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NASM CES Chapter 7: Client Intake and Assessment 1

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    Chapter Goals:

    • Find the various assessments that are used for programming corrective exercise.
    • Find the assessments that are appropriate strategies based upon the client types.
    • Describe the procedures for client intake.
    • Find the instances that warrant referrals to health professionals.
    • Find the legal and the ethical considerations when working with clients.
    • Discuss the most effective and appropriate coaching and communication strategies during the client intake and after.

    Introduction

    The initial session with the client is the most important one.

    This is when the specialist will conduct assessments that are related to the physical readiness, general lifestyle info, medical history, goals, and other physical and psychological behaviors of the client.

    The professional also works to ensure that all of their legal and ethical forms and procedures are completed and signed off on. 

    Assessments will be crucial in designing safe and individualized programs for corrective exercise and it will also include the intake screening, static posture assessments, and the targeted assessments for mobility.

    Client Communication

    Even after the development of a goal of improving balance, for example, there still are many variations of implementation of corrective exercise techniques in the industry.

    One of the most important parts of using corrective exercise is effective communication of the process to be followed and the benefits. 

    The specialist has their responsibility to communicate well with empathy in the initial meeting with the client so that they can create trust and understanding, which will reinforce adherence over time.

    The professional needs to be clear about the benefits of the individuals plan for corrective exercise and they should take time to work on the movements most beneficial for what that person wants. 

    When clients begin their plan for working out with integration of the corrective exercise continuum, there should be constant reminders as to how and why the program helps them to achieve their goals in the safest and most effective manner possible.

    Communicate to the clients that this is achieved through addressing the efficiency of movements addressed and through the proper muscles being recruited at the right time. 

    Types of Assessments

    Client Intake Screen – the client intake screen is the first step in the process of overall assessment.

    The screen collects the valuable subjective information and notes any red flags related to physical readiness, general lifestyle, and medical history.

    The subjective information gives a look at the potential movement impairments that might be shown in the assessment process at a later time. 

    Static Posture Assessments – static postural assessments are those that give us a visual observation of the client’s posture when they are standing in place, not moving at all.

    Proper static posture allows for optimal mobility and joint kinematics, while bad posture shows either a problem structurally or in the musculoskeletal system due to poor recruitment of the system. 

    Movement Assessments – movement assessments are designed for the evaluation of someone’s dynamic posture, which is the reference to structural alignment of the musculoskeletal system when in motion.

    Movements of compensations can be observed in a series of movement assessments like the overhead squat and other transitional and dynamic movement assessments. 

    Mobility Assessments – these assessments are used for finding deficits in joint range of motion and help to refine observations found in the static and the movement assessments used with the client.

    Human movement requires a combo of soft tissue flexibility, range of motion in joints, and control of the neuromuscular system.

    Any restriction in a body segment may alter the patterns of movement and lead to impairments within the kinetic chain. 

    All of these assessments are very important for the process of corrective exercise programming.

    These create a roadmap for the corrective exercise program as a whole. 

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    The CES Assessment Flow

    This is the roadmap that is being made and individualized for each client. The flow starts with the client intake screen.

    It then moves on to the static postural assessment.

    Next is the overhead squat assessment and modified overhead squat assessment.

    The next goes to the single leg squat and the split leg squat assessments.

    We then have dynamic and loaded assessments as optional and they depend on what is found or might be found based on all of the previous steps.

    Next is the mobility assessments.

    And last we have the creation of the program of corrective exercise and the four steps we went over in the last four chapters. 

    Client Intake Screen

    The intake screen is the first step in the assessment process of the client.

    It is also the most important for the client buy in and development of a long term and profitable relationship.

    The session offers many opportunities for the specialist to build rapport with their client. 

    The client intake screen may be turned into a comprehensive questionnaire and be done before the actual visit with the client.

    It can also be a time for the specialist to talk to the client and get these questions done in a one on one setting also.

    It is up to the coach and the client to decide this. 

    Readiness for Activity

    Before anything can be done in the gym, new clients have to be cleared in some form for physical activity.

    The easiest and most popular method for this is through the use of a physical activity readiness questionnaire known as the PARQ+ also.

    It consists of some questions to which you answer yes or no and this decides if there is a need for further look into your readiness for physical activity. 

