Therapeutic Exercise: Foundational Concepts PDF

Chapter 1: Therapeutic Exercise: Foundational Concepts Copyright ©2023 F.A. Davis Company Physical Therapists Teach patients how to prevent or manage their condition to achieve long-term health benefits. Examine each individual and develop a plan, using t...

Chapter 1: Therapeutic Exercise: Foundational Concepts Copyright ©2023 F.A. Davis Company Physical Therapists Teach patients how to prevent or manage their condition to achieve long-term health benefits. Examine each individual and develop a plan, using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. Copyright ©2023 F.A. Davis Company Therapeutic Recreation Therapists Provide treatment service designed to restore, remediate, and rehabilitate a person’s level of functioning and independence in life activities, to promote health and wellness as well as reduce or eliminate the activity limitations to participation in life situations caused by an illness or disabling condition. Focus on play and leisure as a means for therapy and can even be grouped into community recreation instead of health care. Copyright ©2023 F.A. Davis Company Occupational Therapist Help people of all ages participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Helps people function in all of their environments (e.g., home, work, school, community) also knowns as activities of daily living (ADLs) and addresses the physical, psychological, and cognitive aspects of their well-being through engagement in occupation. Copyright ©2023 F.A. Davis Company Athletic Trainers Prevention Clinical Evaluation and Diagnosis Immediate and Emergency Care Treatment and Rehabilitation Organization and Professional Health and Well-Being Copyright ©2023 F.A. Davis Company Personal Trainers Possess the knowledge, skills and abilities necessary to design safe and effective fitness programs. They instruct and assist people in reaching personal health and fitness goals. NSCA, NASM, ACSM, CSCC, and NCSA are reputable and give validity to certification Copyright ©2023 F.A. Davis Company Therapeutic Exercise The human movement system became the focus for achieving universal identification of the physical therapy profession. The vision statement is compelling and clearly speaks to human movement and the role of physical therapy. The human movement system should be the core focus of all therapeutic exercise programs, education, and research. Copyright ©2023 F.A. Davis Company Human Movement System Copyright ©2023 F.A. Davis Company Impact of Physical Function Multidimensional aspects of physical function encompass the diverse yet interrelated areas of movement performance. Copyright ©2023 F.A. Davis Company  Balance  The ability to align body segments against gravity to maintain or move the body within the available base of support without falling; the ability to move the body in equilibrium with gravity via interaction of the sensory and motor systems. Postural Control – ability to align body segments against gravity to maintain (Static Balance) Postural Stability – move the body w/in the available base of support w/out falling (Dynamic Balance) Equilibrium – ability to move the body in conjunction w/ gravity via interaction of the sensory and motor systems. Copyright ©2023 F.A. Davis Company  Cardiopulmonary Endurance  The ability to perform moderate-intensity, repetitive, total body movements over an extended period of time.  A synonymous term is cardiopulmonary fitness.  Examples include walking, jogging, cycling, swimming, etc. Copyright ©2023 F.A. Davis Company  Coordination and Neuromuscular Control  Coordination  Neuromuscular Control The correct timing and Interaction of the sensory sequencing of muscle firing and motor systems that combined with the appropriate enables synergists, intensity of muscular contraction agonists, and leading to the effective initiation, guiding, and grading of antagonists, as well as movement. Coordination is the stabilizers and basis of smooth, accurate, neutralizers, to anticipate efficient movement and occurs or respond to at a conscious or automatic proprioceptive and level. kinesthetic information and, subsequently, to work in correct sequence and magnitude to create coordinated movement. Copyright ©2023 F.A. Davis Company  Flexibility and Mobility  Flexibility The ability to move freely, without restriction; used interchangeably with mobility.  Mobility The ability of structures or segments of the body to move or be moved in order to achieve the range of motion (ROM) needed for functional activities (functional ROM). Passive mobility is dependent on soft tissue (contractile and noncontractile) extensibility; in addition, active mobility requires neuromuscular activation. Copyright ©2023 F.A. Davis Company  Muscle Performance  The capacity of muscle to produce tension and do physical work.  Muscle performance encompasses: Strength Power Muscular Endurance Copyright ©2023 F.A. Davis Company  Stability  The ability of the neuromuscular system through synergistic muscle actions to hold a proximal or distal body segment in a stationary position or to control a stable base during superimposed movement.  