8 Methods for PTAs to Help Patients Improve Mobility and Function

Assessment, treatment planning, and empowering patients for optimal recovery.

Mobility is an intrinsic facet of human existence, woven into our evolutionary blueprint and fundamental to personal autonomy. In contemporary society, mobility assumes an indispensable role in our daily lives. It empowers us to access opportunities, forge connections with others, pursue our aspirations, and uphold our physical and mental well-being. Our capacity to move with ease and carry out various tasks is not merely a prerequisite to survival; it significantly influences the overall quality of our health and life. Whether it’s executing routine activities like dressing, bathing, and cooking, or participating in leisure pursuits, social interactions, and work, mobility nurtures confidence, self-esteem, and a profound sense of purpose.

What is it like then, for those who are experiencing mobile impairment, or a decrease is functional mobility? PTAs play a pivotal role in the healthcare system by working alongside physical therapists to assist patients in improving their mobility and function. They help in assessing patients’ conditions and creating personalized treatment plans, conducting therapeutic exercises and modalities to enhance strength and flexibility and teaching patients proper body mechanics and safe mobility techniques. Furthermore, they help monitor progress and making necessary adjustments to treatment place, providing essential emotional support and motivate to patients on their recovery journey.

The objective of this guide is to equip Physical Therapist Assistants (PTAs) with eight effective methods to assist patients in enhancing their mobility and function. These methods will empower PTAs to provide comprehensive and patient-centered care, ultimately helping individuals regain their independence and improve their quality of life. Refer to the Physical Therapist Assistant Program career guide to access information and resources about Provo’s accredited program, certification requirements, and career prospects. Explore our dedicated resource on top physical therapist assistant jobs for a deeper understanding of the role PTAs play in the profession, including job descriptions, salary* information, and the demand for PTAs in various healthcare settings,

1. Therapeutic Exercises

Therapeutic exercises are a cornerstone of physical therapy and play a crucial role in enhancing strength, flexibility, and mobility for individuals with various conditions or injuries. These exercises are prescribed by physical therapists and carried out by Physical Therapist Assistants (PTAs) to help patients achieve their functional goals. PTAs assist in helping patients improve strength to perform everyday tasks, enhance flexibility to increase range of motion of joints and muscles, improve posture, and alleviate muscle tension.

There are various types of therapeutic exercises that PTAs implement depending on a patients’ goals and needs. Here are few examples:

• Range of Motion (ROM) Exercises: These exercises aim to restore and maintain the normal range of motion in joints. There are two types: passive ROM exercises involve the therapist or PTA moving the patient’s limbs through a range of motion, while active ROM exercises involve the patient moving their limbs independently.
• Strengthening Exercises: Strengthening exercises are designed to increase muscle strength and endurance and they often involve resistance training using weights, resistance bands, or machines.
• Stretching Exercises: Stretching exercises help improve flexibility and reduce muscle tension. The two types include, static stretching, which involves holding a stretch position for a period. Dynamic stretching involves controlled movements through a range of motion.

Examples of Therapeutic Exercise Programs:

1. Post-Surgical Rehabilitation: A patient recovering from knee replacement surgery might start with passive ROM exercises, gradually progressing to active ROM and strengthening exercises to regain mobility and strength.
2. Low Back Pain Management: For someone with chronic low back pain, a program might include a combination of stretching exercises, core strengthening exercises, and posture correction techniques.
3. Stroke Rehabilitation: Stroke survivors may benefit from exercises that focus on regaining mobility and strength in affected limbs, including a mix of passive and active ROM exercises, as well as balance and coordination training.
4. Athletic Performance Enhancement: Athletes looking to improve their performance might undergo strength and conditioning programs involving various strengthening exercises specific to their sport, along with flexibility routines to prevent injuries.

2. Manual Therapy

Manual therapy techniques are a crucial component of physical therapy and are employed by physical therapists and Physical Therapist Assistants (PTAs) to enhance mobility and function in patients. These techniques involve skilled, hands-on manipulation of joints, muscles, and soft tissues to achieve therapeutic goals. Two common types of manual therapy techniques are joint mobilizations and soft tissue mobilizations. These techniques offer several benefits in improving mobility and function. By addressing joint and soft tissue restrictions, manual therapy can relieve pain associated with musculoskeletal conditions and helps release tension in soft tissues, which can alleviate discomfort and promote healing.

