Understanding the Difference: Therapeutic Exercise, Therapeutic Activity, and Neuromuscular Re-education in Occupational Therapy

Understanding the Difference between Therapeutic Exercise and Neuromuscular Re-Education in Occupational Therapy

As dedicated professionals in the field of occupational therapy, we are constantly striving to provide the best possible care for our clients. One crucial aspect of our practice is understanding the nuances between different treatment modalities and knowing when to apply each one effectively. It is important to know the distinctions between three commonly used billing codes: Therapeutic Exercise (97110), Therapeutic Activity (97530), and Neuromuscular Re-education (97112), with a focus on their relevance in adult populations.

Therapeutic Exercise (97110)

Therapeutic Exercise (97110): This billing code is utilized when engaging in interventions aimed at addressing specific joints, structures, or muscles. In alignment with the Biomechanical model of practice, therapeutic exercises are designed to remediate, restore, or maintain the integrity of these elements. Examples of treatments may include:

Strengthening exercises for individuals recovering from orthopedic surgeries such as total knee replacements.
Range of motion exercises for patients with rheumatoid arthritis to maintain joint mobility and prevent contractures.
Endurance training for individuals with chronic obstructive pulmonary disease (COPD) to improve tolerance for daily activities.

Neuromuscular Re-Education (97112)

Functional Ambulation Asymmetrical Stance and Gait

Neuromuscular Re-education (97112): Contrary to common belief, Neuromuscular Re-education (NMRE) does not exclusively pertain to neurological-based diagnoses. Instead, it encompasses various neurological models of practice within the occupational therapy scope. NMRE interventions target balance, coordination, kinesthetic sense, posture, and proprioception for sitting and/or standing activities. Examples may include:

Core stabilization exercises for individuals with low back pain to improve posture and prevent further injury.
Dual-tasking exercises for older adults at risk of falls to improve cognitive-motor integration and balance control.

Therapeutic Activities (97530)

Functional Ambulation-Carry, Modulation, Balance

Therapeutic Activity (97530): Therapeutic activities are movement-based interventions that occur outside of the personal context of the client but often simulate real-life tasks. These activities are designed to improve functional performance and are billed under the therapeutic activity code (97530). Examples include:

Simulated work tasks such as sorting objects or assembly tasks for individuals undergoing vocational rehabilitation.
Community mobility exercises such as navigating public transportation or crossing streets safely for clients with mobility impairments.
Environmental adaptations tasks such as practicing using adaptive equipment or modifying home environments for individuals with physical disabilities.

Core stabilization exercises for individuals with low back pain to improve posture and prevent further injury.
Dual-tasking exercises for older adults at risk of falls to improve cognitive-motor integration and balance control.

Bottom Line:

Understanding the distinctions between Therapeutic Exercise, Therapeutic Activity, and Neuromuscular Re-education is essential for providing comprehensive and effective care in occupational therapy practice. By selecting the appropriate billing code and tailoring interventions to the individual needs and goals of our clients, we can maximize outcomes and promote optimal function and participation in daily life.

Step, Tap, Align Group | Occupational Therapy Intervention

OT Practitioners

Group Therapy Intervention

Occupational Therapy Intervention : Group Therapy

Documentation and Activity Rationale

The patient engaged in a dual-tasking activity with an emphasis on visual memory and recall. The task required the patient to receive a 3-part image at point A, ambulate 20 ft while clearing obstacles of various sizes and heights, and recall and draw the image received at Pt A. This activity is purposed to improve the relationship between perceptual processing and encoding, storage, and retrieval of the resulting neural representations after approximately 10 seconds of time-lapse. The patient demonstrated no evidence of LOB or instability. She required between 2-3 repetitions per image with 2-3 verbal cues. 3 step directions are moderately difficult for the patient.

Grading Strategies

Grading Up:

more narrow BOS
increase the frequency of stepping
integrate dual-tasking (e.g. counting by 2’s)

Grading Down:

increase BOS
decrease stepping outside of BOS (e.g. “tap your foot to the side every 5 steps)

Appropriate Diagnoses / Deficits

Balance deficits
Memory Changes
CVA
TBI

One Leg Stance and Cross Midline Tap Group | Occupational Therapy Intervention

OT Practitioners

Group Therapy Intervention – Balance

Occupational Therapy Intervention : Group Therapy Intervention

Documentation and Activity Rationale

The patient engaged in LE dynamic balance activity designed to promote neuronal excitation, brain plasticity, interhemispheric communication, balance, agility, visualization, and stability. Alternating toe taps were completed invoking crossing midline using a visual target to ensure maximum range and visual perceptual skills, BUE cross midline, internal rotation, adduction > outside BOS. 15 reps were completed per LE.

