Table 1.

Examples of the three foci of Enhanced Medical Rehabilitation (EMR).

Be interactive and patient-directed
Individualized exercise to maximize effort	“You decided that helping care for your grandchildren, getting to church, and walking your dog are your goals. Which one of those would you like to focus on today?”
	“Okay, so we’ll focus today’s therapy on activities that will get you closer to your goal of being able to help take care of your grandchildren again. What will you need to be able to do so that you can get back to doing that?”
	“ Just to make sure we’re on the same page, can you talk me through how this activity will get you closer to your goal of helping care for your grandchildren? ”
“Ask, don’t tell” patient what activity or exercise to do	“ What activity would you like to do next? ”
	“ We’re going to start today by deciding which one of your goals to work on. You decided x, y, and z are important to you. Which one of those would you like to focus on today? ”
Check in with patient after each activity or exercise	“ How do you feel you did with those stairs?”…“It seems you weren’t happy with how you did; how can you make getting from the bed to the wheelchair easier or safer? ”
Increased intensity
Guide patient towards higher- intensity activities	“ Let’s start off with a challenging activity. Which one of those activities we just discussed would you like to try first? ”
	“How hard are you working?” (patient responds “4” on 0-10 scale, indicating that therapeutic exercise requires little effort) “We’d like to get you even stronger. What would it take to get you up to a 7 or 8 while doing this activity?” The patient responds with a suggestion, or the therapist then offers her ideas to increase the effort level. Alternatively, the therapist increases effort-level of an exercise automatically by adding resistance to an exercise, or suggesting a longer or faster gait training, for example.
Individualize tasks to maximize effort	“ Do you want to see how much farther down the hall you can walk? ”
Frequent feedback on effort and progress
Tell patient the benefits when activity/exercise was hard and comments on progress when it becomes easier.	“How hard is this exercise?” (patient responds “9”, indicating that therapeutic exercise was very difficult) “I can see you are working hard, and your heart is beating fast. That means right now you are increasing your stamina…your endurance and your heart and lung capacity are getting better.”
	“ You rated your effort a 3 on getting dressed just now, and last week you rated it an 8. Can you see that you are getting stronger and closer to your goals? ”
Link patient’s progress to goal achievement	“Remember when you told me that you wanted to be able to walk your dog again? Well, today, you were able to walk 15 feet without much assistance. You’re closer to your goal.”
	”Today, you walked around for 15 minutes. And you were safe and confident. You also stood strong while you put away those heavy groceries in the kitchen. That tells me that you’re getting closer to your goal of cooking. It also tells me that by the time you get home, you’ll be able to keep up with your grandkids.”