PT for PT: How Precision Teaching Helped Me With Physical Therapy Shoshana Stein Sorah Stein, MA, BCBA, CSE Indiana University South Bend And Partnership for Behavior Change Physical therapy is not the most desirable activity for the average teenager, however, at times, it is needed. In the present study, a 13-year-old girl treated for probable Mitochondrial disease required physical therapy to address muscle weakness and pain. The physical therapist administered the Functional Movement Screen (FMS; Cook, 2010) to assess movement patterns, provided manual therapy, supervised therapeutic exercises, and assigned home exercises. Carr & Williams (1982) started out with a patient who couldn’t walk independently, pull to stand, walk, or cruise. The goal for the patient was for the patient to pull to stand independently, and eventually to walk independently. Part of the treatment included casting, pulling to stand then holding on the table, and using M&M’s as reinforcers. Independent stand ups rapidly increased, and assists from the therapist stayed at zero. Precision Teaching provides a way to learn in a more effective and personalized way, leading to increased fluency, accuracy, and endurance (Binder et al., 1990; White, 1986). Binder et al. (1990) discuss how precision teaching can help build endurance for classroom tasks. In the present study, we look at how using precision teaching for physical therapy tasks can lead to physical endurance. Introduction Method Results Discussion Similar to the findings of Carr & Williams (1982), by breaking down composite exercises into component movements and collecting data frequently, we helped make physical therapy treatment more effective and safe, and were able to better track progress towards overall strengthening. While the improvement achieved in this case is typical per the physical therapist, we completed this in 7-8 minutes per day with 4 exercises, instead of the more typically prescribed 15-minutes per day with more exercises. This may have interesting implications for people with poor adherence to therapy exercises, and perhaps even more interesting implications for strengthening routines for people with Mitochondrial disease, as endurance and long periods of exercise are not recommended. Before beginning exercises, a physical therapist completed the FMS, an assessment tool that looks at 7 movements, scored on a scale of 0-3 each, based on pain and/or technique. Scores below 14 mean that the patient is at risk for slow recovery from injury. The teen’s baseline score was 12. The teen and her mother broke down the assigned composite exercises into component movements (pinpoint) and conducted frequent, timed exercise sessions (count) and charted them on Standard Celeration Charts (chart) (White, 1986). By doing this, the teen grew stronger in some targeted areas and her mother and the physical therapist were able to identify subtler component areas of weakness from looking at rates of change and implement exercise modifications that were needed to increase safety and effectiveness. The exercises were performed individually, once daily, several days per week. The exercises the teen completed included a bilateral squat, a right/left single knee bend, the plank, and a right/left standing knee raise. Data were charted on Excel-based Standard Celeration Charts. Exercises other than the plank were timed on a cellphone timer. The plank was measured as duration, on a cellphone stopwatch. Binder, C., Haughton, E., & Van Eyk, D. (1990). Precision teaching attention span. Teaching Exceptional Children, 22(3), Carr, B. S., & Williams, M. (1982). Analysis of Therapeutic Techniques Through Use of the Standard Behavior Chart Implications for Physical Therapy. Physical therapy, 62(2), Cook, G. (2010). Movement: Functional movement systems: screening, assessment, corrective strategies. On Target Publications. White, O. R. (1986). Precision teaching—Precision learning. Exceptional Children, 52(6), The Standard Celeration Charts for all 4 exercises show that the teen performed at or below 50 movements per minute in the beginning. After two weeks, the performance accelerated to near 100 exercises per minute. Two months into the regimen, performance plateaued above 100 exercises per minute At the point that data for most of the exercises hit a plateau, the teen replaced these exercises with increased Tae Kwon Do, Zumba, and swimming. Post-test score on the FMS was 17, an increase of 5-points from baseline. By measuring each exercise for exactly 1 minute, we avoided the need to calculate count-per-minute frequencies based on longer timings (Binder et al, 1990) The reinforcer for the teen doing the exercises was to be able create a poster and present it at the ABA conference. When presented with this, the teen pushed herself to complete the exercises daily. The authors would like to thank Dr. Bobby Newman and Ken Mack for assistance with this project.