Therapeutic Exercise Introduction PDF

Therapeutic Exercise Introduction BY: Dr: Mohamed Naeem  Definition of Therapeutic Exercise Therapeutic exercise is the systemic planned performance of bodily movements, postures, or physical activities intended to provide a patient/client with the means to: ...

Therapeutic Exercise Introduction BY: Dr: Mohamed Naeem  Definition of Therapeutic Exercise Therapeutic exercise is the systemic planned performance of bodily movements, postures, or physical activities intended to provide a patient/client with the means to:  prevent impairments  Improve or enhance physical function  Prevent or reduce health-related risk factors  Optimize overall heath status, fitness, or sense of well-being  Patient: A patient is an individual with impairments and functional deficits diagnosed by a physical therapist and is receiving physical therapy care to improve function and prevent disability.  Client: A client is an individual without diagnosed dysfunction who engages in physical therapy services to promote health and wellness and to prevent dysfunction.  Aspects of Physical Function: Definition of Key Terms Balance: The 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 ability to move available base of support without falling; the ability to move the body in equilibrium with gravity via interaction of the sensory or motor systems.  : Aspects of Physical Function: Definition of Key Terms Cardiopulmonary fitness: The ability to perform moderate intensity, repetitive, total body movements (walking, jogging, cycling, swimming) over an extended period of time. Also known as cardiopulmonary endurance. Coordination: The correct timing and sequencing of muscle firing combined with the appropriate intensity of muscular contraction leading to the effective initiation, guiding, and grading of movement. Coordination is the basis of smooth, accurate, efficient movement and occurs at a conscious or automatic level.  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 allow the occurrence of range of motion (ROM) for functional activities (functional ROM). Passive mobility is dependent on soft tissue (contractile and noncontractile) extensibility; in addition, active mobility requires neuromuscular activation.  Muscle performance: The capacity of muscle to produce tension and do physical work. Muscle performance encompasses strength, power, and muscular endurance.  Neuromuscular control: 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 movement.  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. Interrelated aspects of physical function.  Types of Therapeutic Exercise Interventions Aerobic conditioning and reconditioning Muscle performance exercises: strength, power, and endurance training Stretching techniques including muscle-lengthening procedures Neuromuscular control, inhibition, and facilitation techniques and posture awareness training Postural control, body mechanics, and stabilization exercises Balance exercises and agility training  Exercise Safety 1) Patient’s health history and current health status must be explored. 2) The environment in which exercises are performed also affects patient safety. 3)Adequate space and a proper support surface for exercise are necessary prerequisites for patient safety. 4) Proper posture or alignment of the body, execution of the correct movement patterns, and performing each exercise with the appropriate intensity, speed, and duration 5) A patient must be informed of the signs of fatigue, the relationship of fatigue to the risk of injury  Models of Functioning and Disability—Past and Present Early models that depict the relationships among an individual’s overall health status, functioning in everyday life, and disability have been proposed over the past four decades. The first two schema developed were the Nagi model and the International Classification of Impairments, Disabilities and Handicaps (ICIDH) model for the World Health Organization (WHO). After publication of the original ICIDH model, it was subsequently revised with adjustments made in the descriptions of the classification criteria based on input from health-care practitioners as they became familiar with the original model.  Models of Functioning and Disability—Past and Present Despite the variations in the early models, identified the following key components: Acute or chronic pathology Impairments Functional limitations Disabilities, handicaps, or societal limitations  Comparison of Terminology of Two Disablement Models Model Tissue/Cellular Organ/System Personal Level Societal Level Level Level Nagi Active Impairment Functional Disability pathology limitation ICIDH* Disease Impairment Disability Handicap  Need for a New Framework for Functioning and Disability The conceptual frameworks of the Nagi, ICIDH, and NCMRR models, although applied widely in clinical practice and research in many health-care professions, have been criticized for their perceived focus on disease and a medical biological view of disability as well as their lack of attention to the scope of human functioning, including wellness, and to the person with a disability. In response to these criticisms, the WHO undertook a broad revision of its conceptual framework and system for classifying disability described in its ICIDH model. The ICF was designed as a companion to the WHO’s International Statistical Classification of Disease and Related Health Problems (ICD), which serves as the foundation for classifying and coding medical conditions worldwide.  