Therapeutic Exercise Lecture PDF

THERAPEUTIC EXERCISE DR. Sherine Omar El-Sherif Lecturer of Biomechanics Objectives By the end of this lecture you will be able to understand: Definition of Therapeutic Exercise Aspects of Physical Function Types of Therapeutic Exercise Intervention The Disablement Process and models o...

THERAPEUTIC EXERCISE DR. Sherine Omar El-Sherif Lecturer of Biomechanics Objectives By the end of this lecture you will be able to understand: Definition of Therapeutic Exercise Aspects of Physical Function Types of Therapeutic Exercise Intervention The Disablement Process and models of disablement The Patient Management Model Concepts of Motor Learning  Introduction Almost everyone, regardless of age, values the ability to function as independently as possible during everyday life. Health-care consumers (patients and clients) typically seek out or are referred for physical therapy services because of physical impairments associated with movement disorders caused by injury, disease, or health-related conditions that interfere with their ability to perform or pursue any number of activities that are necessary or important to them. Introduction To develop and implement effective exercise interventions, a therapist must understand: How the many forms of exercise affect tissues of the body and body systems and how those exercise-induced effects have an impact on key aspects of physical function. A therapist must also integrate and apply knowledge of anatomy, physiology, kinesiology, pathology, and the behavioral sciences across the continuum of patient/client management from the initial examination to discharge planning. To develop therapeutic exercise programs that culminate in positive and meaningful functional outcomes for patients, a therapist must understand the relationship between physical function and disability. Introduction Of the many procedures used by physical therapists in the continuum of care of patients and clients, Therapeutic Exercise takes its place as one of the key elements that lies at the center of programs designed to improve or restore an individual’s function or to prevent dysfunction. Definition of Therapeutic Exercise Therapeutic exercise is the systematic, planned performance of bodily movements, postures, or physical activities intended to provide a patient/client with the means to: Remediate or prevent impairments Improve, restore, or enhance physical function Prevent or reduce health-related risk factors Optimize overall health status, fitness, or sense of well- being Aspects of Physical Function The ability to function independently at home, in the workplace, within the community, or during leisure and recreational activities is dependent on physical as well as psychological and social function. The multidimensional aspects of physical function encompass the diverse yet interrelated areas of performance. Types of Therapeutic Exercise Intervention Aerobic conditioning and reconditioning Muscle performance exercises: strength, power, and endurance training Stretching techniques including muscle-lengthening 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 and ventilatory muscle training Task-specific functional training  DISABLEMENT Disablement is a term that refers to the impact(s) and functional consequences of acute or chronic conditions, such as 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 functions and roles. Understanding the disabling consequences of disease, injury, and abnormalities of development and how the risk of potential disability can be reduced, therefore, must be fundamental to the provision of effective care and services, which are geared to the restoration of meaningful function for patients and their families, significant others, and caregivers. DISABLEMENT The process of disablement can be described through several models that reflects the complex interrelationships among the following: Acute or chronic pathology Impairments Functional limitations Disabilities, handicaps, or societal limitations DISABLEMENT 1. Pathology/Pathophysiology This first major component of the disablement model refers to disruptions of the body’s homeostasis as the result of acute or chronic diseases, disorders, or conditions characterized by a set of abnormal findings (clusters of signs and symptoms) that are indicative of alterations or interruptions of structure or function of the body primarily identified at the cellular level. DISABLEMENT 2. Impairments Impairments are the consequences of pathological conditions; that is, they are the signs and symptoms that reflect abnormalities at the body system, organ, or tissue level. a. Musculoskeletal b. Neuromuscular c. Cardiovascular/pulmonary d. Integumentary DISABLEMENT 3. Functional Limitations Functional limitations, the third component of the disablement model, occur at the level of the whole person. They are the result of impairments and are characterized by the reduced ability of a person to perform actions or components of motor skills in an efficient or typically expected manner.  DISABLEMENT 4. Disability The final category of the disablement continuum is disability. There is a growing body of knowledge suggesting that physical impairments and functional limitations directly contribute to disability. Consequently, an approach to patient management that focuses on restoring or improving function may prevent or reduce disability and may have a positive impact on quality of life. A disability is the 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 the community as a whole (e.g., family, friends, coworkers) perceive as “normal.” A Patient Management Model The physical therapy profession has developed a comprehensive approach to patient management designed to guide a practitioner through a systematic series of steps and decisions for the purpose of helping a patient achieve the highest level of function possible. Concepts of Motor Learning An exercise is simply a motor task (a psychomotor skill) that a therapist teaches and a patient is expected to learn. Motor learning is a complex set of internal processes that involves the relatively permanent acquisition and retention of a skilled movement or task through practice. In the motor learning literature a differentiation is made between motor performance and learning. Concepts of Motor Learning Performance involves acquisition of a skill, whereas learning involves both acquisition and retention. It is thought that motor learning probably modifies the way sensory information in the central nervous system is organized and processed and affects how motor actions are produced. Motor learning is not directly observable; therefore, it must be measured by observation and analysis of how an individual performs a skill. Concepts of Motor Learning Types of Motor Task There are three basic types of motor tasks: discrete, serial, and continuous. a. Discrete task. A discrete task involves a movement with a recognizable beginning and end. Grasping an object, doing a push-up, or locking a wheelchair are examples of discrete motor tasks. Almost all exercises, such as lifting and lowering a weight or performing a self-stretching maneuver, can be categorized as discrete motor tasks. Concepts of Motor Learning Types of Motor Task b. Serial task. A serial task is composed of a series of discrete movements that are combined in a particular sequence. For example, to eat with a fork, a person must be able to grasp the fork, hold it in the correct position, pierce or scoop up the food, and lift the fork to the mouth. c. Continuous task. A continuous task involves repetitive, uninterrupted movements that have no distinct beginning and ending. Examples include walking, ascending and descending stairs, and cycling. Variables That Influence Motor Learning Pre-Practice Considerations Practice Feedback Thank You