This is the first of a three-part blog series on semi-supervised practice. This blog will discuss the what is meant by the term semi-supervised practice, why this mode of practice might be used, and the education needed for staff, patients and relatives to implement semi-supervised practice in rehabilitation. The following three blogs will contain more information on adapting the physical environment of a gym to make setting up semi-supervised practice easier, and how to use equipment to increase the safety and effectiveness of semi-supervised practice.

What is semi-supervised practice?

Practice that occurs in a gym/ therapy environment but it is not completed with one-to-one supervision of a therapist.

Why use semi-supervised practice?

We know that there is a dose-response relationship between how much practice people do and their functional outcomes. Yet most practice is completed with one-to-one supervison by a therapist, resulting in stroke survivors doing very little practice and spending most of their days inactive. Setting up semi-supervised practice in the gym can result in stroke survivors spending many hours each day in the gym, achieving much greater amounts of practice.

How to start

Start with education of staff, patients and relatives. The following steps could formulate the basis of your education strategies:

Patients and relatives

  • Explain to patients, relatives and/or carers the expectation of participating in semi-supervised practice upon introduction to the rehabilitation environment and reinforce this during their admission.
  • Advise relatives and/or carers that they can assist the patient’s practice by providing physical assistance or supervision.
  • Teach patients to count their repetitions of practice; this encourages patients to continue practicing without therapist supervision, as the amount of practice they do is evident. It also encourages them to increase the amounts of practice they are doing day by day.

Rehabilitation staff

  • Create an expectation among all rehabilitation staff including nurses and medical staff, that patients remain in the gym after their one-to-one therapy sessions so that they can continue to practise.
  • When recording each person’s exercise, record both semi-supervised and one-to-one supervised exercise in their practice record or book. This process means that therapists can set up semi-supervised practice for an unfamiliar patient when the treating therapist is not in the gym.
  • Encourage large numbers of repetitions of practice; set daily or weekly goals for the numbers of repetitions to be completed.
  • Discuss the above expectations with the multidisciplinary team. Encourage team members, particularly medical staff to come into the gym to see patients, for example, during multidisciplinary and medical ward rounds. Routine nursing observations and/or pathology collections can also be performed in the gym.

This summary is an excerpt from a paper on semi-supervised practice, which can be found at: