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

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

OT Practitioners

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)

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)

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.

Wrist Flexion and Extension| Occupational Therapy Intervention

Wrist Flexion and Extension| Occupational Therapy Intervention

OT Practitioners

Wrist Flexion and Extention:

Forearm Strengthening

Occupational Therapy Intervention : Wrist Flexion and Extension

Documentation and Activity Rationale

The patient engaged in a wrist AROM against resistance provided by a 2lb weighted ball. The exercise sequence elicited wrist flexion and extension in order to increase extrinsic forearm musculature. The patient was instructed to perform each movement slowly, methodically, and with complete control. No pain or discomfort verbalized by the patient, though the patient affirmed muscle fatigue at the end of the sequence. Therapeutic rest given after task.

Grading Strategies

Grading Up: 

  • include radial and ulnar deviation, circumduction, pronation and supination in the AROM sequence

Grading Down: 

  • begin with less weight
  • fewer repetitions

Appropriate Diagnoses / Deficits

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

An occupational therapy practitioner would work on wrist flexion and extension using various shaped and weighted items, such as bars for cylindrical grasp, balls for spherical grasp, and books for specific grasp types, to achieve several therapeutic goals:

Strengthening Muscles: Different shapes and weights challenge the wrist flexor and extensor muscles, promoting muscle strengthening and endurance. This is crucial for improving overall wrist stability and function.

Enhancing Grip Variety: Practicing with various objects helps to enhance different types of grips such as cylindrical, spherical, and pinch grasps. This diversity in training ensures that patients can perform a wide range of everyday activities.

Improving Dexterity and Coordination: Using objects of different shapes and sizes requires fine motor skills and coordination. This helps to improve hand-eye coordination and dexterity, which are essential for precise movements.

Functional Application: Activities that involve gripping and manipulating different objects are directly related to daily tasks such as opening jars, picking up objects, and using tools. Training with these objects simulates real-life scenarios, making the therapy functional and relevant to the patient’s daily life.

Promoting Motor Control: Varying the resistance and shape of objects helps in refining motor control and proprioception, which are important for smooth and controlled movements of the wrist and hand.

Addressing Specific Deficits: Different objects target specific muscle groups and movement patterns. For example, using cylindrical objects primarily targets wrist flexion and extension, while spherical objects challenge the intrinsic muscles of the hand.

Encouraging Neural Adaptation: Engaging in diverse and challenging tasks promotes neuroplasticity, which is the brain’s ability to reorganize itself by forming new neural connections. This is especially important for patients recovering from neurological injuries.

Here’s an example of how specific objects can be used:

Cylindrical Grasp: Bars or tubes to improve wrist flexion and extension strength.

Spherical Grasp: Balls to enhance overall grip strength and coordination.

Lateral Pinch: Books or flat objects to practice the lateral pinch grasp, improving precision grip used in activities like holding cards or sheets of paper.