    General Lifestyle Information

    Asking very basic questions regarding someone’s occupation and the way they live their life is going to give you a significant amount of information to work with.

    The majority of compensations we see that ae not from injuries, will be form their own static posture throughout the day, and you can get a lot of insight into this based on what they do throughout their days.

    Daily movement patterns, or daily nonmovement patterns are very beneficial to look into for help with deciding on the assessments to give. 

    Occupation:

    We need to know things such as extended periods of sitting, repetitive movements, the use of dress shoes, heavy lifting throughout the day, and their amount of occupational stress.

    Lifestyle:

    We need to know things in the realm of mental stress, levels of sleep attained each night, their activities they participate in, and even their fluid intakes. 

    Recreation

    This refers to the amount of time that someone spends doing physical activity outside of their own environment of work.

    By finding this out, the professionals can design a program that better benefits their needs and the things they do for recreation.

    Hobbies

    This refers to the activities that people partake in regularly, but not necessarily of the athletic nature. It provides the same level of insight and assistance to the program as the recreational activities does. 

    Medical History

    Learning the medical history for your clients is crucial for the process of corrective exercise.

    This could reveal important information regarding possible cardiorespiratory problems, or some other thing to look out for.

    Here we will typically ask questions regarding the past injuries of the individual and the surgeries they have had.

    Both are very relevant for corrective exercise. 

    Past injuries and the Kinetic Chain

    Ankle Sprains – these sprains have been shown to decrease our neural control of the gluteus med and glute max muscles.

    Also, the chronic instability of the ankle may lead to alterations in knee flexion and landing.

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    This again leads to poor neuromuscular control and balance, which may result in more injuries of a similar variety later on. 

    Knee Injuries – knee injuries can cause reductions in lumbar mobility, slower time to move, and reductions in proprioception.

    If these are not addressed, there will be limitations in lumbar mobility and this will affect the kinetic chain, since the spine works as a functional unit. 

    Other Injuries – injuries from imbalances of the human movement system will include things such as repetitive hamstring complex strains, groin strains, patellar tendonitis, and headaches. 

    Past Surgeries

    The ones to really note will be surgeries to the foot and ankle, knee, back, shoulder, an appendectomy, and a C section for birth.

    These have effects on performance that should be noted. 

    Goal Setting

    The final step to the objective postural assessments is to set some goals.

    The professional should work well with their client to make sure the goals serve as a foundation for what they will advance on later.

    These goals will help to inform how the process will go. The NASM recommends that we set SMART goals. Smart goals are:

    • S – specific: what does the client want to achieve? Consider the what, where, when, why, who, and how.
    • M – measurable: how will the goal be measured? What are the criteria we will use to find completion status?
    • A – attainable: is the goal achievable by the person? The time and effort need to be considered for the client’s sake.
    • R – realistic: is the goal a relevant one to what they need in their life and is it something that they can reasonably expect to achieve?
    • T – timely: what is the timeframe that they would like to have this goal completed in? 

    Ethical and Legal Considerations

    The corrective exercise specialists need to meet all of the laws and regulations that govern their own profession.

    States do not regulate, so they must follow their certifier.

    The scope of practice and the code of professional conduct should be thoroughly and well understood. 

    Scope of Practice

    This is defined as the procedures and actions that the professionals will be allowed to give in accordance to both national and state laws. 

    Code of Professional Conduct

    This is a set of policies and procedures that are made so the client safety is maximized and there is a set of unified standards for professionalism and organization. 

    Client consent and record keeping is vital for pretty much all parts of the job.

    Everything should be stored well and kept out of just anyone finding it.

    We have to care for our client confidentiality.

    When to Refer Out

    Swelling – swelling of joints or other parts of the body is a sign of internal trauma of some form.

    If you notice that your client has some form of swelling, you should have them cleared by a medical professional before going further. 

    Acute pain – if clients have these sharp types of pains, the client should be advised to visit a medical specialist to have it checked out. 

    When in doubt – it is true that it is always better safe than sorry when it comes to training your clients and being unsure about a problem they have.

    You should understand your limitations and refer to other professionals when you need to. 

    NASM CES Chapter 7: Client Intake and Assessment 2
    NASM CES Chapter 7: Client Intake and Assessment 3
    NASM CES Chapter 7: Client Intake and Assessment 4

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