# PWR-039 — Capability preservation during unloading: learner worksheet Release: Revision 7T · Full Tutorial Edition Estimated time: Estimated 11 min reading; practical time is provider-set Difficulty: Intermediate Equipment: Basic stationery or digital tools — Firm bed or plinth and provider-approved knee support/towel; Brace/cast and positioning aids kept as prescribed; Visible or tactile quadriceps cue and hold timer; Pre-unloading baseline and daily symptom/function record; An unloading-preservation sheet for current orders, limb position, hold force and time, repetitions, heel validity, breathing, symptoms and separate muscle, fitness and functional baselines. Space: Room-scale practice space Automated structural checklist: 10 of 10 structural checks present Evidence quality/context: G4; Focused research depth Automated method-quality band: Comprehensive Method-rating basis: Structure coverage, instruction/check specificity, alternative distinctness, source troubleshooting, comparison depth and whether purpose/check fields are authored rather than derived. Editorial review: Pending manual editorial sign off ## Before you begin - [ ] I read the tutorial authority and stop conditions. - [ ] I have the required equipment/space or a declared accessible alternative. ## Canonical source context Capability preservation during unloading means limiting loss during bed rest, immobilisation, reduced weight-bearing or another named unloading state. This lesson teaches one provider-prescribed component: a supine quadriceps isometric set. The learner aligns the leg, gently presses the knee toward the support by tightening the front thigh, keeps the heel down, breathes through the timed hold and fully releases. The clinical team controls whether movement is allowed, force, hold time, repetitions, frequency and the wider countermeasure plan. Target outcome: The learner completes the prescribed quadriceps-set sequence without moving a restricted joint or holding the breath, and records valid holds, symptoms and a separate baseline function. ### Authority and setup conditions - Confirm the diagnosis/reason for unloading and every movement, brace and weight-bearing restriction. - Ask the treating team exactly where support goes and how hard/long to contract. - Report new calf swelling/pain, chest symptoms, skin problems, numbness, fever, wound changes or sudden weakness. - Read the current restriction sheet aloud and position the leg exactly as written. Ask the supervising clinician to confirm the brace, wound, weight-bearing and joint-position limits before the first contraction. - Use a gentle provider-observed contraction to locate the front thigh while keeping heel, hip and breathing quiet before timed holds. ### Required or supplied materials - Firm bed or plinth and provider-approved knee support/towel - Brace/cast and positioning aids kept as prescribed - Visible or tactile quadriceps cue and hold timer - Pre-unloading baseline and daily symptom/function record - An unloading-preservation sheet for current orders, limb position, hold force and time, repetitions, heel validity, breathing, symptoms and separate muscle, fitness and functional baselines. ## 1. Protect restrictions Lie in the prescribed position with brace/cast/support unchanged and the leg aligned; do not straighten or bend beyond permission. Why: Preservation work must not violate tissue protection. Success check: Position matches the clinical plan; the visible 'Protect restrictions' check is satisfied. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Position matches the clinical plan; the visible 'Protect restrictions' check is satisfied.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 2. Find the front-thigh contraction At minimal effort, tighten the front thigh so the kneecap area draws upward and the back of the knee presses gently toward support. Why: The learner must distinguish muscle tension from whole-leg movement. Success check: The provider sees/touches the quadriceps contract without joint motion. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The provider sees/touches the quadriceps contract without joint motion.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 3. Keep heel and hip quiet Leave the heel on the support and avoid lifting the leg, squeezing the buttock hard or turning the hip. Why: Substitution can move a restricted joint or hide weak activation. Success check: Only the intended thigh contraction is observed. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Only the intended thigh contraction is observed.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 4. Hold and breathe Maintain the provider-set contraction for the timed hold while breathing normally and keeping face/shoulders relaxed. Why: Breath-holding adds strain and changes the task. Success check: The hold lasts the prescribed time with visible breathing. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The hold lasts the prescribed time with visible breathing.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 5. Release fully Let the thigh soften completely for the prescribed rest; confirm skin, pain and sensation are unchanged. Why: Full release controls duty cycle and reveals symptoms. Success check: The muscle returns to baseline before the next cue. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The muscle returns to baseline before the next cue.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 6. Repeat only valid holds Count only holds with correct muscle, no forbidden movement, full duration and normal breathing; stop at first repeated substitution or symptom. Why: Invalid volume does not preserve the target capability. Success check: The record distinguishes valid and attempted holds. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The record distinguishes valid and attempted holds.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 7. Measure preservation against baseline Track valid activation/force as available and the team's meaningful function, strength or muscle measure relative to pre-unloading baseline. Why: One exercise completion does not prove preservation. Success check: The record shows change from baseline and the support/restriction state. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The record shows change from baseline and the support/restriction state.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## Reflection What changed? ________________________________________________________________________________ What remains difficult? ________________________________________________________________________________ What will I repeat, adapt, ask for help with, or stop? ________________________________________________________________________________ --- Completion of this worksheet demonstrates tutorial participation only. It does not establish capability, qualification, safety clearance, diagnosis, treatment or independent validation.