Joint stability is the maintenance of proper alignment of bony partners of a joint by means of passive and dynamic components. Copyright ©2023 F.A. Davis Company Impact on Physical Function Systematic, planned performance of physical movements, postures, or activities intended to provide a patient with the means to: Remediate or prevent impairments of body functions and structures. Improve, restore, or enhance activities and participation. Prevent or reduce health-related risk factors. Optimize overall health, fitness, or sense of well-being. Programs are to be individualized to the unique needs of each patient while using critical thinking, assessment of movement patterns, and knowledge of how to apply forces at appropriate tolerance levels that will optimize movement of the patient. Copyright ©2023 F.A. Davis Company Impact on Physical Function Types of therapeutic exercise interventions Risk or cause of impairments in body function or structure, activity limitations, or participation restrictions as identified in the patient exam. Wide variety of activities, movements, and techniques Posture Awareness Relaxation Exercises Breathing and Ventilatory Muscle Training Exercises Copyright ©2023 F.A. Davis Company Safety Patient Safety Health history and current health status Medical Clearance needed? Medications Balance and coordination Environment Space and support surfaces Performance of exercises Proper posture and execution Fatigue Risk of injury or re-injury minimized Therapist Safety Copyright ©2023 F.A. Davis Company Health Status, Functioning, and Disability Knowledge of the health status, function, and/or disability provides the foundation for effective health-care services. Dependent upon: access to quality care severity and duration of the condition motivation and attitude of the patient support from family and society Copyright ©2023 F.A. Davis Company International Classification of Functioning (ICF) ICF provides a classification system intended to define both functioning and disability as interactive situations in which individuals respond to health conditions and to the environmental and personal factors that influence how people live and participate in society. World Health Organization (WHO) has a companion classification system. International Classification of Disease (ICD) Classify health conditions (diseases, disorders, and injuries) Copyright ©2023 F.A. Davis Company International Classification of Functioning (ICF) Copyright ©2023 F.A. Davis Company International Classification of Functioning (ICF) Explanation of Using ICF to meet individual needs https://www.youtube.com/watch?v=uoEIc4 wBaIo Explanation of Body Structure and Function https://www.youtube.com/watch?v=O2pRq r-THMs Copyright ©2023 F.A. Davis Company International Classification of Functioning (ICF) Impairments in body function: Problems associated with the physiology of the body systems (including psychological functions). Impairments in body structure: Problems with the anatomical features of the body. Activity limitations: Difficulties an individual may have in executing actions, tasks, and activities. Participation restrictions: Problems an individual may experience with involvement in life situations, including difficulties participating in self- care; responsibilities in the home, workplace, or the community; and recreational, leisure, and social activities. Copyright ©2023 F.A. Davis Company International Classification of Functioning (ICF) Primary impairments: Directly arise from the health condition itself. Secondary impairments: May be the result of pre-existing conditions Example: Tendonitis of the shoulder from throwing causing pain and loss of ROM (primary) but caused from postural impairments which lead to faulty mechanics Copyright ©2023 F.A. Davis Company International Classification of Functioning (ICF) Contextual factors: The entire background of an individual’s life and living situation, composed of: Environmental factors: Factors associated with the physical, social, and attitudinal environment in which people conduct their lives; factors may facilitate functioning (facilitators) or hinder functioning and contribute to disability (barriers). Personal factors: Features of the individual that are not part of the health condition or health state; includes age, gender, race, lifestyle habits, coping skills, character, affect, cultural and social background, education, etc. Copyright ©2023 F.A. Davis Company International Classification of Functioning (ICF) Example of ICF at work http://www.abpts.org/uploadedFiles/ABPT Sorg/MOSC/Requirement_3/ABPTS_Samp eICFChart.pdf Copyright ©2023 F.A. Davis Company Principles of Comprehensive Patient Management Coordination, communication, and documentation are required of the therapist throughout the entire episode of patient management. This role encompasses many patient-related administrative tasks and professional responsibilities: Writing reports (evaluations, plans of care, and discharge summaries); Designing home exercise programs; Communicating with third-party payors, other health-care practitioners, or community-based resources; and participating in care team conferences. Copyright ©2023 F.A. Davis Company Clinical Decision-Making Involves making judgments and determinations in the context of patient care Selection, implementation, and modification of therapeutic exercise interventions based needs. Coordination, communication, and documentation are required of the therapist throughout the entire episode of patient management. Clinical Prediction Rules Contain predictive factors based on the results of the history, physical examination, and tests performed that help a clinician determine a specific diagnosis or identify subgroupings of patients within large, heterogeneous groups who are most likely to benefit from a particular approach to treatment or specific therapeutic interventions Copyright ©2023 F.A. Davis Company Evidence-Based Practice Evidence from well-designed research studies with the expertise of the clinician and the values, goals, and circumstances of the patient. Steps: 1. Identify problem or patient 2. Research literature and collect relevant studies that contain evidence