ensure meets Criteria for PSI intervention and is at risk of falls
• Complete all paperwork - (questionnaires + functional
grid) in assessment pack
• Complete 1500 word ‘write up’ – see case study guidelines in
Summative Assessment Pack
• Submit on day 6/7
• Pass mark 70%
All results (case study, practical and theory paper) in post
(8-10 weeks later)
ASSESSMENT INSTRUCTIONS
Specialist PSI Exercise Module
PSI Workshop
Warm Up1. Circulation Exercise
2. Mobility
3. Stretch
Workout
5. Dynamic Endurance
6. Dynamic Balance
7. Resistance Bands
8. Backward Chaining
9. Floorwork
Cool Down10. Circulation Lowerer11. Flexibility
12. Tai Chi
Specialist PSI Exercise Module
Teaching Workshop Feedback Guidelines
1. Content
2. Teaching
3. Personal Performance
pace
Appropriate to component and evidence-based
transitions
- Position
- T. Instruction
- T. Points
- 1 - 1
WhatWhereWhen
- Attire, Organised, Technique, Voice, Communication
Howobservinganalysing,solution,communicating