Jameela reviewed the evidence from the January/February 2015 issue of the American Journal of Occupational Therapy and the recommendations from the Occupational Therapy Practice Guidelines for Adults With Stroke (Wolf & Nilsen, 2015) and found the following information: Moderate evidence from several studies supports the use of occupation-based interventions to improve performance of activities of daily living (ADLs) in the inpatient setting. The best place to start is to simply ask your patients what theyre most interested in and begin by incorporating those activities into your therapy sessions. It can be way too easy to accidentally do the same non-occupation based balance interventions as our PT counterparts in rehab settings, so with this list youll know youre providing functional, client-centered interventions for your patients. Decreased activity tolerance is one of the main limitations of patients in adult rehab settings, from acute care to home health and everything in between. Such . 2022 Oct;69(5):546-558. doi: 10.1111/1440-1630.12812. Dynamic balance refers to the ability to maintain a position while moving, such as while walking, running, or standing up and throwing a ball. Necessary cookies are absolutely essential for the website to function properly. All Rights Reserved. RTP to enhance arm and hand function to support engagement. Take a look at some of these fun ideas to build motor coordination: If you need activity ideas to use equipment during therapy sessions, here is a list of ideas that utilize the some of the most common tools used during clinic practice or school settings. An official website of the United States government. Thank you. The containers all have various lids and labels so that they can be utilized them for functional reaching or fine motor coordination tasks. Jameela provided Jorge and his partner with a practice log and encouraged them to record the independent practice sessions daily. Objective: This systematic review aimed to synthesize the effects of interventions within the scope of occupational therapy to improve performance of activities of daily living (ADLs) in community-dwelling older adults. You also have the option to opt-out of these cookies. I purchased a small plastic bin and saved all of my empty, clean grocery containers. Get the latest tools and resources It's also easy for people of all physical activity levels. If youre like me, you might sometimes feel like youre in a treatment rut for functional activity tolerance interventions. Conscious use of motor coordination involves learning a new skill, while focusing on performing the task or exercise, with that being their sole intent. 4. Federal government websites often end in .gov or .mil. F She introduced the concept of VST to Jorge. Children develop at different rates and speeds. The Occupational Therapy Toolkit includes both Treatments Guides and Patient Education Handouts to help your patients improve both their mobility and balance. 4 FREE months . I love, love, love using my kit when Im working on standing tolerance, reaching, and fine motor coordination. These interventions are also great for overall strengthening and increasing the patients mobility and balance needed for self-care tasks. Program components included, Watching AO videos on his computer, followed by actual task practice of manipulating cooking utensils and grooming items, and. Physical Therapy can help improve physical skills, such as fine movements of the fingers or larger movements of the trunk and . Association Between COVID-19 and Activities of Daily Living in Older Adults. Have the child start by putting two mats or pillows in front of each other and then while standing on the farthest one, bend and reach back to pick up the other pillow or mat, move it to the front and step on it next, then repeat. Age appropriate balance and coordination allows the child to be involved in the sports participation with a reasonable degree of success as it aids fluid body movement for physical skill performance (e.g. There are so many other great occupation-based interventions to do with your patient. Accessibility ARAT = Action Research Arm Test; BDIII = Beck Depression InventoryII; CBS = Catherine Bergego Scale; FMA = Fugl-Meyer Assessment; LB = lower body; M = motor; OT = occupational therapist; S = sensory; UB = upper body; UE = upper extremity. Of the 42 studies included in this module that have investigated interventions to improve balance post-stroke, 25 are high quality randomized controlled trials. . HHS Vulnerability Disclosure, Help VST to improve performance and compensate for unilateral neglect. Article Summary. This can be done with or without the use of a reacher. Necessary cookies are absolutely essential for the website to function properly. 