Making Daily Exercises Fun Again

By Noah Pennypacker, OTD, OTR/L, ATC
LSVT-BIG Certified Occupational Therapist, Ohio

Achieving complete patient participation during a therapy session can be one of the most challenging tasks as a clinician. To overcome this, I constantly look for new and inventive ways to help my patients achieve their goals while making therapy fun and engaging. One of the most effective approaches I’ve found is to design treatments that don’t resemble traditional therapy sessions but instead feel like a game. Here are two of my favorite activities to engage patients, particularly those needing to improve dynamic balance, dressing ability, and transporting items: bowling, golf, and volleyball.  All interventions performed must have a clear link to a functional goal area.  Additionally, each of these interventions is a suggestion, and though they may be able to be modified for your patient’s needs, all chosen interventions should always be patient-specific based on your skilled assessment. The below are examples of ways to diversify your plan of care with three commonly performed activities that may be utilized to facilitate improved functional performance by improving strength, balance, joint stability, flexibility, or cardiovascular endurance, to name a few. 

Bowling 

At my assisted living facility, I am fortunate to have a rubber bowling ball and pins. However, if this equipment is not available to you, a rubber ball and cones will work just fine. Here’s how I incorporate bowling into a session:  

• Approaching the Task: I work with the patient to align their body in the optimal position to throw the ball. This involves stepping forward outside their base of support to throw the ball. You can use this as a good time to educate on joint protection and body mechanics as well! 

• Throwing the Ball: The patient throws the ball toward the pins, which typically requires dynamic modifications to the patient’s functional balance and guided directional forces to allow for improved coordination. Then, we walk down a 10-foot “alley” where the patient bends forward to reset the pins.  

• Connecting to ADLs: After the game, we relate the movements to activities of daily living (ADLs). For instance, I guide the patient to their closet in their room and approach it just like we did the “alley” to throw the ball. Then they step forward to retrieve clothing from the hanger and step back. 

Following a 10-set game, the patient will have completed 100ft of functional mobility, at least 10 squats to retrieve items from the floor, and taken 10 forward steps outside of their base of support.  

Golf 

Setting up for golf is simple. You will need a putter (or a substitute like a pool noodle, a cane, or a reacher), a golf ball or another small ball, and a cup. Here’s an example of how I use golf in therapy sessions: 

1. Setting Up the Game: I measure out a 10-foot “putting green” where the patient will play. The patient starts by bending forward to place the ball on a small X marked on the floor. 

2. Swinging the Club: The patient then steps to the side of the ball, assesses their base of support to ensure their stability and readiness, and swings to hit the ball. We walk to the ball’s location to either hit it again or pick it up, depending on the distance. It is important to note that, depending on the patient’s functional status, gradation of the patient’s BUE force and coordination may be needed to accurately strike the ball.  

3. Connecting to ADLs: Following a golfing session, if my patient has a cane, I like to talk to them about cane placement to assist in the reduction of falls. In the way that accuracy is required to putt a golf ball, cane placement must be accurate to continue to provide a stable base of support for the individual to improve stability and prevent a potential loss of balance.  Reaching for the golf ball is similar to retrieving items from below waist level in the home and upper extremity movements for completing dressing. 

Like bowling, golf involves walking, bending, and squatting. Using more than one ball can double the number of squats performed.  

Chair Volleyball 

In my community, I am fortunate to have a net and a FOX volleyball. If you don’t have these supplies, you can use a balloon and any object like a chair that can serve as your “net”.  I recommend thinking about the activity analysis of the task and what movements you want to work on when setting up the environment with whatever is accessible!   Here is how I use volleyball during my sessions: 

1. Setting Up the Game: The net height is determined by how high I would like the patient to reach during the session. Position the patient’s chair very close to the net to prevent the ball from falling at their feet and needing to constantly retrieve it.  

2. Hitting and Spiking: I encourage the patient to win the game at all costs. This means having them sit in a fully upright position, spiking the ball, and actively attempting to make me miss. I will frequently use pillows or other supports to grade the patient’s positioning to optimally challenge the patient’s core for strengthening. 

3. Connection to range of motion and strengthening: After completing a quick game of volleyball, the patient will have completed anywhere from 50-100 repetitions of shoulder flexion/overhead reaching. Based on what the goals are for your patient, feel free to incorporate wrist weights on the patient’s arms to further improve strengthening. Consider the impact an activity like this would have on sitting balance to complete self-care, such as dressing, toileting, or bed mobility.  The ROM movements alone will promote increased ease of completing upper-body dressing. 

Unlike bowling and golf, chair volleyball is completed while sitting and does not challenge the patient’s dynamic balance. However, it is an amazing tool for patients who need a little extra motivation to complete upper extremity strengthening.  

The Benefits of Creativity 

These activities are simple to set up, easy to clean up, and are almost guaranteed to have your patient completing exercises without even knowing it. From my experience, other residents often see these sessions and ask to join or request similar activities for their sessions. While our number one goal is to fully rehabilitate our patients and help them return to their daily lives with maximized function, the therapy we use to get them there does not have to be boring or generic. Think outside the box, and most importantly, HAVE FUN!