Grading Strategies

Grading Up:

integrate dual-tasking
utilize directional component (e.g. “tap you left foot 3 times and your right foot 2 times)

Grading Down:

allow for one-handed support (e.g. a chair/non-wheeled walker)

Appropriate Diagnoses / Deficits

Balance deficits
Memory Changes
CVA
TBI

Baoding Balls | Occupational Therapy Interventions

OT Practitioners

Fine Motor Strengthening – Baoding Balls

Occupational Therapy Intervention : Fine Motor Strengthening

Documentation and Activity Rationale

The patient engaged in Baoding balls 2 x 2-minute intervals in the left hand to promote intrinsic muscle strength, stability, and control and wrist, muscle isolation, manipulation, passive tendon glides, and muscle stamina/endurance.

Grading Strategies

Grading Up:

the ultimate goal is to have enough control in order for the balls not to touch

Grading Down:

decrease time and repetitions

Appropriate Diagnoses / Deficits

generalized weakness
atrophy s/p hand and/or wrist surgery
CVA
TBI

Baoding balls, also known as Chinese meditation balls, are small, handheld balls that can be rotated in the palm. Traditionally used for relaxation and stress relief, Baoding balls have found a valuable place in occupational therapy for their ability to enhance fine motor skills, dexterity, and hand strength. They are versatile tools that can be adapted for use with a variety of clients, from children to older adults, and for a range of therapeutic goals.

Benefits and Applications of Baoding Balls

In-Hand Manipulation

Finger Isolation and Coordination: Rotating Baoding balls requires precise movement of the fingers, promoting finger isolation and coordination. This skill is essential for tasks like typing, writing, and using utensils.
Dexterity: The challenge of moving the balls in different directions and patterns enhances dexterity. This improves the ability to perform complex hand movements required in activities like playing musical instruments or engaging in crafts.

Intrinsic and Extrinsic Hand Strengthening

Intrinsic Muscles: These small muscles within the hand are crucial for fine motor control. Using Baoding balls can help strengthen these muscles, improving grip strength and the ability to perform delicate tasks.
Extrinsic Muscles: The larger muscles that control the hand movements from the forearm also benefit from this exercise. Stronger extrinsic muscles support activities that require sustained hand and wrist movements, such as gardening or lifting objects.

Calming and Attention

Mindfulness and Stress Relief: The rhythmic, repetitive motion of Baoding balls can have a calming effect, similar to meditation. This helps reduce stress and anxiety, promoting a sense of well-being.
Improved Focus: Engaging in the activity requires attention to the movements, which can help improve focus and concentration. This can be particularly beneficial for individuals with ADHD or other attention-related challenges.

From Therapy to Everyday Life: The Occupational Benefits of Baoding Balls

Baoding balls are more than just therapeutic tools; they serve as bridges to enhanced occupational performance. By incorporating Baoding balls into therapy sessions, clients can experience significant improvements in their daily activities. For example, the improved in-hand manipulation and finger coordination developed through the use of Baoding balls can directly enhance handwriting and typing skills. This is crucial for students, professionals, and anyone who needs to communicate effectively through written words. The strengthened intrinsic and extrinsic hand muscles gained from Baoding ball exercises translate to greater ease in performing everyday tasks such as buttoning clothes, opening jars, or carrying grocery bags. These improvements lead to increased independence and confidence in daily life.

Moreover, enhanced dexterity and fine motor control benefit clients in their hobbies and recreational activities, such as playing musical instruments, painting, or engaging in crafts, ultimately enhancing their quality of life and personal satisfaction. The calming effect and improved focus resulting from the rhythmic, repetitive motion of Baoding balls help clients manage stress and maintain attention during work or study, which is particularly beneficial in high-stress occupations or academic settings. Additionally, the integration of cognitive and motor skills developed through Baoding ball exercises supports better performance in tasks that require both cognitive and motor abilities, such as cooking (following a recipe while handling utensils) or driving (processing information while controlling the vehicle). Overall, the use of Baoding balls in therapy promotes safer and more effective task performance, helping clients achieve greater independence and an improved quality of life.

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