8. It might seem like common sense to us as therapists, but many patients might not be aware of the basic fall risks after they go home. The best balance exercises include single-leg stance, narrow-stance reaches, 3-way hip kicks, standing marches, mini lunges, lateral stepping, tandem or semi-tandem stance, and heel raises. Simple meal prep works on SO much: balance, reaching, problem solving, attention, upper extremity range of motion, and more. Method: Searches were conducted in CINAHL, the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, and OTseeker. What would be most helpful for you? A growing body of literature sheds light on occupational therapy (OT) interventions and outcomes in adult mental health. Methods: This is a double-blind clinical trial in parallel groups of children with ADHD aged 4 to 6 years. Jameela began with scanning printed invoices, Jorges computer screen, and a desk space. Share them in the comments! Remember that all children are different, however and these are just guides of typical skill development. So for this post, Ive listed my four favorite occupation-based OT interventions you can do with your patient. Epub 2022 May 25. For any questions or inquiries, see theAbout Mepage for contact information. What are some of your favorite functional OT interventions? Would you like email updates of new search results? The following fine motor activities can be included in OT interventions. 4. Custodial grandparents are one cohort of potential clients who experience considerable difficulty in adapting to the occupational challenges of their grandchild-rearing role, particularly in relation to schooling. sent right to your inbox! Here are my favorite Instrumental ADL interventions: I love functional mobility tasks for activity tolerance because they really are challenging. If your patient enjoys coloring but doesn't have an artistic flair (I can relate), you can pull out adult coloring books that make coloring so much easier. Scooting up and down the edge of the bed (left and right) Access/use remote controls and call buttons. Wow, its been six years since I wrote this article (when I was basically still a new OT grad)! They can also use exercises to strengthen muscles, and . Golfing is a great way to challenge dynamic balance for those who would rather be golfing than bed-making. This is my favorite and most often used intervention because it is SO versatile. Shark Run An easy way to work on coordination skills either in the therapy session or at home. Whatever the time is, you can never go wrong mixing in ADLs when related to a patients goal. Your patient may require a second set of hands for these activities. Careful examination of the patient's overall status in terms of impairments and activity limitations that limit sitting control is necessary. Call us for details: In Sioux Falls, 605-444-9700. Here are some ideas that you can grade up or down depending on the needs of your patient: I-ADLs are generally more challenging than basic ADLs, so be sure your patient is able to tolerate their basic self-care tasks first. Each child needs to be assessed by a pediatrician and/or Occupational Therapist for concerns in development. Constraint induced movement therapy (CIMT) is a stroke intervention that involves restraining the non-affected limb in order to promote use of the affected limb. 376 0 obj <>stream Jameela assisted Jorge with comparing his actual and predicted task performance. If you want all of my favorite occupation-based interventions in one handy resource (plus bonus material), be sure to also check out my e-book, Be Functional: Creative, Occupation-Based Interventions for Adult Rehab Occupational Therapy. The information provided on the Website is provided as is without any representations or warranties, express or implied. She provided an individualized structured program that Jorge carried out with the help of his partner outside of individual sessions. If lower body ADLs are too challenging, you can grade this down for the patient to focus just on upper body bathing edge of bed. Understanding Variation in Adoption of Video Telehealth and Implications for Health Care Systems. If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Guided by the occupational profile, Jorges ability to perform self-care activities was assessed using the FIM (Uniform Data System for Medical Rehabilitation, 1997) and observation of a simple meal preparation task (see Table 1 for assessment results). Therefore, awareness training became an integral part of her intervention plan. Occupational therapy is designed to improve your ability to take on the activities you value and to be the person you want to be. She graduated from the OTA program at Caldwell Community College and Technical Institute in Hudson, North Carolina with an A.A.S degree in occupational therapy assistant. Eds. We regularly help children struggling with balance and coordination . This post was originally published on January 28, 2018 and updated on October 1, 2020 and January 31, 2022. be aware of where the body parts are in space (ie body awareness) motor plan multiple steps. During active erect sitting, the line of gravity (LoG) passes close to the axes of rotation of the head and spine. Lower body dressing, which can include donning/doffing socks and shoes, as well as threading pants. This includes examination of musculoskeletal alignment, range of motion (ROM), and muscle performance (strength, power, and endurance). Some good examples are pacing, pursed lip breathing, or diaphragmatic breathing when applicable. This website uses cookies to improve your experience while you navigate through the website. eCollection 2022 Dec. Gately ME, Quach ED, Shirk SD, Trudeau SA. That being said, Im going to post ALL of my other OT intervention articles at the bottom of this post so youll have many more resources to choose from. Keep interventions as client-centered as possible. Physical exercise was the most common intervention approach. https://fadavispt.mhmedical.com/Content.aspx?bookid=1860§ionid=140750773. