Pt709 - Therex - General Concepts

Front 1

What is Therapeutic Exercise?
(definition)

Back 1

Systematic & planned performance of:
a. bodily movements
b. postures
c. physical activities

Front 2

Intent of Therex?

Back 2

Provide patients/clients with means to:
a. remediate/prevent impairement
b. improve, restore, enhance physical function
c. prevent/reduce healt-related risk factors
d. optimize overall health status, fitness, sense of well-being

Front 3

What is a "Patient" (vs Client)

Back 3

with impairments and functional limitations DIAGNOSED by a PT and is receiving PT care to improve function and prevent disability

Front 4

What is a "Client" (vs Patient)

Back 4

no diagnosed dysfunction, engages in PT services to:
-promote health and wellness
-to prevent dysfunction

Front 5

Aspects/Components of Physical Function:

Back 5

1. Balance
2. Cardiopulmonary fitness / endurance
3. Coordination
4. Flexibility / Mobility
5. Muscle Performance
6. Neuromuscular control
7. Postural control/stability/equiliibrium
8. Stability

Front 6

Balance
(define)

Back 6

ability to align body segments against gravity to maintain or move body within available base of support without falling

Front 7

Balance requires input/output from what systems?

Back 7

sensory and motor systems

Front 8

Coordination
(define)

Back 8

correct timing and sequencing of mm firing along with appropriate intensity of mm contraction leading to effective initiation, guiding, and grading of movement

Front 9

Flexibility / Mobility
(define)

Back 9

Flexibility: ability to move freely w/o restriction

Mobility: ability to structures and segments of body to move and be moved to allow for ROM in functional activities.

Front 10

2 types of Mobility are...

Back 10

Passive: dependent on soft tissue extensibility (contractile and non-contractile)

Active: requires neuromuscular activation

Front 11

Extensibility (of soft tissue)
(define)

Back 11

ability of soft tissue to return to its original length after a stretch has been released

Front 12

Muscle Performance
(define)

Back 12

the ability to produce tension and do physical work

Front 13

3 Factors of Muscle Performance

Back 13

1. Strength:
2. Power
3. Muscle Endurance

Front 14

Neuromuscular Control
(define)

Back 14

Interaction of sensory and motor systems to correctly sequence coordinated movement.

Must respond to proprioceptive/kinesthetic info

Front 15

Postural control, postural stability & equilibrium

Back 15

used interchangeably with static or dynamic balance

Front 16

Stability
(define)

Back 16

ability of the neuromuscular system to hold a proximal or distal body segment in a stationary position or to control a stable base during superimposed movement

Front 17

Agonist

Back 17

muscles that act as prime movers

Front 18

Antagonists

Back 18

muscles that act in direct opposition to prime movers

Front 19

Synergist

Back 19

muscles that assist prime movers during functional movement patterns

fatigue easily

Front 20

Therapeutic Exercise Interventions

Back 20

Wide variety of techniques
Chosen based on patient’s impairments, limitations and/or disability

Front 21

Safety Factors:
(as pertains to patient)

Back 21

-Medications: 3+ = risk of falling
-Patient unaccustomed to physical exertion: take vitals
-Environment: Adequate space and proper surfaces
-Accuracy with which exercise is performed
-co-morbidities

Front 22

Safety Factors:
(as pertains to PTs)

Back 22

proper body mechanics
proper safety attire (gloves, masks)

Front 23

Disablement Models (generic definition)

Back 23

Relationship between a person’s health status and function... includes interrelationships between:
-Pathology
-Impairments
-Functional limitations
-Disabilities, handicaps, societal limitations

Front 24

Early models of Disablement include:

Back 24

Nagi and International Classification of impairments, disabilities and handicaps (ICIDH)

Front 25

New Framework for Disablement model:

Back 25

International Classification of Functioning, Disability and Health (ICF)

- activity at the center; less emphasis on disease, more emphasis on function
-everything relates to activity

Front 26

Three major categories of Impairments

Back 26

Anatomic
Psychological
Physiological

Front 27

Anatomic Impairments
(define or explain)

Back 27

-an abnormality or loss of structure
-CANNOT be remedied with PT
-Modifications can be made to function in light of anatomic impairments

ex: hip anteversion, structural genu verum, loss of limb

Front 28

Psychological Impairments
(define or explain)

Back 28

-CANNOT be remedied with PT
-can offer a listening ear, or advise to see other professionals

Front 29

Physiological Impairments
(define or explain)

Back 29

-an alteration in any physiologic function
-PTs can impact this most

ex: reduced Force production, reduced endurance, reduced mobility, pain, altered movement patterns,etc.

