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Objectives

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After completion of this chapter, the physical therapist should be able to do the following:

  • Define functional exercise progression.

  • Define the SAID (specific adaptations to imposed demands) principle.

  • Outline the need for functional progression and testing.

  • Describe the continuum of functional progression for low- and high-level patients.

  • Outline a functional progression program for the lower extremity.

  • Outline a functional progression program for the upper extremity.

  • Outline a functional progression program for the spine.

  • Discuss major functional testing research.

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The physical therapist plays an important role in helping individuals return to their preinjury level of function. While working to achieve impairment-based goals, functional testing is employed to gauge readiness to move through the rehabilitation program and to return to activity. A functional exercise progression can be initiated prior to functional testing or following the results of functional tests. In either case, functional testing or progression should not exceed the healing constraints of the injured tissue. By breaking down functional activities into basic tasks, a safe and effective rehabilitation program can be designed. This chapter examines functional exercise testing and functional exercise progression, and provides examples for some common upper- and lower-extremity disorders, as well as a sample spine program.

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What Is Functional Testing and Functional Exercise Progression?

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The ultimate goal of any rehabilitation program is to return an individual to the preinjury level of function as quickly and safely as possible. Decreasing pain and swelling—and restoring normal range of motion (ROM), strength, proprioception, and balance—are only part of the plan. Functional testing and a functional exercise progression will complete the rehabilitation program. Functional testing encompasses measuring various activities to provide a baseline for determining progress or to provide normative data with which to compare performance. A functional exercise progression can be defined as a series of activities that have been ordered from basic to complex, simple to difficult, that allows for the reacquisition of a specific task. Many of the exercises in the functional progression may be used for functional testing. Functional testing and functional exercise progression allow the clinician to bridge the gap between basic rehabilitation and a full return to activity.

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How Is Functional Testing Performed?

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Functional testing and functional exercise progression are used in a variety of physical therapy settings but in very different capacities. Physical therapists practicing in outpatient orthopedic settings use these techniques to help their patients return to activities of daily living (ADL), work, and sports. In neurologic and geriatric rehabilitation settings, functional testing and functional exercise progression take on a different meaning, being geared more toward ADL, transfers, and ambulating on level and unlevel surfaces.

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Despite these differences, the principles that guide functional testing and exercise progression are the same regardless of the practice setting and level of the patient. Some patients will move further through the program than others, based on their specific rehabilitation goals. ...

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