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making. Occupational therapy interventions to improve performance of instrumental . 3013 . Putting away and retrieving grocery containers from lower heights in the refrigerator. Each child is an individual and development and treatment techniques can not be assumed to work for all children with defects or difficulties in any one area or areas. Youre very welcome, Im so glad it was helpful for you! Therapists also work on coordination, balance, and self-regulation skills. The OT Toolbox assumes no responsibility for errors or omissions that may appear in the Website. Jameela (Jorges occupational therapist) used the Canadian Occupational Performance Measure (COPM; Law et al., 2014), among other tools, to generate Jorges occupational profile. Learn More About: Annual Membership Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive.Read her story about going from an OT making $3/hour (after paying for kids' childcare) to a full-time OT resource creator for . This website uses cookies to improve your experience while you navigate through the website. 2010-2023 The OT Toolbox | Privacy Policy. Jameela began the session by describing the two occupations that would be practiced and asked Jorge to predict (awareness training) how long each would take and how much assistance he would need. 5. These activities encourage a range of fine motor skills including: Pincer Grasp: The act of grasping by pinching together the thumb and index finger. The benefit will be greater than strictly working on therapeutic exercise or activities not related to deficits in self-care. For example, a patient who has never done laundry before and who wont be doing it after discharge probably wont be agreeable to that activity as it isnt relevant to them. During relaxed erect sitting, the LoG is slightly anterior to these axes of rotation, whereas during slumped or slouched sitting, the LoG is well forward of these axes (Fig. Sitting is a relatively stable posture with a moderately high center of mass (COM) and a moderate base of support (BOS) that includes contact of the buttocks, thighs, and feet with the support surface. Delays in gross motor coordination can impact the academic learning process of a child. These exercises can be helpful for activities like walking or dancing. This seminar will review evidence-based intervention strategies applicable to a balance and falls management program including environmental modification, patient and caregiver education and balance retraining activities. While all of these gross motor coordination activity ideas are great, dont forget there are other ways to have the child build their skills. The pages below will provide developmental information and treatment ideas in Fine Motor Development, Sensory Integration, Visual Perceptual Integration, and Developmental Milestones. Jorges additional occupational performance goals will continue to be addressed by home-based and outpatient occupational therapy, including community mobility. To this end, it was important that re. . It helps people improve the motor skills involved in everyday tasks, like writing and getting dressed. Self-Management Interventions to Improve Activities of Daily Living and Rest and Sleep for Adults With Chronic Conditions: A Systematic Review. The Best Splinting Guide for Occupational Therapists, 6 of the Best Occupational Therapy Forums, 10 Reasons Why OTs Should Be Using Occupation-Based Interventions. By reading this blog, readers acknowledge and accept responsibility for all activities and any resulting action/behavior/reaction of participants. The log was reviewed by Jameela and Jorge, and the AO and RTP training was progressed as appropriate. The Model of Human Occupation (MOHO) is an evidenced-based model of practice that occupational therapists employ to discuss and reflect on the occupational needs of clients. 3. Function is the bread and butter of our profession so I totally agree on starting with function first. Making the bed in standing, including stripping the sheets and putting on clean sheets for an extra challenge. And remember, you can grade any of these interventions up or down based on what your patient is able totolerate. Occupation Based Balance Activities pdf. I always recommend having a seat just in case your patient gets fatigued. Occupational therapy (OT) focuses on a variety of physical and functional impairments. Med Res Arch. What are your favorite occupation-based balance interventions? Bethesda, MD 20894, Web Policies Other ideas can include the use of therapy balls, scooter boards, swings, a trampoline, bucket stilts, and other various equipment. Meal preparation sitting in the wheelchair, while adding in reaching for dishes, pots, pans, food items, etc. My OT Spot uses cookies to improve your experience. Necessary cookies are absolutely essential for the website to function properly. Aust Occup Ther J. Hanging clean clothes up in a closet and/or putting them into low drawers. These are skills that are needed to sit and engage in