that is related Treatments, interventions, delivery 3. Critically analyze evidence found and make reflective judgements. Comparing research (no intervention/intervention/alternative intervention) 4. Incorporate findings and decisions and assess the outcomes Outcomes your interested in (reduction of pain, improved quality of life, etc.) Copyright ©2023 F.A. Davis Company Evidence-Based Practice PICO Format PATIENT OR PROBLEM What are the most important characteristics of the patient? INTERVENTION, EXPOSURE, PROGNOSTIC FACTOR What main intervention are you considering? What do you want to do with this patient? COMPARISON What is the main alternative being considered, if any? OUTCOME What are you trying to accomplish, measure, improve or affect? Copyright ©2023 F.A. Davis Company Principles of Comprehensive Patient Management A patient management model Examination Health history with review of systems Systems review Specific tests and measures Evaluation Diagnosis Diagnostic process Diagnostic category Classification systems Copyright ©2023 F.A. Davis Company Principles of Comprehensive Patient Management Prognosis and plan of care Plan of care Setting goals and outcomes in the plan of care Intervention Purposeful interaction of the therapist Patient/client instruction (education) Outcomes Functional outcomes Measuring outcomes Impact of intervention on patient-related functional outcomes Patient satisfaction Discharge planning Copyright ©2023 F.A. Davis Company Principles of Comprehensive Patient Management Copyright ©2023 F.A. Davis Company Strategies for Effective Exercise Intervention and Patient Instruction Exercise prescription and progression Determining specific goals; Selecting and advancing interventions; and Initial exercise prescription Load constitutes the many variables that can be manipulated to create a therapeutic environment, such as exercise mode, intensity, volume, frequency, and duration. Tolerance refers to the ability of the patient to successfully manage a given input or load based on their current level of abilities, impairments, and overall health. Physical Stress Theory (PST) is the amount and type of physical stresses applied to specific tissues will result in predictable changes to that tissue. Progression of exercise Crawl – Walk - Run Patient instruction Copyright ©2023 F.A. Davis Company Strategies for Effective Exercise Preparation for exercise instruction Does the patient believe exercise will lessen symptoms or improve function? Is the patient concerned that exercising will be uncomfortable? Is the patient accustomed to engaging in regular exercise? Adherence to exercise Factors that influence adherence to an exercise program Health Literacy: Capacity to obtain, process, and understand basic health information and services Patient-related factors Factors related to the health condition or impairments Program-related variables Copyright ©2023 F.A. Davis Company Strategies for Effective Exercise Strategies to Foster Adherence (Box 1.18, pg 27) Challenging when a patient is unaccustomed to regular exercise or when as exercise program must be carried out of an extended period of time. Positive outcomes from treatment are contingent not so much on designing a program for a patient, but rather on designing a program that a patient or family will actually follow. Should expect that most patients will not dutifully adhere to any treatment program, particularly if regular exercise has not been a part of the patient’s life prior to the occurrence of disease or injury. Copyright ©2023 F.A. Davis Company Strategies for Effective Exercise Concepts of motor learning A complex set of internal processes that involves the acquisition and relatively permanent retention of a skilled movement or task through practice. Conditions and progression of motor tasks Motor Performance – acquisition of the ability to carry out a skill Motor learning is not directly observable, it must be measured by observation and analysis of how an individual performs a skill. Copyright ©2023 F.A. Davis Company Strategies for Effective Exercise Types of Motor Tasks Discrete: An action or movement with a beginning and an end. (Like a quad set) Serial task: A series of discreet movements – like moving a coffee cup to your mouth to drink Continuous tasks: Repetitive/uninterrupted movements- walking/ cycling/moving up and down stairs Copyright ©2023 F.A. Davis Company Closed Vs Open Environments Environmental conditions of a task address whether objects or people (around the patient) are stationary or moving during the task and if the surface on which the task is performed is fixed or moving. Closed- the distal end is fixated. Like a squat Open- the distal end is not fixed or is unstable. Copyright ©2023 F.A. Davis Company Strategies for Effective Exercise Stages of Motor Learning Cognitive stage: Person figures out what to do- they must know the goal of the exercise Associative stage: Person makes infrequent errors and concentrates on fine tuning the motor tasks Autonomous stage: Movements are automatic Copyright ©2023 F.A. Davis Company  Strategies for Effective Exercise Variables that influence motor learning: Considerations for exercise instruction and functional training. Pre-practice considerations Attention to the task at hand also affects learning. Demonstration of a task before commencing practice also enhances learning. Practice The amount, type, and variability of practice directly affect the extent of skill acquisition and retention. Feedback Feedback is sensory information that is received and processed by the learner during or after performing or attempting to perform a motor skill. Copyright ©2023 F.A. Davis Company