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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

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.

Stroop and Hurdles | Occupational Therapy Interventions

Stroop and Hurdles | Occupational Therapy Interventions

Cognitive Dual Tasking – Stroop and Hurdles

Occupational Therapy Intervention : Cognitive Dual Tasking

Documentation and Activity Rationale

The patient engaged in a dual-tasking activity requiring the ability to recruit executive functioning components while alternating between movement-based performance. This task utilized the stroop color and word test (SCWT) to maximize the ability to inhibit cognitive interference when the processing of a specific stimulus feature impedes the simultaneous processing of a second stimulus attribute. The movement-based component required the ability for the patient to clear 5/5 hurdles approximately 8″ in height to improve reaction time, visual-perceptual functions, reaction time, eye-foot coordination, neuromuscular communication, and the ability to process sensory-motor stimuli s/p executive-function based activity in order to elicit neuronal excitation and maintain cognitive reserve.

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Grading Strategies

Grading Up: 

  • more complex stroop
  • more hurdles

Grading Down: 

  •  begin with larger stroop with less words
  • decrease amount of hurdles
  • start with just the stroop

Appropriate Diagnoses / Deficits

  • Alzheimer’s
  • Dementias
  • Memory Changes
  • Attention deficits [alternating/divided]
  • CVA
  • TBI

Volitional Functional Reach | Occupational Therapy Interventions

Volitional Functional Reach | Occupational Therapy Interventions

Volitional Functional Grasp

Occupational Therapy Intervention : Cylindrical Grasp

Documentation and Activity Rationale

The patient engaged in a grasp and release activity in today’s session emphasizing principles of interhemispheric communication by way of continuous midline crossing in order to promote neural excitation, UE strength, ROM, motor initiation, motor termination, and calibration of UE movements. The patient was set up in a high-back chair and was tasked with reaching and grasping an object with a cynlindrical grasp.  The patient completed 3×12 repetitions in today’s session.

Grading Strategies

Grading Up: 

  • complete standing/ dynamically
  • challenge pt with numerous items (e.g. bean bags, cones…) 

Grading Down: 

  • start with smaller objects that the patient is able to form the whole hand around
  • move the object to facilitate complete grasp (turning the object so that the patient can complete the grasp)

Appropriate Diagnoses / Deficits

  • CVA
  • TBI 
  • Alzheimer’s (cognitive deficits that result in difficulty of grasp and release/ movement initiation)