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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.

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

Stroop and Hurdles | Occupational Therapy Interventions

Stroop and Hurdles | Occupational Therapy Interventions

OT Practitioners

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

Step, Tap, Align Group | Occupational Therapy Intervention

Step, Tap, Align Group | Occupational Therapy Intervention

OT Practitioners

Group Therapy Intervention

Occupational Therapy Intervention : Group Therapy

Documentation and Activity Rationale

The patient engaged in a dual-tasking activity with an emphasis on visual memory and recall. The task required the patient to receive a 3-part image at point A, ambulate 20 ft while clearing obstacles of various sizes and heights, and recall and draw the image received at Pt A. This activity is purposed to improve the relationship between perceptual processing and encoding, storage, and retrieval of the resulting neural representations after approximately 10 seconds of time-lapse. The patient demonstrated no evidence of LOB or instability. She required between 2-3 repetitions per image with 2-3 verbal cues. 3 step directions are moderately difficult for the patient.

Grading Strategies

Grading Up: 

  • more narrow BOS
  • increase the frequency of stepping
  • integrate dual-tasking (e.g. counting by 2’s)

Grading Down: 

  • increase BOS
  • decrease stepping outside of BOS (e.g. “tap your foot to the side every 5 steps)

Appropriate Diagnoses / Deficits

  • Balance deficits
  • Memory Changes
  • CVA
  • TBI

Opening a Jar Activity | Occupational Therapy Interventions

Opening a Jar Activity | Occupational Therapy Interventions

OT Practitioners

Functional Hand Strength – Jar Opening

Occupational Therapy Intervention : Functional Hand Strength

Documentation and Activity Rationale

The patient engaged functional hand strengthening activity in which she was tasked with maintaining a spherical grasp against ‘power web’ resistance. The patient completed x2 repetitions of x3 different sized lids in order to increase intrinsic and extrinsic hand musculature and increase participation in patient-specified meaningful activities like opening jars, pop bottles, medicine bottles, containers, and more. 

Grading Strategies

Grading Up: 

  • increase repetitions 
  • increase variability in lid/functional grasp items 

Grading Down: 

  • begin with AROM before adding resistance
  • decrease repetitions 
  • incorporate rest breaks in between each set

Appropriate Diagnoses / Deficits

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