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The Caregivers' Role in Rehabilitation 

By Sean Kenny

(Page 3 of 3)

Most rehabilitation programs are geared towards progression. In regards to resistance training and strength improvement, one of the most commonly used programs is the Daily Adjustable Progressive Resistance Exercise (DAPRE) system. This is a four set exercise program (the first two sets are progressive warm-ups) that take in to consideration the daily variations of a patient's strength levels. Resistance can be applied through weights, machines, latex bands, or manually by the caregiver or therapist.

Another common exercise prescription for strength improvement is isometric exercises. An isometric contraction is when the muscle is neither shortened or lengthened, merely contracted and tensed. Tension is generated, and energy is released in the form of heat, not mechanical work. Pushing against an immovable object such as a wall is an example of isometric exercise. These are especially valuable to a patient who needs to exercise an immobilized limb or when joint motion is hindered by inflammation. Instead of using repetitions to measure work, "seconds of contraction" are the units in isometric programming.

Flexibility drills, active-assisted exercise and limited ROM exercises are also frequently employed by the therapist and introduced to the caregiver.

Muscle Function

Below is an example of a few of the major muscle groups that are targeted by rehabilitation programs. You can see how conditioning each area can improve one's quality of life. The person in this example is wheelchair bound (paraplegic).

Muscles Strengthened Functional Benefits

  • Shoulders, deltoids (anterior, Self-care, loading/unloading wheelchair, posterior), trapezius. lifting objects, wheelchair sports.

  • Biceps Transfer activities such as repositioning legs.

  • Rotar Cuff (supraspinatus, Transfers, pressure relief, counteract subscapularis, infraspinatus, tight internal rotors from wheelchair teres m.). propulsion.

  • Triceps Transfers, wheelchair propulsion.

  • Chest (pectoralis major). Wheelchair propulsion, driving and braking.

  • Back (latissimus dorsi, rhomboids, posterior deltoid) Pressure relief, transfers, pulling activities.


Sean Kenny, C.P.T, a certified trainer, author, and guest speaker is a consultant with Mercy Hospital and Pacific Health Education Center in Bakersfield, Ca., reviews exercise protocols for the senior, disabled and diabetic populations. Visit Sean's Fitness Web Site:, or call (805) 831-0805

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