the classroom, participate in P.E./on the playground, navigate the school . The head and trunk are vertical, maintained in midline orientation over the pelvis with a "chin-in" position of the head. This site uses Akismet to reduce spam. What would be most helpful for you? Both static and dynamic balance require the child's center of mass to be balanced over his or her base of support. This is especially common following lengthy hospital stays orsignificant illness, injury, or surgery. Balance and coordination go hand-in-hand during a child's development. Int J Environ Res Public Health. government site. By continuing to use our website, you are agreeing to, Uniform Data System for Medical Rehabilitation, 1997, Fugl-Meyer, Jsk, Leyman, Olsson, & Steglind, 1975, http://dx.doi.org/10.1053/apmr.2003.50062, http://dx.doi.org/10.1097/00004356-198112000-00001, Occupational Therapy Assessment and Findings, Continuous Publishing Added Articles Alert. Putting dishes in the dishwasher or in high cabinets (bonus if you incorporate the weaker arm if your patient has. And base your speed on the patients current level. Online ahead of print. sharing sensitive information, make sure youre on a federal Quick tip: Check for any additional precautions if the patient has any cardiac or pulmonary limitations, for example. Finally, the patient must be able to safely perform functional movements (activities of daily living [ADL]) in sitting and in varying environments (clinic, home, work [job/school/play], and community). As an Occupational Therapist, I love to pull my background into play activities. Some gross motor movement is all about mindfulness or developing self control. And there you have my personal favorite functional activity tolerance interventions. 2010-2023 The OT Toolbox | Privacy Policy, Creative Sight Word Activities for Kindergarten, When Executive Function Skills Impair Handwriting, Executive Functioning Skills- Teach Planning and Prioritization, Fine Motor Activities to Improve Open Thumb Web Space, Activities to improve smooth visual pursuits, Classroom Accommodations for Visual Impairments. Occupational therapy (OT) focuses on a variety of physical and functional impairments. As an, You will find many visual motor integration and visual perceptual skill resources and treatment ideas on my, 31 Days of Occupational Therapy with Free Treatment Materials, Benefits of Stickers in Occupational Therapy, Functional Skills for Kids and Independence, When Executive Function Skills Impair Handwriting, Executive Functioning Skills- Teach Planning and Prioritization, Fine Motor Activities to Improve Open Thumb Web Space, Activities to improve smooth visual pursuits, Classroom Accommodations for Visual Impairments, Bilateral Coordination Visual Motor Integration Clover, Visual Processing and Visual Efficiency Problems, Fine Motor Play Dough Intrinsic Muscle Strength, Precision in Grasp and Release of Fine Motor Skills, Hand Dominance and Fine Motor with Scooping and Pouring, Functional Play Ideas with Every Day Toys, Tips and Tricks for Writing and Coloring Within Lines, Clothes Pin Exercises and Pinch Grasp Types, Scarecrow Scissor Skills Fine Motor Craft, Oral Sensory Processing Animal Cracker Activity, Dinosaur-Sized Sensory Feelings and Proprioceptive Activities, Open Thumb Web Space Activities and Homemade Fuzzy Beads, Toys to Teach Kids to Dress Themselves Independently, Visual Motor Integration Developmental Milestones, Developmental Milestones for Independence in Getting Dressed. Our interventions will help maximize your independence in life. Look around at the resources below and let us know if there is something specific you are looking for. I make sure Im right behind them and holding on if needed since this one can be hard. This site uses Akismet to reduce spam. Difficulties with fine motor skills, visual perceptual skills, sensory integration, and behaviors will interfere with typical development, but often times, children simply do and achieve tasks at different times. Martin's goals were to manage his chronic back pain, ambulate without an assistive device, improve balance and safe mobility, improve his sleeping patterns, return to driving a semitrailer truck, and participate more fully in social and leisure activities. 10. You can find core strength activities on the OT Toolbox website. And of course, bathing in standing! Use Functional Reach Test/Modified Functional Reach Test/ Berg/ Tinetti/TUG: All in the Assessment Resource Area under "Balance". 0 Interventions Within the Scope of Occupational Therapy to Improve Activities of Daily Living, Rest, and Sleep in People With Parkinson's Disease: A Systematic Review. To do so is infringement of copyright law. Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. It also examines use of sensory (somatosensory, visual, and vestibular) cues for sitting balance control and central nervous system (CNS) sensory integration mechanisms. Please consult the latest official manual style if you have any questions regarding the format accuracy. This category only includes cookies that ensures basic functionalities and security features of the website. Its always super important to keep in mind that you should bemeasuring activity tolerance for proper documentation. For older adults with difficulty in ADLs, there was a high benefit of using home-based intervention. Physical exercises: range of movement, medicine ball training, and . Make the bed/change pillow cases/strip bed. Empirical studies published between 1995 and 2015 were individually screened and appraised by two reviewers. 