Chapter 23: Advanced Functional Training

Introduction

Functional training involves developing and progressing exercise programs that enable patients to regain their preinjury level of function. For individuals wishing to return to high-level work, leisure, recreational, or athletic activities, rehabilitation must progress sufficiently to meet the anticipated demands of those activities. For the therapist, it requires a continuous process of decision-making that involves:

• A thorough knowledge of human anatomy, physiology, biomechanics, and function.

• An understanding of tissue healing, especially the effect of time on healing and the response of tissues to imposed stresses.

• An understanding of neuromuscular responses to various forms of exercise.

• The ability to examine and evaluate the structural and functional impairments that restrict activity and full functional participation within the context of personal and societal expectations.

• Knowledge of diagnoses, surgical and therapeutic exercise interventions, special precautions, and each patient's potential for achieving the projected outcomes.

Functional training can begin in the early phases of rehabilitation with specific muscle activation and training techniques designed to develop a balance in the strength and timing of contractions among synergists and antagonists. Because proximal stability is critical for coordinated functioning of the extremities, exercises to develop stability and balance are also incorporated into the early phases of the rehabilitation.

As muscle strength, endurance, and control of the involved region(s) improve, greater emphasis is placed on strengthening muscle groups in functional patterns, using both weight-bearing and nonweight-bearing exercises. Care is taken to ensure that the activity of stronger muscles does not dominate the weaker, impaired muscles during the execution of these functional patterns. As function improves, the exercises can become more activity specific.

Functional motor skills encompass an array of movements completed using multiple postures, at varying speeds, and over many repetitions or durations of time. The cornerstone of a functionally relevant therapeutic exercise program is the inclusion of task-specific movements that are superimposed on sufficient stability, balance, and muscle function to meet the necessary, expected, and desired functional demands in a patient's life.

The purpose of this chapter is to describe a variety of advanced functional training exercises that involve the total body and may be appropriate for the final phase of rehabilitation. The chapter is divided into two sections. The first section focuses on advanced exercises for stability and balance and the second on advanced exercises for strength and power. Exercises selected for this phase of rehabilitation are based on the patient's desired outcome and emphasize the motor skills needed to achieve that outcome.