Joint Mobilizations

Joint mobilizations involve skilled manipulation of a joint’s passive range of motion. This technique aims to restore or improve joint mobility, reduce pain, and enhance joint function. It can be effective in treating conditions like arthritis, joint stiffness, and musculoskeletal dysfunctions. Joint mobilizations are often characterized by graded, oscillatory movements applied to the affected joint by a trained therapist or PTA. Joint mobilizations also help restore or enhance joint mobility, allowing patients to move more freely.

Soft Tissue Mobilizations

Soft tissue mobilizations focus on addressing issues within the muscles, tendons, ligaments, and fascia. Techniques like massage, myofascial release, and deep tissue work are used to manipulate and release tension in soft tissues. Soft tissue mobilizations can help reduce muscle tightness, improve tissue flexibility, and alleviate pain. They are particularly effective in treating conditions such as muscle strains, trigger points, and scar tissue adhesions. soft tissue mobilizations work on breaking down adhesions and increasing the extensibility of muscles and fascia. This can lead to better overall function and reduced risk of injury.

Examples of Manual Therapy Interventions:

1. Shoulder Impingement: A physical therapist may perform joint mobilizations to improve glenohumeral joint mobility and soft tissue mobilizations to address muscle imbalances and reduce pain in a patient with shoulder impingement.
2. Plantar Fasciitis: For someone with plantar fasciitis, a therapist may employ soft tissue mobilizations to release tension in the calf muscles and fascia, along with joint mobilizations for the ankle to improve mobility and reduce heel pain.
3. Low Back Pain with Lumbar Stiffness: Joint mobilizations can be used to target lumbar spinal segments, increasing flexibility and reducing stiffness in the lower back. Soft tissue mobilizations may also be applied to address muscle tightness and discomfort in the lumbar region.
4. Post-Surgical Rehabilitation (e.g., ACL Reconstruction): Following ACL reconstruction surgery, a combination of joint mobilizations for the knee and soft tissue mobilizations for the quadriceps and hamstrings can aid in restoring function, reducing pain, and facilitating recovery.

3. Modalities

Physical therapists and Physical Therapist Assistants (PTAs) often employ various modalities that support traditional interventions to improve mobility and function in patients. These modalities are non-invasive techniques used to enhance the effectiveness of treatment plans. Three common modalities include heat therapy, cold therapy, and electrical stimulation. Let’s look at the different modalities that are often employed:

1. Heat Therapy:
   • The application of heat can help alleviate pain by relaxing muscles, decreasing muscle spasms, and increasing blood flow to the affected area.
   • Heat therapy can promote tissue healing by improving oxygen and nutrient delivery to injured tissues.
   • Increased blood flow from heat can enhance circulation, facilitating the removal of metabolic waste products.

Applications of heat therapy include hot packs for muscle tightness or pain to relax muscles and increase blood flow, warm whirlpool baths provide overall relaxation and pain relief, and infrared therapy delivers deep heat to tissues and is often used for chronic back pain.

2. Cold Therapy (Cryotherapy):
   • Cold therapy can reduce pain by numbing the area and decreasing inflammation, which helps reduce swelling and alleviate discomfort.
   • Cold therapy can slow down tissue metabolism and reduce the risk of tissue damage in the acute phase of an injury.
   • Although cold therapy initially constricts blood vessels, the subsequent rewarming of the area can lead to increased blood flow.

Applications of cold therapy include ice packs to acute injuries like sprains, strains and bruises, ice baths accelerate recovery after intense workouts or competitions, and cryocuffs provide controlled cold compression, ideal for post-surgical rehabilitation.

3. Electrical Stimulation (E-Stim):
   • Electrical stimulation can help manage pain by blocking pain signals, triggering the release of endorphins (natural painkillers), and reducing muscle spasms.
   • Specific electrical stimulation modalities, such as neuromuscular electrical stimulation (NMES), can promote muscle re-education and tissue healing after injuries or surgeries.
   • E-Stim can improve blood circulation by contracting muscles and facilitating venous return.

Neuromuscular Electrical Stimulation (NMES) is applied to stimulate muscle contractions in individuals with muscle weakness or after surgeries to prevent muscle atrophy. Functional Electrical Stimulation (FES) is used to restore functional movements, like walking in patients with paralysis or neurological conditions.

