The importance of incorporating functional objects in therapy for older adults

Dr. Julie Brauer // #GeriOnICE // www.ptonice.com

In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty member Julie Brauer discusses how fitness equipment is not necessary for older adults to reach fitness goals, how fitness equipment is not feasible for older adults to obtain or use, and that older adults likely do not want to use this fitness equipment because they can't correlate how using it translates to functional activity

Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

INTRODUCTIONHey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PT on ICE Daily Show, let's give a shout out to our sponsor, Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at sign up to receive a one month free grace period on your new Jane.

JULIE BRAUER Good morning crew. Welcome to the PT on Ice daily show. My name is Julie. I am a member of the older adult division. Excited to be hanging out with you all this morning. Our discussion this morning I am hoping to offer you all an expanded perspective and even maybe a perspective shift when it comes to how you approach loading older adults. The shift is this. The barbell is a tool to help get our older adults brutally strong and stave off functional decline, but it is not a rule. The barbell is a tool, not a rule. So this perspective shift has occurred for me over the last nine plus years of my career, working with the sickest of the sick in the ICU, all the way to higher level athletes in a CrossFit gym. So across that entire spectrum, I've had to be incredibly creative and unique when it comes to introducing loading. I have worked with folks where loading them up is the last of their priorities. What's more important is the fact that they don't have the money to keep their lights on or they are having to use clothes to fill holes in the ceiling. I have worked with folks who have meaningful goals that have absolutely nothing to do with floating. And I have definitely had to shift my own perspective of what is success as a therapist. So let's unpack this. I've learned a lot over the past nine years of working with such a wide spectrum of folks. These are the things that I've learned. I want to share them with you. Number one, the barbell or a kettlebell or a dumbbell, insert any fitness forward tool, is not 100% necessary for older adults to reach their meaningful goals, okay? Number two, it's not feasible. The barbell and fitness forward tools, they're not feasible in many settings and in many populations that we serve. Number three, in many cases, older adults may not want anything to do with weights. Number four, final one here, is that in many cases no matter how hard we try older adults are not able to make the correlation of how lifting a weight is going to translate to their meaningful activity. So these are some themes. This is what I've learned over my nine plus years. And what I have also learned from my own experience and also being out across the country, meeting and connecting with you all, is that when we get really excited about fitness forward care, and this was me to a T, sometimes we can have blinders on and we become so laser focused on having our older adults lift weights. I mean, it makes sense. It's badass. Many times they feel like it's badass. It's sexy. It's cool. However, we can start to equate our success as a therapist with our ability to get our older adult to lift weights. And that can be a really limited perspective here. And what it can do is it can make us forget about the fact that the majority of the older adults that we're serving are not lifting barbells or kettlebells in their homes. They are lifting, pushing, pulling functional objects like laundry baskets or bags of mulch, kitty litter, dog food, pots and pans, Amazon boxes, buckets of tools. I could go on and on and on. The problem though is that many of us will develop an entire plan of care and we will never actually use these items that older adults are lifting at home. So this is where I want you to start to get a little curious and think, huh, why wouldn't I use the actual objects that my patients are using at home in my plan of care? Like that makes so much sense, right? Now, I know what you're thinking. You're thinking, well, Julie, there's so much carryover. If I can get an older adult brutally strong in their deadlift, then lifting that laundry basket is going to be successful, and it's going to be easier. And the answer is, yes, I 1000% agree with you. And that's the most beautiful thing about fitness forward tools, is that we can use them to help our older adults become brutally strong. And then the meaningful activity is easier right that deadlift we get them loaded up really heavy that laundry basket is going to feel lighter they're going to have less fear when they go to lift it their rpe is going to be a lot lower That's the beautiful thing about fitness forward tools. I think about that with my own training. So I have a bias towards a barbell. If any of you are thinking, man, this girl must hate a barbell. I love a damn barbell. I use it in my training. I'm a trail runner and I do strict strength training with a barbell to get my legs as strong as possible so that when I am running uphill or scrambling up rocks during my races, it feels a lot easier, okay? But here is where we have to really think about this. I