Therapeutic Exercise

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Therapeutic Exercise

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Systematic, planned performance of bodily movements, postures, or physical activities intended to provide a pt/client with the means to...

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The main reasons for Therapeutic Exercises is to...

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Prevent impairments
Prevent health-releated risk factors
Improve, restore, or enhance physical function
Optimize overall health status, fitness, or sense of well-being.

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Are therapeutic exercise programs designed by physical therapist are individualized to the unique needs of each patient or client? True or False

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True

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What is a patient?

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Individual with impairments and functional limitations dx by a PT and receiving PT care to improve funciton and prevent disability.

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What is a client?

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Individual without a dx dysfunction who engages in PT services to promote health and wellness and to prevent dysfunction.

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Balance

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Ability to align body segments against gravity to maintain or move the body (center of mass) within the available base of support without falling; the ablity to move the body in equilibrium with gravity through interaction of the sensory and motor systems.

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Cardipulmonary fitness

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ability to perform low-intensity, repetitive, total body movements over an extended period of time (examples: walking, jogging, cycling, swimming)

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Coordination

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Correct timing and sequencing of muscle firing combined with appropriate intensity if muscular contraction leading to effective initiation, guiding, and grading of movement.

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Flexibility

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Ability to move freely, without restriction; used interchangeably with mobility.

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Mobility

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Ability of structures or segments of the body to move or be moved in order to allow occurrence of ROM for functional activities.

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Muscle performance

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The capacity of muscle to produce tension and do physical work; encompasses strength, power, and muscular endurance.

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Neuromuscular Control

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Interaction of the sensory and motor systems that enables synergists, agonists, and antagonists, as well as stabilizers and neutralizers to anticipate or respond to proprioceptive and kinesthetic information and subsequently, to work in correct sequence to create coordinated movements.

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Postural Control, postural stability, and equilibrium

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Used interchangeably with static or dynamic balance

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Stability

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Ability of the neuromuscular system through synergistic muscle actions to hold a proximal or distal segment in a stationary position or to control a stable base during superimposed movement.

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Joint Stability

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Maintance of proper alignment of bony partners of a joint by means of passive and dynamic component.

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Types of Therapeutic Exercise

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Aerobic conditioning and reconditioning
Muscle performance exercises:strength, power and endurance training
Stretching techniques:muscle-lengthing procedures and joint mobilization techniques
Neuromuscular control, inhibition, and facilitation techniques and posture awareness training
Postural control, body mechanics, and stabilization exercises
Balance exercises and agility training
Relaxation exercises
Breathing exercises
Task-specific functional training

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Disablement process

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Disablement is a term that refers to the impact and functional consequences of acute or chronic conditions; such as a disease, injury, and congenital or developmental abnormalities; on specific body systems that compromise basic human performance and an individual's ability to meet necessary, customary, expected, and desired societal funcitons and roles.

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What are impairments?

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Consequences of pathological conditions; that is, they are the signs and symptoms that relfect abnormalities at the body system, organ, or tissue level.

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How are impairments categorized?

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Arising from anatomical, physiological, or psychological alterations as well as losses or abnormalities of structure or function of a body system.

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PT's generally address impairments that affect?

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Musculoskeletal, neuromuscular, cardiovascular/pulmonary, or integumentary systems

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What are some common impairments managed with Therapeutic exercise?

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Pain, muscle weakness, Limited ROM, joint hypermobility, poor posture, muscle imbalance, impaired balance, abnormal tone, delayed motor development, incoordination, decreased aerobic capacity, impaired circulation, intermittent claudication, skin hypomobility

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What are functional limitations?

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Occur at the level of the whole person. Result of impairments. Characterized by reduced ability of a person to perform actions or cmponents of motor skills in an efficient or typically expected manner.

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Example of a funcitonal limitation

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Decreased ROM of shoulder may lead to inabilty to reach overhead while trying to brush hair

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Common functional limitations

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Reaching, lifting, pushing, turning, throwing, rolling, jumping, kicking, standing, kneeling, running, walking

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What is a disability?

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Inability to perform or participate in activities or tasks related to one's self, the home, work, recreation, or the community in a manner or to the extent that the individual or community as a whole perceive as normal.

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What are some common impairments managed with Therapeutic exercise?

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Pain, muscle weakness, Limited ROM, joint hypermobility, poor posture, muscle imbalance, impaired balance, abnormal tone, delayed motor development, incoordination, decreased aerobic capacity, impaired circulation, intermittent claudication, skin hypomobility

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Primary prevention

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Activities such as healh promotion designed to prevent in at-risk populations

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Secondary prevention

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Early diagnosis and reduction of the severity or duration of existing disease and any resulting abnormality

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Tertiary prevention

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Use of rehabilitation to reduce the degree or limit the progression of existing disability and improve multiple aspects of function in persons with chronic, irreversible disease.

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Risk Factors

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Influences or characteristics that predispose a person to the process of disablement. Biological, behavioral, physical environment, socioeconomic

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Ways to foster adherence to an exercise program?

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Explain the importance and rationale of each exercise/functional activity. Tell pt how specific exercises are designed to meet specific goals. Allow input from pt. Keep the program as brief as possible. Identify functional ways to incorporate exercises into everyday tasks. Point out progress that pt has made.

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What is motor learning?

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A complex set of internal processes that involves acquisition and retention of a skilled movement or task through practice.

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Performance

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Involves acquisition of a skill

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learning

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Involves acquisition and retention

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Discrete Task and an example?

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Involves a movement with a recognizable beginning and end.
Ex. grasping an object, doing a push up, locking a wheelchair

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Serial Task and an example?

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Composed of a series of discrete movements that are combined in a particular sequence
Ex. eating with a fork

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Continous Task and an example?

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Involves repetitive, uninterrupted movements that have no distinct beginning and ending.
Ex. walking, cycling

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What are the stages of motor learning?

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Cognitive
Associative
Autonomous

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Cognitive Stage

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Must learn what to do,how, purpose, goals

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Associative stage

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Focus on making the most consistent and efficient movemnets "fine tuning"

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Autonomous stage

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Movements are automatic

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Biological risk factors

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age, sex, race, height, family history of disease

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Behavioral/Psychologica/Life style risk factors

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Sedentary lifestyle, poor nutrition, inadequate coping skills

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Physical environmnet risk factors

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community, homoe, work, school

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Socioeconomic risk factors

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Low income, education

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Questions to help establish pt. centered goals and outocmes?

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What activities are most important to you?
What activities do you currently need help with that you would like to be able to do independently?
What are your goals for coming to PT?
What would you like to be able to accomplish through therapy?
How soon do you want to reach your goals?
of the problems you are having, which ones would you like to try to eliminate first?

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Effective exercise instructions

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Select a nondistracting environment
Demonstrate proper performance, then have pt repeat
Use clear, concise verbal and written directions
Use illustrations on home program
Provide specific feedback
Teach program in small increments to allow time to learn over several visits