Therapeutic Exercises Lecture 1 PDF

Therapeutic Exercises 1 Physical Therapy Lecture 1 Lamis Gharram PT, MSc  Outline 1. Foundational concepts 2. Definition and goal of therapeutic exercises 3. Components of Physical Function 4. Types of Therapeutic Exercise In...

Therapeutic Exercises 1 Physical Therapy Lecture 1 Lamis Gharram PT, MSc  Outline 1. Foundational concepts 2. Definition and goal of therapeutic exercises 3. Components of Physical Function 4. Types of Therapeutic Exercise Interventions 5. Exercise safety 6. How do our muscles work?  Foundational concepts The value of ability to function as independently as possible during activities of everyday life. Patients and clients typically seek out or are referred for physical therapy services because of physical impairments (caused by injury, disease, or health-related conditions) Which restrict their ability to participate in any number of activities an individual with impairments and functional deficits Patient diagnosed by a physical therapist and is receiving physical therapy care to improve function and prevent disability. an individual without diagnosed dysfunction who engages in Client physical therapy services to promote health and wellness and to prevent dysfunction.  An individually designed therapeutic exercise program is almost always a fundamental component of the physical therapy services provided. So, the therapist: Must understand how the many forms of exercise affect tissues of the body and 1 body systems. 2 How those exercise-induced effects have an impact on key aspects of physical function. 3 Must integrate and apply knowledge of anatomy, physiology, kinesiology, pathology from the initial examination to discharge planning. Must understand the relationships among physical functioning, health, and 4 disability and apply these conceptual relationships to facilitate the provision of effective and efficient health-care services. The goal of a therapeutic exercise program is the achievement of an optimal level of movement during basic to complex physical activities.  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. Therapeutic exercise programs designed by physical therapists are individualized to the unique needs of each patient or client.  Components of Physical Function The ability to function independently at home, in the workplace, within the community, or during leisure and recreational activities is contingent upon physical as well as psychological and social function.  These elements of function are characterized by the following definitions: Balance: the ability to align body segments against gravity to maintain or move the body within the available base of support without falling. Balance is a result of interaction of the sensory and motor systems. Cardiopulmonary fitness (A synonymous term is cardiopulmonary endurance): the ability to perform moderate intensity, repetitive, total body movements (walking, jogging, cycling, swimming) over an extended period of time.  Components of Physical Function Coordination: the correct timing and sequencing of muscle firing combined with the appropriate intensity of muscular contraction. The coordination is the basis of smooth, accurate, efficient movement and occurs at a conscious or automatic level. https://youtu.be/r7zEI4WVml0?t=33 Flexibility. The ability to move freely, without restriction; used interchangeably with mobility. https://youtu.be/bapSoJtRauA?t=24 Mobility. The ability of structures or segments of the body to move (Active) or be moved (Passive) in order to allow the occurrence of range of motion. Passive mobility is dependent on soft tissue extensibility; in addition, active mobility requires neuromuscular activation.  Components of Physical Function Muscle performance: the capacity of muscle to produce tension and do physical work. Muscle performance encompasses strength, power, and muscular endurance. 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  Components of Physical Function The systems of the body that control each of these elements of physical function react, adapt, and develop in response to forces and physical stresses placed upon tissues that make up body systems. Gravity/ Additional forces/ excessive/ absence of typical forces  Types of Therapeutic Exercise Interventions Therapeutic exercise procedures embody a wide variety of activities, actions, and techniques. The techniques selected for an individualized therapeutic exercise program are based on a therapist’s determination of the underlying cause of a patient’s functional impairments.  Types of Therapeutic Exercise Interventions Aerobic conditioning and reconditioning Muscle performance exercises: strength, power, and endurance training Stretching techniques including muscle-lengthening procedures and joint mobilization/manipulation techniques Neuromuscular control, inhibition, and facilitation techniques and posture awareness training  Cont.. Postural control, body mechanics, and stabilization exercises Balance exercises and agility training Relaxation exercises Breathing exercises and ventilatory muscle training Task-specific functional training  Exercise Safety Regardless of the types of therapeutic exercise interventions in a patient’s exercise program, safety is a fundamental consideration in every aspect of the program whether the exercises are performed independently or under a direct supervision. Safety is essential for both patient and therapists.  Medical history Medications Medical clearance Adequate space proper support surface Many factors exercise equipment can influence Accuracy of performing a patient’s exercises Fatigue and rest safety Home exercise instruction and education Therapists proper body mechanics  Many factors can influence a patient’s safety during exercise. Prior to engaging in exercise, a patient’s health history and current health status must be explored. A patient unaccustomed to physical exertion may be at risk for the occurrence of an adverse effect from exercise associated with a known or an undiagnosed health condition. Medications can adversely affect a patient’s balance and coordination during exercise or cardiopulmonary response to exercise. Therefore, risk factors must be identified and weighed carefully before an exercise program is initiated. Medical clearance from a patient’s physician may be indicated before beginning an exercise program.  The environment in which exercises are performed also affects patient safety. Adequate space and a proper support surface for exercise are necessary prerequisites for patient safety. If exercise equipment is used in the clinical setting or at home, to ensure patient safety, the equipment must be well maintained and in good working condition, must fit the patient, and must be applied and used properly. The accuracy with which a patient performs an exercise affects safety, including proper posture or alignment of the body, execution of the correct movement patterns, and performance of each exercise with the appropriate intensity, speed, and duration.  A patient must be informed of the signs of fatigue, the relationship of fatigue to the risk of injury, and the importance of rest for recovery during and after an exercise routine. When a patient is being directly supervised in a clinical or home setting while learning an exercise program, the therapist can control these variables. However, when a patient is carrying out an exercise program independently at home or at a community fitness facility, patient safety is enhanced, and the risk of injury or re- injury is minimized by effective exercise instruction and patient education  As mentioned, therapist safety also is a consideration to avoid work- related injury. For example, when a therapist is using manual resistance during an exercise designed to improve a patient’s strength or is applying a stretch force manually to improve a patient’s ROM, the therapist must incorporate principles of proper body mechanics and joint protection into these manual techniques to minimize his or her own risk of injury. How do our muscles work? https://youtu.be/PX5yImSFFaI?t=30 https://www.youtube.com/watch?v=rX sxjyAD-hs https://youtu.be/99R-XCGme8Q  References Kisner C, Colby LA, Borstad J. Therapeutic exercise: foundations and techniques. Fa Davis; 2017 Oct 18.