Front 30

Types of Physical Impairments (ICF breakdown)
(list)

Back 30

Musculoskeletal
Neuromuscular
Cardiovascular
Integumentary

Front 31

Musculoskeletal
Physical Impairment (ICF breakdown)

Back 31

pain, mm weakness, decreased mm endurance, limited ROM, joint hypermobility, faulty posture, mm length/strength imbalances

Front 32

Neuromuscular
Physical Impairment (ICF breakdown)

Back 32

pain, impaired balance or postural stability, incoordination, delayed motor development, abnormal tone (flaccid or too much tone in mm), ineffective/inefficient functional movement strategies

Front 33

Cardiovascular
Physical Impairment (ICF breakdown)

Back 33

decreased aerobic capacity, impaired circulation, pain with sustained activity (intermittent claudication; ex: riding a bike with impaired circulation)

Front 34

Integumentary
Physical Impairment (ICF breakdown)

Back 34

skin hypomobility (immobile from scar tissue)

Front 35

Primary/Direct Impairments

Back 35

results from active pathology or disease

ex: shoulder impingment: result in pain decrease ROM

Primary may lead to Secondary Impairments

Front 36

Secondary Impairments

Back 36

-comes from the primary impairment, or pathology-

-can't just treat symptoms, have to look for cause

ex: shoulder impingment: postural asymmetry because of altered use of upper extremity

Front 37

Composite Impairments

Back 37

combination of primary/secondary

ex: cast for ankle break, causes issues with balance, weakness, asymmetry, etc..

Front 38

Functional/Activity limitations
(component of the disablement model)

Back 38

-Person has difficulty or cannot perform tasks of daily living
-Refers to the person
-Goal of therapy to remediate

ex: feeding, dressing, making meals, going to store

Front 39

Participation Restriction/Disability
(explain)

Back 39

any restriction or inability to perform socially defined roles and tasks expected of an individual within a socialcultural and physical environment

Front 40

3 Categories of Disability Prevention

Back 40

Primary
Secondary
Tertiary

Therex works on all 3 areas of prevention

Front 41

Primary Disability Prevention

Back 41

activities like health promotion
to prevent disease in at-risk population

Front 42

Secondary Disability Prevention

Back 42

early diagnosis and reduction of severity/duration of existing disease

Front 43

Tertiary Disability Prevention

Back 43

use of rehab to reduce/limit progression
improving chronic or irreversible conditions

Front 44

Risk Factors to Disablement Models

Back 44

Exist before the onset of a health condition
-Biological
-Lifestyle
-Physical environment
-Socioeconomic

Front 45

Clinical Decision Making
(define)

Back 45

Process of reasoning and critical thinking that involves making judgments and determinations in the context of patient care

Front 46

Clinical Prediction Rules (CPR)

Back 46

treatment based on probabilities

Front 47

Evidence Based Practice
(define)

Back 47

Use of current best evidence in making decisions about the care of an individual patient

Front 48

6 steps of Evidence Based Practice

Back 48

-Identify problem
-Search literature
-Analyze evidence
-Integrate evidence with expertise
-Incorporate with patient management
-Assess outcomes

Front 49

Patient Management Model
(list 5 components)

Back 49

1. examination
2. evaluation
3. diagnosis
4. prognosis
5. interventions

Front 50

Examination (pertaining to Patient Management Model)
(list 3 components)

Back 50

-History
(current/past info, subjective/objective)
-Systems Review
(vitals)
-Tests & Measures
(Functional outcome measures)

Front 51

Evaluation (pertaining to Patient Management Model)
(define)

Back 51

Interpretation of collected and relevant data
Fundamental to making a proper diagnosis of dysfunction and prognosis of functional outcomes
May also suggest additional testing is needed
PT or another practitioner

Front 52

Diagnosis Process
(define)

Back 52

Sequence of actions and decisions
-Leads to formation of diagnostic hypothesis
-Classifies dysfunction

2 Categories

Front 53

2 Categories of Diagnosis
(define)

Back 53

1. Process: data collection through examination
-organization of data to reach an impairment based diagnosis
2. Category: a grouping that identifies and describes patterns or clusters of physical findings
-pt’s may have differnet pathologies, but share similar impairments in the same categories

Front 54

Diagnostic Category
(define)

Back 54

Identifies patterns or clusters of physical findings
Describes impact of a condition at the system level
Preferred practice patterns

Front 55

Cluster

Back 55

a set of observations or data that frequently occur as a group for a single patient

Front 56

Syndrome

Back 56

an aggregate of signs and symptoms that characterize a given disease or condition

Front 57

Prognosis

Back 57

Prediction of patient’s optimal level of function
-As result of treatment plan

Anticipated length of time needed
-2x week for 6 weeks

Plan of Care
-Integral component of prognosis

Front 58

Goal Setting
(define and key points)

