John Whyte, MD, PhD, FACRM, Marcel P

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The Importance of Voluntary Behavior in Rehabilitation Treatment and Outcomes John Whyte, MD, PhD, FACRM, Marcel P. Dijkers, PhD, FACRM, Tessa Hart, PhD, FACRM, Jarrad H. Van Stan, PhD, CCC-SLP, Andrew Packel, PT, NCS, Lyn S. Turkstra, PhD, CCC-SLP, BC-ANCDS, Jeanne M. Zanca, PhD, MPT, Christine Chen, ScD, OTR/L, FAOTA, Mary Ferraro, PhD, OTR/L Archives of Physical Medicine and Rehabilitation Volume 100, Issue 1, Pages 156-163 (January 2019) DOI: 10.1016/j.apmr.2018.09.111 Copyright © 2018 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 1 The causal chain in a volitional exercise treatment. Ingredients (gray shaded boxes) are delivered by the clinician. Volition ingredients result in performance of the necessary treatment activity by the patient (black shaded box) and other ingredients contribute to the effects of the exercise, as performed. Ultimately, these ingredients lead to an increase in strength, which is the direct target of treatment (unshaded box). The left side of the figure is in brackets to indicate that in the case of supervised treatments, the clinician may need to give relatively little thought to the volition ingredients, because they can be adjusted as required based on the patient’s performance. When patient exercise is unsupervised, this side of the figure requires more careful planning and formal articulation of the volition target. Archives of Physical Medicine and Rehabilitation 2019 100, 156-163DOI: (10.1016/j.apmr.2018.09.111) Copyright © 2018 American Congress of Rehabilitation Medicine Terms and Conditions