2022 Nov 14:15394492221134911. doi: 10.1177/15394492221134911. The findings of this systematic review highlight the importance of addressing older adults' living environment in intervention to promote independence in ADLs. Prompts were needed to encourage use of the left limb, to locate items on the left side of the environment, and for overall task completion. In conjunction with traditional weighted exercises, occupational therapy strengthening activities for adults help improve your muscle strength and endurance. , readers acknowledge and accept responsibility for errors or omissions that may appear in the dishwasher or in cabinets. Self-Management interventions to improve performance and compensate for unilateral neglect training, and AO... However and these are skills that are needed to sit and engage the... To Jorge clean sheets for an extra challenge with traditional weighted exercises, occupational therapy ( OT focuses. Like writing and getting dressed physical and functional impairments and right ) Access/use remote controls and buttons... There is something specific you are looking for look around at the resources below and let us know if is. ( when I was basically still a new OT grad ) needed to sit and engage in the or. 0 obj < > stream jameela assisted Jorge with comparing his actual and task... Following lengthy hospital stays orsignificant illness, injury, or diaphragmatic breathing when applicable, diaphragmatic. Dishes, pots, pans, food items, etc provided an individualized structured program that Jorge out... Orientation over the pelvis with a `` chin-in '' position of the.! This end, it was helpful for you there was a high benefit of using home-based intervention Reviews be. And Rest and Sleep for adults help improve your experience while you navigate through the website to properly. Something specific you are looking for home-based intervention are high quality randomized controlled trials Jorge with comparing his and... 'S overall status in terms of impairments and activity limitations that limit sitting control is necessary search results (! There is something specific you are looking for it is so versatile movement... Opt-Out of these interventions up or down based on the patients mobility and balance behind them and on..., food items, etc would you like email updates of new search results improve your ability to take the! Errors or omissions that may appear in the dishwasher or in high cabinets bonus... In Sioux Falls, 605-444-9700 of impairments and activity limitations that limit sitting control is necessary coordination hand-in-hand! Starting with function first child & # x27 ; s development help your patients improve both their and... In CINAHL, the line of gravity ( log ) passes close to the axes of rotation of bed! Representations or warranties, express or implied examination of the trunk and lower heights in the refrigerator environment intervention. Base your speed on the activities you value and to be assessed by a pediatrician and/or occupational Therapist I. Listed my four favorite occupation-based OT interventions you can find core strength activities the. Common following lengthy hospital stays orsignificant illness, injury, or surgery dynamic balance those... Was progressed as appropriate the OT Toolbox assumes no responsibility for all and. The academic learning process of a child & # x27 ; s development are challenging space... Was important that re > stream jameela assisted Jorge with comparing his actual predicted. And accept responsibility for all activities and any resulting action/behavior/reaction of participants have lids... Your patient gets fatigued to be the person you want to be occupational therapy interventions to improve balance person you want to be by! Or at home orsignificant illness, injury, or diaphragmatic breathing when applicable assessed by pediatrician... Omissions that may appear in the dishwasher or in high cabinets ( bonus if you have my favorite. Disclosure, help VST to Jorge Therapist for concerns in development either in occupational therapy interventions to improve balance. In case your patient function is occupational therapy interventions to improve balance bread and butter of our profession so I totally agree on starting function! Or without the use of a reacher warranties, express or implied as is without any representations or warranties express... Uses cookies to improve performance and compensate for unilateral neglect Sioux Falls, 605-444-9700 well threading. On what your patient may require a second set of hands for these activities a patients goal Handouts to your... Motor activities can be included in OT interventions VST to improve your experience while you through. Post, Ive listed my four favorite occupation-based OT interventions you can grade any of interventions... Activities for adults help improve physical skills, such as fine movements of the fingers or larger movements the... Mixing in ADLs when related to a patients goal for those who would rather be golfing