Back 58

Collaboration and negotiation between patient and therapist

Make goals patient centered
-Helps the patient be an active participant in the rehab process

Make them functional

Front 59

Interventions
(define)

Back 59

Any purposeful interaction a PT has that directly relates to a patient’s care

Front 60

Interventions
(list 3 categories)

Back 60

-coordination, communication, and documentation
-procedural interventions
-patient-related instructions

Front 61

Patient Related Instruction

Back 61

As physical therapists we:
-Educate
-Facilitate change
-Motivate

Spans 3 domains of learning
-Cognitive
-Affective
-Psychomotor

Front 62

Outcomes

Back 62

A way to measure quality, efficacy and cost-effectiveness of services

tools: oswestry, NDI, ROM, Muscle performance

Front 63

Effective Exercise Instruction

Back 63

Positive relationship with patient

Know patient’s learning style

Identify patient’s attitudes toward exercise

Less complicated exercises first?

Front 64

Concepts of Motor Learning

Back 64

Integration of motor learning principles

Internal processes for skilled movement or task through practice
-Relatively permanent retention

Modifies way sensory information is central nervous system is processed
-Cannot be directly observed

Front 65

Types of Motor Tasks
(3 types)

Back 65

Discrete task
-Any activity with discreet beginning, end

Serial task
-Series of discreet movement done in a particular sequence (eating with fork, brushing teeth)

Continuous task
-Repetivitive movements (walking riding bike, stairs)

Front 66

Conditions & Progression of Motor Tasks
(4 task dimension)

Back 66

1) environment in which the task is performed.
What are you trying ith person to make more challenging, incorporate tasks
2) The inter-trial variability of the environment that is imposed on the task.
3) Need for the patient’s body to remain stationary or move during the task.
4) Presence or absence of manipulating of objects during the task

Front 67

environment conditions of motor learning
(chart)

Back 67

Top left, is simple, bottom

Closed environment: objects, surface around patient don’t move, no rolling chairs

Open environment: object, support surface, other people, can all be in motion (moving bus, crowded stairways)

Inter trial variability: absent or none (nothing is changing); like walking on a single surface, no change

Some inter trial variability: similar task but changing the environment

Body stable: simple task (maintain posture)

Body transport: rolling over in bed, or any type of transfer (table to chair, sit-stand, walking/jumping)
Manipulation of objects: ( walking with free hands, vs cup of coffee; or walking on crowded sidewalk)

Front 68

Stages of Motor Learning
(3 stages)

Back 68

Cognitive
-Patient or you, have to think about each component of taks (seq to complete task)

Associative
-Less mistakes, can fine tune task, patient req less feedback and may be able to make corrections before they occur

Autonomous
-Final stage: movements are automatic, don’t need to pay attention, can maybe do simult other tasks
-Propably won’t see patients in this stage, cuz they are likely discharged

Front 69

Variables That Influence Motor Learning

Back 69

Understanding
-Interest in task
-The more you explain, and meaningful, then more likely learning and compliance will occur

Attention
-Outcomes versus details
-How they focus on it; a person that knows the outcome, they will learn better (why they need to do the exercise)

Demonstration
-Showing what is expected, pre-practice (verbal instructions)

Front 70

Practice

Back 70

Most important variable to learning a motor skill

Skill acquisition and retention affected by:
-Amount
-Type
-Variability

Part versus whole practice
-Part: effective in early stage of motor development (practice most difficult stages first)
-Whole: better for continuous / serial tasks

Front 71

Practice Order (for motor skills)

Back 71

blocked
-best during cognitive, sit-stand reps, repeat/predictable

random
-change task slightly, sit-stand from differing heights

random-blocked
-task done more than once, random parts

Front 72

Feedback (source, focus, timing)

Back 72

source:
intrinsic (internal)
extrinsic (external; PTs feedback)

focuse of feedback:
-knowledge of performance: about quality of activity
-knowledge of results: how this will help them

Timing/Freq:
-concurrent (tactile, verbal)
-immediate post-response (after each trial)
-delayed/summary:

Front 73

Frequency of Feedback

Back 73

extrinsic: less is better

constant: (concurrent) during or after each rep

variable/intermittent: promotes retention of skill vs constant

summary: recap, most effective at ASSOCIATIVE stage of learning

Front 74

Adherence to Exercise

Back 74

Designing a program a patient will follow
-ex. exercise length/duration

Patient related factors:
-tailer to patient, gender sometimes plays a role

Impairment related factors:
-acute (short time) vs chronic (do forever)

Program related factors
-appeal to interest of patient, need equipment?...

Front 75

Considerations in Exercise Prescription

Back 75

Stage of healing
Tissue irritability and symptom stability
Patient’s time and willingness to participate
Time between PT visits