4. Functional Training

Functional training is a fundamental aspect of physical therapy and fitness programs, emphasizing the improvement of activities of daily living (ADLs). Its importance lies in the fact that it bridges the gap between isolated strength and mobility exercises and real-life movements. Functional training focuses on movements and exercises that directly relate to everyday activities, making it highly applicable and beneficial for individuals looking to enhance their independence in daily living activities. By mimicking real-life movements, functional training helps individuals regain or enhance their walking, bending, lifting, and reaching, with greater ease and efficiency. Functional training helps strengthen the muscles and joints needed for common movements, reducing the risk of injuries during daily activities or sports.

Principles of Functional Training:

• Functional training exercises replicate the specific movements or tasks a person wishes to improve, ensuring that the training is directly applicable to their goals.
• Exercises often involve multiple joints and muscle groups working together, reflecting the complexity of real-life movements.
• As with traditional strength training, functional training involves gradually increasing the resistance or intensity of exercises to promote muscle and skill development.
• Functional training places a strong emphasis on balance and stability, as these are critical for many functional tasks.

Examples of Functional Training Exercises:

1. Squat Variations: The functional goal of this exercise, for example, is to improve the ability to stand up from a chair or toilet. It can include bodyweight squats, goblet squats, or squat-to-stand exercises.
2. Lunge Variations: These exercises enhance walking and stair-climbing abilities. They can include forward, lateral, or reverse lunges.
3. Balance Exercises: Balance exercise reduce the risk of falls and improve overall stability. They can include single leg stands, tandem walking, or balance board exercises.
4. Functional Core Exercises: These exercises are good for enhancing posture, reducing lower back pain, and improving core stability for activities like lifting and bending. They can include, planks, woodchops, or standing medicine ball twists.
5. Functional Mobility Drills: These exercises are good for improving the ability to reach or bend down to pick up objects. The application includes hip hinges, standing hamstring stretches, or cat-cow stretches.
6. Functional Coordination Drills: These exercises are good for enhancing coordination for activities like cooking or dressing. Exercise includes juggling, ladder drills, or reaction ball drills.
7. Carry and Lift Exercises: The functional goal of these types of exercise are about improving the ability to carry groceries, lift children, or perform various lifting tasks. Some examples include sandbag lifts, or kettlebell carries.

5. Gait Training

Gait training is a crucial component of physical therapy and rehabilitation that focuses on improving walking patterns and overall mobility. It holds great significance for individuals with various conditions or injuries, as well as those recovering from surgery. Walking is a fundamental activity of daily living, and gait training helps individuals regain or improve their ability to walk independently, reducing the need for assistance. Gait training targets specific impairments in walking patterns, allowing individuals to move more efficiently and safely during daily activities. For those with musculoskeletal or neurological conditions, gait training can reduce the risk of falls and secondary injuries by addressing gait abnormalities. After orthopedic surgeries (e.g., joint replacements), gait training is essential for ensuring a successful recovery and return to normal mobility.

Techniques for Assessing Gait Abnormalities:

Assessing gait abnormalities is crucial to identify areas for improvement and tailor gait training interventions effectively. Physical therapists and healthcare professionals use several techniques. Watching a patient walk and noting any deviations from a normal gait pattern, such as limping, shuffling, or uneven stride length. Assessments like the Timed Up and Go (TUG) test, 6-Minute Walk Test (6MWT), and 10-Meter Walk Test (10MWT) measure various aspects of gait, including speed, endurance, and balance. Using specialized equipment like gait analysis systems, which include cameras and force plates, to analyze biomechanical aspects of walking, such as joint angles and forces. Lastly, gathering information from the patient about their walking difficulties, pain, or discomfort during walking, and any specific goals they have for improvement.

Examples of Gait Training Exercises and Interventions:

Gait training exercises and interventions are tailored to address specific gait impairments and overall mobility. Here are some examples:

1. Strengthening Exercises: These exercises address muscle weaknesses that can lead to an unstable gait. Applications include leg lifts, step-ups, or resistance band exercises to target weak muscle groups and improve stability during walking.
2. Balance and Coordination Training: This training improves balance and coordination to reduce the risk of falling. Balance drills like standing on one leg, tandem walking, or navigating obstacle courses.
3. Range of Motion Exercises: These exercises address joint stiffness and limited range of motion affecting the gait. Stretching exercises for tight muscles and joints, such as calf stretches for ankle mobility.
4. Gait Pattern Re-Education: This is about correcting abnormal gait patterns (e.g., toe-walking, hip drop) through guided practices of proper heel-to-toe walking, hip abduction exercises, or gait drills with a therapist’s guidance.
5. Assistive Devices and Orthotics: This means enhancing stability and support for individuals with mobility aids or orthotic needs. Evaluation and fitting of canes, walkers, braces, or custom orthotic devices for improved gait.
6. Functional Mobility Tasks: These tasks are about simulating real-life situations to improve functional walking skills, like walking on uneven surfaces, ascending and descending stairs, or navigating curbs and ramps.
7. Treadmill Training: This improves walking endurance and speed with gradual adjustments in speed and incline, often with or without body weight support.

