Exercising Decisions

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December 2004

Exercise equipment is among the key tools of the physical therapist's trade, and can be an important element in getting a patient on the fast track to recovery. Rehab Management recently spoke with Jennifer B. Green, MSPT, ambulatory sports coordinator for Spaulding Rehabilitation-Framingham Neighborhood Center, Framingham, Mass, about how and why to choose exercise equipment.

Rehab Management: What are the one or two key pieces of exercise equipment needed in most rehab settings?
Jennifer B. Green: It is difficult to choose one or two pieces since rehab settings vary with the populations they treat. A rehabilitation facility that deals with neurologically impaired patients or pediatrics differs significantly from an orthopedic outpatient facility. We have a pulley system that was developed in Scandinavia. It is a great system that allows you to move the pulley from floor height to six feet tall. With two weight stacks, it also enables you to work with less than a half kilogram to 45 kilograms of weight in different positions. This allows a great variety of...exercises to be performed. The other piece of equipment that, in my opinion, is priceless is a therapeutic exercise ball. The ball allows you to perform many different exercises throughout the entire body for strengthening, stretching, proprioception, balance, eye-hand coordination, and neurological stimulation.

Rehab Management: Do these needs vary depending on whether the setting is a private practice or a large hospital?
Green: Absolutely! The needs vary as stated above, depending on the patient population and the clinical setting. If you have a large space for exercise equipment, that clinic could obviously hold more equipment. [But ultimately] it really depends on space, budget, and patient population.

Rehab Management: What criteria should you use when picking exercise equipment? Is it just a matter of a price tag or are there other factors involved?
Green: Pricing and budget are usually the primary factors for choosing equipment. Typically, rehab facilities put together a list of their absolute needs and a wish list to best serve their clients. Obviously, space, needs, and budget factor into what can be achieved.

Rehab Management: Who should choose equipment-just the PTs or should other medical and administrative staff be involved? If the latter, should the PTs take the lead in directing the choice?
Green: In our facility, our manager requests a list of needs and the priority of those needs from the therapists and clinical supervisor. She then proceeds to order what is within her budgetary guidelines. In my opinion, the therapists who are utilizing the equipment should be the people suggesting clinical exercise equipment. We are the professionals who have the expertise to decide what is applicable for the patient population. If you have other medical staff who may be utilizing the equipment or would like it to be utilized with their patients, that too should be addressed with the rehab staff and managers. Many times equipment is ordered without the opinion of the therapists, and it can end up collecting dust in the corner. Due to strict budgetary guidelines in health care, it is important to make sure the therapists will use the equipment.

Rehab Management: How has the use of exercise equipment changed in the last few years?
Green: This is a difficult question to answer since there are so many variables with what types of equipment are used. In our practice, I have seen a greater focus on functional exercises and equipment rather than equipment used mostly for research or testing.

Rehab Management: How important is exercise equipment to long-term recovery? Does the way equipment needs to be used change throughout the rehab process?
Green: Exercise is very important to the rehabilitation process and therefore the equipment is also very important. The more we can teach patients proper motor control, strengthening, flexibility, proprioception awareness, and balance, the better the patient will succeed. As patients progress, their physical demands change so it is vital for the therapist to be aware of these demands and make the appropriate changes to achieve the most effective treatment plan for their clients.

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December 2004