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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.

Inhibition Techniques After Stroke

Inhibition Techniques After Stroke

OT Practitioners

Inhibition Techniques After Stroke

Occupational Therapy Intervention : Neuromusclar Re Education 

Documentation and Activity Rationale

The patient engaged in AAROM of RUE working proximally to distally (shoulder flexion, shoulder abduction, adduction, external rotation, internal rotation, elbow flexion, elbow extension, wrist flexion/extention, fingers flexion/extension, abduction/adduction) within 2 planes (15 repetition each movement) in order to decrease tone, increase strength and mobility, and re-establish correct movement patterns for ongoing independence with ADLs and IADLs important to his quality of life. The patient is noted to have ongoing hemiplegia in RUE and demonstrates elicitation of AROM to approximately 40% of WNL due to continued mm. weakness.

Appropriate Diagnoses / Deficits

  • SCI
  • CVA
  • TBI

Functional Ambulation Work Conditioning

Functional Ambulation Work Conditioning

OT Practitioners

Functional Ambulation and Work Conitioning

Occupational Therapy Intervention : Functional Ambulation

Documentation and Activity Rationale

The patient engaged in a heavy-work obstacle course requiring engagement for 10 consecutive minutes fulfilling 10 repetitions with close supervision for safety and confidence. Obstacle course used to address several deficits including: Functional ambulation addressed with 1 step placed throughout course with variable  rise and 4/4 hurdles to promote agility, balance, and ambulation efficiency. Lower body strengthening and balance training invoked by way of patient participation in stepping up to and balancing on an aeorbic stepper x2 while carrying variably weighted bags and objects from 2lbs to 5lbs equiring patient to elicit trunk/core muscles throughout the course.

Grading Strategies

Grading Up: 

  • ankle weights BLE
  • Increase weights or objects required for carrying
  • measurable pace/speed
  • Increased obstacles

Grading Down: 

  • Decrease speed
  • Decrease or eliminate weight on bats
  • Do not incorporate any stepping, use static standing and grade to dynamic standing
  • Unilateral involvement instead of bilateral engagement 

Appropriate Diagnoses / Deficits

  • Generalized Weakness 
  • SCI
  • CVA
  • TBI
  • Balance deficits

Sharp and Dull Assessment

Sharp and Dull Assessment

OT Practitioners

Sharp and Dull Assessment in Occupational Therapy

Occupational Therapy Intervention : Assessments

Documentation and Activity Rationale

Patient participated in a collaborative assessment with the practitioner to identify the presence and extent of peripheral neuropathies and/or paresthesias throughout L foot. During the assessment, the patient was asked to correctly identify 10/10 sensations between dull and sharp, the patient incorrectly identified 6/10 elements in dermatome regions L4/L5 signifying a significant sensory deficit. Education provided regarding the outcome of this assessment and the implications of sensory impairments in the feet when engaging in meaningful activity. Patient receptive and demonstrated good understanding as evidenced by re-stating information in her own words.

Dynamic Balance Obstacle Course

Dynamic Balance Obstacle Course

OT Practitioners

Dynamic Balance Obstacle Course

Neuromuscular Re-Education and Body Mechanics

Documentation and Activity Rationale

The patient engaged in an obstacle course designed with a rocker board, tandem line walk, aerdic steppers, and balancing on a foam pad to simulate various obstacles required during continuous community mobility. Task requiring verbal cues to correct posture and sequence steps. Task increase body schema, generalized strength, and proprioceptive awareness.

Grading Strategies

Grading Up:

  • Use ankle or wrist weights
  • Increase Weight on Batton
  • Use more Hurdles
  • Increase Speed

Grading Down: 

  • Decrease or eliminate weight 
  • Eliminate obstacles
  • Decrease Speed

Appropriate Diagnoses / Deficits

  • Generalized Weakness 
  • SCI
  • CVA
  • TBI
  • Balance deficits

Helpful PDFs in the Occupational Therapy Store

Isometric versus isotonic contractions in occupational therapy- BOT Resources

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Dual Tasking on Variable Surfaces & Handwriting

Dual Tasking on Variable Surfaces & Handwriting

OT Practitioners

Dual Tasking on Variable Surfaces with Handwriting

Occupational Therapy Intervention : Dual Tasking

Documentation and Activity Rationale

The patient engaged in cognitive-motor dual tasking techniques. leveraging motor-based practices  for inter-hemishpheric communication to elicit neuronal excitation overflow into executive functioning and increased functional independence. The patient engaged in a task requiring auditory memory and alternating memory via the memorization of 5/5 occupation-specifc  vocabulary words  in order to practice writing during the completion of the 5 point obstacle course with hurdles and unstable surfaces. The patient recalled 5/5 vocabulary words with good wrist extension during writing task. Written text continues to display ascending orientation demonstrating persisting visual spacial deficits. 

Grading Strategies

Grading Up:

  • Use ankle or wrist weights
  • Increased obstacles
  • Speed
  • Holding something 

Grading Down: 

  • Decrease speed
  • Decreased obstacles
  • Decreased words
  • Decrease length of course

Appropriate Diagnoses / Deficits

 

  • SCI
  • CVA
  • TBI