want you to open up your mind. Here is where a perspective shift can come in. I want you guys to start thinking about this as an and, not, or scenario. So while you are working on moving your older adults towards brutally strong, building their reserve and their resiliency, I also want you guys to be thinking, only always, in tandem, use the functional objects that your folks are using at home. It's, I'm going to have Betty in the clinic today, lift a heavy barbell, and I'm going to have her lift a bag of mulch that she is wanting to lift at home. And not or, do these things in tandem. Why? Well, think about it. If we're using the objects that folks are actually using at home, let's say Betty walks into your clinic, she's scared, she's never deadlifted before, she doesn't even know what a kettlebell is, she's gonna call it a kettleball, but she sees over on a shelf that there's familiar objects that she's used at home. So subliminally, she's walking into your clinic and she's like, There's a bag of mulch in here. There's kitty litter in here. There's a bucket of tools. There's a laundry basket. Huh, I use all that stuff at home. Immediately, your environment becomes less intimidating. So imagine having those objects at your disposal when you are going to introduce the deadlift to your patient. They're familiar. Many times, they're much more approachable than a weight, especially if there's fear on board. And most of all, they are incredibly specific. We know how important task specificity is when we are teaching someone a new skill. You cannot get more specific than having your patients actually use the objects that they are lifting at home. I had a wonderful discussion with another one of our members, Trissa Hutchinson. She's on our older adult team. She's an OT. She's absolutely brilliant. She really opened my mind to this perspective as well. And she was telling me a story of how her patients, who many of them, they reside in memory care. So a lot of her folks have cognitive impairment on board. And she was telling me, Julie, it is such a high level cognitive skill to be able to correlate that kettlebell on the ground to the groceries that I have to lift from the ground. That sometimes can be too high level of a cognitive skill for many of our individuals. So she really has to put her folks in the exact scenario. She gave me a very specific example of she's working with her folks and she gives them the FES. So she's evaluating how fearful some of her folks are doing certain activities. So she does everything she can to create an obstacle course in her clinic that mimics what she is fearful of in her environment so she can build her confidence with her patient. That FES score did not go up at all. The FES scores, typically when she sees with her folks, do not improve until she puts her patient in exactly the scenario. And perhaps that means actually taking her patient outside to do a nature walk. And she actually sees herself in that scenario in the clinic because it is the exact same as what she is encountering at home. So my call to action for you all is this. I want you to think about lift with the barbell, but also lift the grocery bags. What could that look like? If you were in an outpatient clinic, I would love to hear some people start to bring in functional objects into the clinic. Many folks that we talk to across the country are telling us that they have spent so much time trying to convince their managers to put a squat rack in the clinic. Keep going after that. Keep being the squeaky wheel because it's so beneficial to have a squat rack and a barbell. However, the barrier a lot of the time, our managers are saying it's too expensive and why do we actually need that? Okay, so while you're working on that goal, what if you brought in stuff from your garage, right? Stuff that is readily available and it's not very expensive. If you're like me, I would go in my garage, my husband has a lot of stuff in there that I would want to just get rid of. Maybe I would go and try and do a little clean sweep of stuff in my garage, bring it in with some buckets, bring in some functional objects. Maybe I go and I buy a bag of mulch, right? Maybe I go and I bring in a laundry basket. Start filling your clinics with this stuff. They're readily available to most of us, and it's offering the opportunity for older adults to start lifting in a different way, a way that could be more approachable. And you could start to get further with them right out the gate.

SUMMARY All right, y'all, that's all I have for you this morning. I love if I could hear any of you start to talk about how maybe you're starting to use some actual meaningful functional objects in the clinic. If you have any questions, comments, I'd love to talk further about this. Have a wonderful rest of your Wednesday. I will leave you with what is coming up within the older adult division. So the rest of July, is it? It's not even July yet. For the month of July, we're almost there. We have several courses, so we will be in Virginia Beach, we will be in Victor, New York, and then our whole team will be in Littleton, Colorado, for our MMOA Summit, which is gonna be awesome. And then our next L1 course, our eight-week online course, starts in August, August 14th. PTNIS.com is where you find all that info. Have an awesome rest of your day.

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