Therapeutic Exercise Introduction

Study Notes

Therapeutic exercise involves planned bodily movements, postures, or physical activities.
The goal is to help patients/clients prevent impairments, improve physical function, and prevent health risks.
The aim is also to optimize overall health, fitness, and well-being.

A patient has diagnosed impairments and functional deficits and receives physical therapy to improve function and prevent disability.
A client doesn't have diagnosed dysfunction and engages in physical therapy to promote health and prevent dysfunction.

Balance: The ability to align body segments against gravity to maintain or move the body while on a base of support.
Cardiopulmonary Fitness: The ability to perform moderate-intensity repetitive total-body movements (like walking, jogging, cycling) over an extended period.
Coordination: Correct timing and sequencing of muscle firing, leading to smooth, accurate and efficient movement.
Flexibility/Mobility: The ability of body structures to move freely. Passive mobility relies on soft tissue extensibility. Active mobility needs neuromuscular activation.
Muscle Performance: Muscle capacity to create tension and do physical work (strength, power, endurance).
Neuromuscular Control: The sensory and motor systems enabling synergists, agonists, and antagonists to respond to proprioceptive and kinesthetic information to create coordinated movement.
Stability: The ability of the neuromuscular system to hold body segments stationary or control a base during movement.

A diagram shows how balance, posture, muscle performance, cardiopulmonary endurance, mobility/flexibility, neuromuscular control/coordination are interconnected aspects of overall physical function.

Aerobic conditioning and reconditioning
Muscle performance exercises (strength, power, endurance training)
Stretching techniques
Neuromuscular control, inhibition and facilitation techniques with posture awareness training
Postural control, body mechanics and stabilization exercises
Balance exercises and agility training

It is crucial to explore patient health history and current health status.
The environment for exercises affects safety.
Proper space, support surfaces are essential for safety.
Correct posture, movement patterns, intensity, speed, and duration are vital.
Patients must be educated about fatigue signs and their relationship with injury risk.

Early models focused on relationships among health, functioning and disability, like the Nagi and ICIDH models.
WHO's ICIDH model was later revised to the ICF (International Classification of Functioning, Disability and Health).
The ICF is a bio-psycho-social model, encompassing diverse aspects of human functioning and disability.
Key components identified in various models include acute/chronic pathology, impairments, functional limitations, and disabilities/handicaps/societal limitations.

Differences in terminology (active pathology vs. disease, impairments, etc) between Nagi and ICIDH models across different levels (tissue/cellular, organ/system, personal, societal) are outlined in table format.

Early models faced criticisms, focusing on disease rather than overall functioning and wellness plus lack of attention on the person with a disability.
WHO developed the ICF, a companion model to the ICD, to address these limitations to support worldwide disease classification and coding.

The ICF model is a bio-psycho-social model, combining aspects of human functioning and disability.
The model categorizes functioning and disability with contextual factors.
Functioning depends on the integrity of body functions or structures and ability to participate in life's activities.
Disability is due to impairments, activity limitations, and participation restrictions.

Impairments result from pathologies, signs and symptoms showing abnormalities in body systems.
The ICF model categorizes impairments across various body systems (musculoskeletal, neuromuscular, cardiovascular/pulmonary, integumentary).

The text details common musculoskeletal, neuromuscular, cardiovascular/pulmonary and integumentary impairments amenable to therapeutic exercise interventions.

Primary impairments directly result from the underlying condition.
Secondary impairments are consequences of preexisting conditions.
Examples illustrated (e.g., impingement syndrome, demonstrating both primary and secondary impairments).

Composite impairments arise from multiple underlying causes, a combination of primary or secondary impairments.
Illustrated case example (ankle inversion sprain causing a composite impairment).

Disability in the ICF model is the inability to perform activities related to oneself, home, work, or community in a societal setting (family, friends).

Prevention categories include primary prevention (disease prevention in at-risk populations), secondary prevention (early diagnosis & treatment to limit existing diseases), and tertiary prevention (rehabilitation to reduce progression of chronic, irreversible conditions).

Therapists need knowledge of anatomy, physiology, kinesiology, pathology, and testing procedures to apply to each patient’s condition.
The design must account for how different exercises affect the body system and be individualized.

Initial comprehensive examination of the patient.
Determining patient's problems, functional disabilities.
Defining aims and objectives of the program.
Selecting suitable exercises.
Re-evaluating and modifying the program as needed to achieve optimum improvement.