6. Balance Training

Balance training is a critical component of physical therapy and rehabilitation programs that plays a significant role in improving stability, reducing the risk of falls, and enhancing overall mobility. Balance training helps individuals develop better control over their body’s position in space, leading to increased stability during standing, walking, and various activities of daily living. Many injuries and health complications are the result of falls, especially among older adults. Balance training can significantly reduce the risk of falls by improving proprioception and reaction times. Good balance is fundamental for maintaining independence and performing functional tasks such as walking, climbing stairs, and reaching for objects without fear of falling. For athletes and individuals engaging in physical activities, balance training can help prevent sports-related injuries by enhancing neuromuscular coordination and control.

Balance training exercises can be categorized into static and dynamic balance drills. Statis balance exercises involve maintaining a stationary position without changing the base of support. Exercises such as single leg stands, tandem stance, yoga poses such as tree pose or warrior pose are all great examples of static balance exercises. Dynamic balance exercises on the other hand, require controlled movement while maintaining balance, replicating real-life activities. For example, walking heel-to-toe, lateral step-ups, ball toss or catching and functional mobility tasks like stair climbing or walking on uneven surfaces.

Balance Training Interventions:

Balance training interventions should be tailored to an individual’s balance impairment level and functional goals:

1. Mild Balance Impairment: This intervention improves static balance for better stability during daily activities. An application includes single leg stands on a stable surface, as one example.
2. Moderate Balance Impairment: This is about enhancing postural control and prepare for more dynamic tasks with tandem stance or balance board exercises.
3. Severe Balance Impairment: This requires developing initial balance skills to progress toward more challenging activities, such as with chair-assisted squats or balance exercises using a stable surface.
4. Athletic Performance Enhancement: Improving balance and coordination for sports or physical activities using sport-specific dynamic balance drills (e.g., agility ladder drills) are excellent for enhancing athletic performance.
5. Fall Prevention for Older Adults: These interventions reduce fall risk and improve overall stability in daily life. Tai Chi or seated balance exercises are excellent for preventing falls.
6. Post-Injury Rehabilitation: Restoring balance and mobility following an injury or surgery can be accomplished by progressing from basic static balance to dynamic movements related to the patient’s injury.

7. Education and Home Exercise Program

Patient education is a crucial element of healthcare, especially in physical therapy, as it empowers individuals to take an active role in their recovery and promotes adherence to home exercise programs. Educating patients about their condition, treatment options, and exercises empowers them to make informed decisions about their health. Patients who understand the importance of exercises and their role in recovery are more likely to adhere to their home exercise programs, leading to better outcomes. Educated patients can self-manage their conditions effectively, reducing the need for frequent medical interventions and improving their overall quality of life.

Physical Therapist Assistants (PTAs) play a vital role in delivering patient education, including instructions on proper exercise techniques, safety precautions, and exercise progression. PTAs guide patients through the correct performance of exercises, ensuring they understand the mechanics and movement patterns involved. PTAs educate patients about potential risks and safety measures, helping them avoid injuries while performing exercises at home. PTAs design exercise programs that start at an appropriate level and gradually progress to more challenging activities as patients’ strength and abilities improve. Finally, PTAs provide ongoing feedback, monitor progress, and make necessary adjustments to exercise programs to ensure optimal results.

