"Priming is a non-conscious process associated with learning where exposure to a stimulus alters the response of another stimulus. When used successfully with a therapeutic intervention, priming results in a behavior change coinciding with changes in neural processes." (Stoykov, p.1)  Simply put, priming exercises /activities prime the NEUROMUSCULAR SYSTEM for functional training.

The modes of priming most therapists are familiar with are mirror therapy, motor imagery, and sensory priming (i.e. sensory input, motor output). Other priming modes include semantic priming and noninvasive brain stimulation (like repetitive transcranial magnetic stimulation and transcranial direct current stimulation).

Priming exercises are geared for the neuromuscular system, while warm-up exercises are for the musculoskeletal and cardiovascular systems. 

When a medically complex patient who requires extensive assistance is transferred to the SNF after hospitalization, physiologic standing is one of the first interventions used. Physiologic standing is used primarily to activate anti-gravity muscles. Occasionally,  patients physically or verbally (i.e. screaming) resist physiologic standing. When this happens, physiologic standing becomes a coerced intervention.

Other times, because the patient requires extensive assistance to assume and maintain the standing position, the activity's frequency and duration are minimal due to patient and therapist fatigue. In addition, the activation of antigravity muscles is based on the assumption that this activation occurs during the activity. 

ASSISTED PRIMIN IN SUPINE is an excellent and effective alternative to physiologic standing.

This prompted me to develop a novel intervention - Assisted Priming in Supine (APS).

It is movement-based priming I use in the first two weeks of an SNF stay immediately before functional task training.  It allows post-op patients or those with severe anxiety or cognitive impairment to explore pain-free movement independently, enhancing agency and minimizing or eliminating guarding. It has diagnostic value because it allows the therapist to observe anti-gravity muscle activity. Because it is done in supine, it eliminates fear of falling as a factor for engagement among this patient population.

 I have found this mode of priming to be very useful for ambulatory older adults admitted to the hospital with non-neurologic diagnoses and who are discharged to the SNF requiring extensive assistance or who are dependent. It has been effective in the most difficult, non-neurologic clinical cases I have encountered in the SNF. The patient can produce volitional movement with minimal effort in the supine position. Elastic potential moves the lower extremity in one direction, and elastic resistance resists the movement of anti-gravity lower extremity muscles in the opposite direction, making it an effective precursor to the upright/standing position.

ASSISTED PRIMING IN SUPINE:

1. stimulates the mirror system when the patient sees their lower extremities move

2. provides the patient the sensation of "normal movement"

3. allows for unilateral, reciprocal and bilateral, symmetrical movement of both lower extremities with muscle groups contracting concentrically, isometrically, and eccentrically in different combinations

4. allows for coordinating breath with movement in a safe position

5.  allows for coordinating core activation with lower extremity movements

When I describe this intervention during presentations,  most people point out its similarity to Pilates exercises.

In reality, I developed ASSISTED PRIMING IN SUPINE (APS)  using my experience as a pediatric PT. In pediatrics, one of the treatment principles is "to provide the child the sensation of normal movement through facilitation." Pediatric therapists have cage therapy or spider therapy as a treatment option. When a previously ambulatory older adult becomes non-ambulatory and weak after hospitalization, APS provides them the "sensation of normal movement," using the elastic potential of elastic tubings to assist with movement.

Click on link for a discussion on EQUIPMENT.

Click on the link for SAMPLE EXERCISES.