Therapeutic Exercise Introduction

Therapeutic Exercise Introduction

• 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.

Patient vs. Client

• 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.

Aspects of Physical Function

• 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.

Interrelated Aspects of Physical Function

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

Types of Therapeutic Exercise Interventions

• 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

Exercise Safety

• 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.

Models of Functioning and Disability

• 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.

Comparison of Disablement Models

• 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.

Need for a New Framework

• 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- An Overview of the Model

• 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

• 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).

Common Physical Impairments Managed with Therapeutic Exercise

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

Primary and Secondary Impairments

• 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

• 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

• 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 of Disability

• 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).

Prerequisites for Designing an Exercise Program

• 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.

Steps for Designing an Exercise Program

• 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.