Energy Conservation
Energy conservation techniques provide the easiest way to decrease the work of muscles without loss of function. Analysis of all activities by type, time, distance, and intensity is valuable in designing interventions. Such an inventory forms the basis for setting priorities and determining where and how individuals wish to use their limited neuromuscular capacity.
Questions addressed include the following:
- Can one trip do for two or three?
- Can the activity be performed in a less strenuous way, such as by sitting or using a rolling basket?
- Can the activity be broken up into parts with change of activity or rest?
- Are there easier ways to perform the activity with modern comforts and technology, including motorization and electronics?
- Can someone else perform some of the physical aspects of the activity?
Particular attention should focus on activities that produce fatigue and pain. Specific suggestions may address breaking tasks into subtasks, environmental adaptations such as work height and locations, using frequent rest breaks during activities, and use of adaptive or ergonomic equipment.
Psychological considerations play a major role in designing an acceptable and appropriate management plan that will encourage compliance. Lifestyle modifications may not be favorably viewed by some individuals who have "conquered" the disease and pushed themselves to be independent. Prescription of interventions that are perceived to be "radical" should be done with sensitivity and caution. The rationale for interventions should be carefully considered in light of the client's current functional status and goals. Introduction of orthoses, assistive devices, and mobility modifications is often difficult for the individuals with congenital or childhood onset of disease to accept, given the long, arduous effort expended over years to avoid such devices.
Home management activities may be divided into two components: light home management and heavy home management. Light home management includes money management, preparing a snack in the kitchen, laundry, and making the bed. Heavy home management includes grocery shopping, preparing a complex meal in the kitchen, dusting, and vacuuming. The clinician should discuss the role the client would like to assume at home. The client may want to resume previous home management roles or want to discuss changing roles with a family member or caregiver to have energy for other skills.
Energy Conservation Examples
Orthotics and Assistive Devices
Reduction of muscular overuse and fatigue may be accomplished with lightweight splints and braces, adaptive equipment, walkers, or crutches.
As with every intervention, a thorough explanation of the specific rationale and goals for the intervention will not only be helpful in gaining the client's trust but will also improve compliance. Rationale for orthotic use includes preventing falls and potential fractures, limiting joint motion and preventing pain, restoring weight bearing on the weaker extremity to decrease the work of the less affected leg in locomotion, improving posture and decreasing back pain, and decreasing energy expenditure.
Thoughtful consideration for the appropriateness of orthosis or assistive devices is critical; such devices should not be haphazardly prescribed or given as the only intervention of choice. They should be prescribed cautiously. Ineffective and inappropriate use of such devices will lead to malalignments, ineffective movement strategies, and postures that will cause more harm. Therapists should carefully evaluate the functions that may be lost or gained and the emotional and physical cost of their use.