Guidance on Developing Personalized Home Exercise Programs:

Developing personalized home exercise programs requires tailoring the plan to each patient’s unique needs and goals. Here are steps to consider when creating such programs:

1. Assessment: Begin with a thorough evaluation of the patient’s condition, including their current physical abilities, limitations, and any contraindications.
2. Goal Setting: Collaborate with the patient to set clear and achievable goals for their rehabilitation or fitness objectives.
3. Exercise Selection: Choose exercises that align with the patient’s goals and address their specific impairments or weaknesses.
4. Exercise Progression: Start with basic exercises and gradually increase intensity, duration, or complexity as the patient becomes more comfortable and capable.
5. Instruction and Demonstration: Teach and demonstrate each exercise to the patient, emphasizing proper technique and safety precautions.
6. Documentation: Provide written instructions or diagrams to reinforce verbal guidance and allow patients to reference the exercises at home.
7. Frequency and Duration: Specify the recommended frequency (e.g., daily, three times a week) and duration (e.g., 10 repetitions, 2 sets) for each exercise.
8. Monitoring and Follow-Up: Schedule regular follow-up appointments to monitor progress, address questions or concerns, and make necessary adjustments to the program.
9. Motivation and Feedback: Encourage and motivate patients to stay engaged in their home exercise program and provide positive feedback on their achievements.
10. Safety Precautions: Emphasize safety measures, including warm-up and cool-down routines, proper equipment use, and the importance of not pushing through pain.
11. Communication: Maintain open communication with patients, ensuring they feel comfortable asking questions and reporting any changes or difficulties.
12. Reassessment: Periodically reassess the patient’s condition and adjust the home exercise program accordingly to ensure continued progress.

8. Assistive Devices and Orthotics

Assistive devices help individuals regain independence, reduce pain, and improve overall quality of life. Assistive devices provide support and stability, allowing individuals to move safely and with greater confidence, even when facing mobility challenges. Devices like canes and walkers help prevent falls by providing additional support and balance during walking. Orthotics and supportive devices can alleviate pain by redistributing weight, reducing pressure on specific areas, or improving alignment.

Physical Therapist Assistants (PTAs) play a crucial role in assessing the need for assistive devices and providing training on their proper use. PTAs assess patients’ physical limitations, mobility challenges, and functional goals to determine the appropriateness of assistive devices. Based on their assessment, PTAs may recommend specific devices and ensure that assistive devices are properly fitted to each patient’s height, weight, and unique needs. PTAs also provide instruction on proper techniques, safety precautions, and maintenance. PTAs monitor patients’ progress and may adjust the use of assistive devices as needed.

Examples of Assistive Devices and Orthotics:

• Canes: Canes provide stability and support during walking and can help distribute weight away from an injured or weaker limb. Examples include standard canes, quad canes, and forearm crutches.
• Walkers: Walkers offer substantial support and balance assistance. They are suitable for individuals with significant mobility impairments or balance issues. Examples include, standard walkers, rollators (walkers with wheels and a seat), and hemi walkers (for use on one side of the body).
• Orthotics: Orthotics are custom or prefabricated devices designed to improve alignment, support, and comfort in various body areas. Examples include ankle-foot orthoses (AFOs) for foot drop or ankle instability, knee braces for stability and pain reduction, custom insoles, and lumbar or cervical orthoses for spinal support.
• Prosthetics: Prosthetic devices replace lost limbs, restoring mobility and function. Examples include lower limb prostheses (below-knee, above-knee, or hip disarticulation prostheses) and upper limb prostheses (arm or hand prostheses).
• Wheelchairs and Mobility Scooters: These devices are for individuals with more significant mobility limitations, wheelchairs and mobility scooters provide the ability to move independently over longer distances.
• Home Modifications: Modifications to the home environment, such as grab bars, ramps, or stairlifts, can improve accessibility and safety.

Prepare for a Successful Career in the Rewarding Field of Physical Therapy Now!

The guide for Physical Therapist Assistants (PTAs) emphasizes eight effective methods to assist patients in enhancing their mobility and function. By integrating these methods into patient care plans, PTAs can provide comprehensive and personalized rehabilitation strategies, ultimately promoting greater independence and improved quality of life for their patients. Each patient’s condition, needs, and goals are unique, and PTAs must tailor their interventions accordingly. Setting clear and achievable goals in collaboration with patients ensures that the rehabilitation process is patient-centered and meaningful. Regular assessments and adjustments to treatment plans help track progress and adapt interventions as necessary, leading to more effective and successful outcomes.

To excel in the field, PTAs should commit to continuous professional development and staying updated on best practices in mobility and function rehabilitation. The healthcare landscape is ever evolving, and staying informed about the latest research, techniques, and technologies allows PTAs to provide the highest level of care to their patients. Provo College offers a comprehensive Physical Therapist Assistant program designed to prepare students for successful careers in this rewarding field. The program combines rigorous academic coursework with hands-on clinical experiences to equip students with the skills and knowledge needed to excel as PTAs and contribute to the well-being of their patients and communities.