The supine position allows the patient to consciously coordinate their breathing with their movement - inhaling in one direction, exhaling in the opposite direction.

Use of elastic resistance provides a more objective information on the strength of anti-gravity lower extremity muscles, better than manual muscle testing. This objective information can be used when deciding whether to proceed to the standing position.

When moving one extremity while the contralateral extremity is "resting" on the mat (with BLE's attached to elastic resistance), the "resting extremity" is still working (i.e. isometrically contracting). This solves the problem of "lack of activity" when a patient refuses to participate or engage.  I have never encountered a patient who has refused to engage with these exercises.  In every instance, the patient is surprised that they are able to move their post-op limb pain-free. This encourages them to continue to participate, and express "how good" the exercises were.

These exercises allows the therapist to focus on correcting movement impairment instead of physically helping the patient produce the movement. 

 The patient is able to produce movement through eccentric control. This eliminates "cognitive effort" as a factor in movement production, and in exercise participation among severely debilitated individuals.

 One of the "mantras" in pediatric physical therapy is to allow the child to experience "normal" movement. These exercises allows  the post-op patient to explore movement independently in pain-free ranges. These exercises minimize guarding and fear of movement as factors in movement production or exercise participation. 

Each muscle group can be engaged to contract concentrically, isometrically and eccentrically in combination with other muscle groups in multiple permutations.

The lower extremities can be engaged to move bilaterally, symmetrically.  This allows for actively engaging the lower abdominal muscles even for severely debilitated patients.

 With traditional open chain exercises, the patient "relaxes" musculature of non-moving joints. Attaching elastic resistance to BLE's throughout the treatment session requires all muscles to maintain a "state of activation, " albeit in different degrees.  The latter  is how we normally function.

 These exercises potentially benefit the same neural substrates of the "mirror system."

The therapist can  actively work on core activation while moving the lower extremities by providing elastic resistance to both upper extremities (BUE's), with BUE's isometrically contracting next to the patient.

In the SNF,  almost all exercises performed to activate the glutes require for the patient to be in the standing position. When we use standing in itself as a way of activating the glutes, we are assuming that this is what is happening, neglecting the major contribution of proper alignment and locking joints as factors in maintaining standing. These exercises allow the therapist to go beyond assumptions, and observe actual muscle activity.

Some patients are mildly afraid to stand-up after surgery or after hospitalization. They are concerned that their legs "will not hold them up." These exercises provide the patient objective feedback on their ability to move against resistance. It gives them some idea of their strength, and provides them confidence to participate in standing activities.