The ICF—An Overview of the Model The conceptual framework of the ICF is characterized as a bio-psycho-social model that integrates abilities and disabilities and provides a coherent perspective of various aspects of human functioning and disability as they relate to the continuum of health. The ICF also is intended to provide a common language used by all health professions for documentation and communication. The model consists of two basic parts: Part 1: Functioning and Disability Part 2: Contextual Factors Functioning is characterized by the integrity of body functions and structures and the ability to participate in life’s activities. Disability is the result of impairments in body functions and/or structures, activity limitations, and participation restrictions.  Impairments Impairments are the consequences of pathological conditions, they are the signs and symptoms that reflect abnormalities at the body system. Types of Impairment In the ICF model, impairments are subdivided into impairments of body function and body structure that affect the following systems: Musculoskeletal Neuromuscular Cardiovascular/pulmonary Integumentary  Common Physical Impairments Managed with Therapeutic Exercise Musculoskeletal Muscle weakness/reduced torque production Decreased muscular endurance Limited range of motion due to: Restriction of the joint capsule Restriction of periarticular connective tissue Decreased muscle length Joint hypermobility Faulty posture Muscle length/strength imbalances Neuromuscular Impaired balance, postural stability, or control Incoordination, faulty timing Delayed motor development Abnormal tone (hypotonia, hypertonia, dystonia) Ineffective/inefficient functional movement strategies Cardiovascular/Pulmonary Decreased aerobic capacity (cardiopulmonary endurance) Impaired circulation (lymphatic, venous, arterial) Pain with sustained physical activity (intermittent claudication) Integumentary Skin hypomobility (e.g., immobile or adherent scarring) Primary and secondary impairments: Impairments may arise directly from the health condition (direct/primary impairments) or may be the result of preexisting impairments (indirect/secondary impairments). For example: A patient who has been referred to physical therapy with a medical diagnosis of impingement syndrome or tendonitis of the rotator cuff (pathological condition) may exhibit primary impairments of body function, such as pain, limited ROM of the shoulder, and weakness of specific shoulder girdle and glenohumeral musculature during the physical therapy examination. The patient may have developed the shoulder pathology from a preexisting postural impairment (secondary impairment), which led to altered use of the upper extremity and impingement from faulty mechanics. Composite impairments: When an impairment is the result of multiple underlying causes and arises from a combination of primary or secondary impairments, the term composite impairment is sometimes used. For example: A patient who sustained a severe inversion sprain of the ankle resulting in a tear of the talofibular ligament and whose ankle was immobilized for several weeks is likely to exhibit a balance impairment of the involved lower extremity after the immobilizer is removed. This composite impairment could be the result of chronic ligamentous laxity (structural impairment) and impaired ankle proprioception from the injury or muscle weakness (functional impairments) due to immobilization and disuse.  Disability Disability The final category of the ICF model, Definition: inability to perform or participate in activities related to one’s self, the home, work or the community as a whole (e.g., family, friends).  Prevention of Disability Categories of prevention Prevention falls into three categories. Primary prevention: Activities such as health promotion designed to prevent disease in an at-risk population. Secondary prevention: Early diagnosis and reduction of the severity or duration of existing disease. Third prevention: 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 health conditions.  Pre-requisites for designing exercise program - The therapist must have knowledge of Anatomy, Physiology, Kinesiology and Pathology, Testing Procedures, and can integrate and apply this knowledge to each condition. - The therapist must understand the different forms of exercises and how these exercises affect body system. - The exercise program should be individualized to the special needs of each patient  Steps for designing exercise program - Start with comprehensive examination of the patient. - Determine the problems and functional disabilities of patient. - Set the aims and objectives of the treatment program. - Select the proper exercise program that can solve the patient’s problems and improve functional capabilities. - Re-evaluation and examination of the patients. - According to the result of the re-evaluation, modifications of the program should be made to attain the optimal degree of improvement. THANKS