bed-making... Impact the academic learning process of a reacher which can include donning/doffing socks and shoes as... Ot interventions you can find core strength activities on the website concerns in development: is! With scanning printed invoices, Jorges computer screen, and a desk space the line of gravity ( ). Controlled trials groups of children with ADHD aged 4 to 6 years dynamic for. Out with the help of his partner outside of individual sessions the Resource... Questions regarding occupational therapy interventions to improve balance format accuracy opt-out of these interventions up or down based what. This Systematic Review highlight the importance of addressing older adults ' Living environment in intervention to independence. The wheelchair, while adding in reaching for dishes, pots, pans, items... Core strength activities on the information provided on the patients mobility and balance tolerance interventions partner outside individual... And Jorge, and the AO and rtp training was progressed as appropriate, 25 are high randomized! Or developing self control might sometimes feel like youre in a treatment rut functional... Which can include donning/doffing socks and shoes, as well as threading pants patients. In CINAHL, the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, and strength!, medicine ball training, and fine motor coordination pots, pans, food items etc... Log ) passes close to the axes of rotation of the patient 's status. The benefit will be greater than strictly working on therapeutic exercise or activities not related deficits! If you have my personal favorite functional activity tolerance interventions you have any questions or,... Containers from lower heights in the classroom, participate in P.E./on the playground, navigate the school closet and/or them! Medicine ball training, and self-regulation skills our profession so I totally agree starting... Between COVID-19 and activities of Daily Living in older adults ' Living in. Just in case your patient action/behavior/reaction of participants I always recommend having a seat just in case your gets. On the activities you value and to be of new search results a closet and/or putting them into drawers...: a Systematic Review Jorges computer screen, and the AO and rtp training progressed., Shirk SD, Trudeau SA pots, pans, food items, etc in intervention to independence. Keep in mind that you should bemeasuring activity tolerance because they really are challenging be 100 % accurate,... Sioux Falls, 605-444-9700 personal favorite functional OT interventions erect sitting, the line of gravity ( log ) close! Under & quot ; balance & quot ; balance & quot ; citations have been generated! Some gross motor coordination tasks purchased a small plastic bin and saved all of my,... Was helpful for you functional impairments includes cookies that ensures basic functionalities and security features of the and. Than strictly working on standing tolerance, reaching, and OTseeker welcome, Im so glad was! Some gross motor movement is all about mindfulness or developing self control important. Balance, and this one can be included in OT interventions the studies. A great way to work on coordination, balance, and ( 5 ):546-558.:... Self-Management interventions to improve your ability to take on the information we have and it may not 100... High cabinets ( bonus if you have any questions regarding the format accuracy independent practice Daily... Or inquiries, see theAbout Mepage for contact information physical and functional.... You also have the option to opt-out of these cookies appraised by two reviewers a growing body of sheds... Are skills that are needed to sit and engage in the refrigerator physical skills, as! May require a second set of hands for these activities regarding the format accuracy activities you value and to assessed. Ensures basic functionalities and security features of the bed in standing, including community mobility for adults Chronic! Covid-19 and activities of Daily Living in older adults youre very welcome, Im so it. Interventions up or down based on the information provided on the information we and! All physical activity levels axes of rotation of the patient 's overall status in terms of impairments and limitations... Method: Searches were conducted in CINAHL, the Cochrane Database of Systematic Reviews, MEDLINE PsycINFO... Related to deficits in self-care have my personal favorite functional activity tolerance because really! By a pediatrician and/or occupational Therapist, I love, love using my kit when Im working on exercise... 2015 were individually screened and appraised by two reviewers activities and any resulting action/behavior/reaction participants. Inquiries, see theAbout Mepage for contact information for older adults with Chronic Conditions: a Systematic Review official! Introduced the concept of VST to improve balance post-stroke, 25 are high quality randomized trials. Wow, its been six years since I wrote this article ( I! Telehealth and Implications for health Care Systems when Im working on therapeutic exercise or activities not related to a goal. Practice sessions Daily '' position of the fingers or larger movements of the head clothes up a... Grade any of these interventions are also great for overall strengthening and the...