Tugas PPT Ziz Exercise

Range of Motion
Chapter 3
Part II: Applied Science of Exercise and

Techniques
Copyright © 2013. F.A. Davis Company
Range of Motion
 Basic technique used for examination of
movement and for initiating movement into a
purposeful therapeutic intervention
– Range of motion (ROM)
– Functional excursion
– Active insufficiency
– Passive insufficiency

Types of Range of Motion (ROM)
Exercises
 Passive ROM (PROM)
– Motion produced by an external force, manual or
mechanical
 Active ROM (AROM)
– Motion produced by active contraction of the muscles
 Active-Assistive ROM (A-AROM)
– Motion produced by a combination of external force and
active muscle contraction (type of AROM)

Indications, Goals, and Limitations
of ROM
 Passive ROM (PROM)
– Indications for PROM
– Goals for PROM
– Other Uses for PROM

Indications, Goals, and Limitations
of ROM (cont'd)
 Active and Active-Assistive ROM (AROM and
A-AROM)
– Indications for AROM
– Goals for AROM
– Limitations of A-AROM

Precautions and Contraindications
to ROM Exercises
 ROM should not be done when motion is
disruptive to the healing process
– Follow specific precautions during early phases of
healing
 ROM should not be done when the patient’s
response or condition is life threatening
– Follow specific precautions when the patient’s
condition is critical or severe

Principles and Procedures for
Applying ROM Techniques
 Examination, Evaluation, and Treatment
Planning
– Determine appropriate level of ROM
– Determine safe amount of motion
– Decide the pattern of motion to best meet goals
– Monitor patient response to ROM intervention
– Document and communicate findings
– Re-evaluate and modify as appropriate

Applying ROM Techniques (cont'd)
 Patient Preparation
– Describe the intervention to meet set goals
– Free the area from restriction
– Drape the patient
– Position the patient for alignment and stabilization
– Position yourself for proper body mechanics

 Application of Techniques
– Control movement grasping around the joint
– Support areas of poor structural integrity
– Move the segment through pain-free range to the
point of resistance
– Perform motions smoothly and slowly
– Repetitions are determined in the plan of care

 Application of PROM
– Movement of the segment by a therapist, PTA ,or
mechanical device
– No active muscle contraction
– Motion only through the pain-free ROM without
tissue resistance

 Application of AROM
– Demonstrate the motion using PROM
– Ask the patient to perform the motion
– Provide assistance for smooth motion, weakness,
at the beginning or end of range only as needed
– Motion within available pain-free ROM

ROM Techniques
 Upper Extremity
 Lower Extremity
 Cervical Spine
 Lumbar Spine

Self-Assisted ROM
 Self-Assistance
 Equipment
– Wand (T-bar)
– Wall climbing, finger ladder
– Ball rolling
– Overhead pulleys
– Skate board/powder board
– Reciprocal exercise unit

Continuous Passive Motion (CPM)
 Passive motion that is performed by a
mechanical device that moves a joint slowly
and continuously through a pre-set, controlled
range of motion

Benefits of CPM
 Prevents development of adhesions, contractures
 Stimulates healing of tendons, ligaments
 Enhances healing of incisions
 Increases synovial fluid lubrication
 Prevents degrading effects of immobilization
 Quicker return of ROM
 Decreases postoperative pain

General Guidelines for CPM
 Device is applied immediately after surgery
 Arc of motion is adjustable and determined
 Rate of motion is adjustable and determined
 Duration on the machine is determined
 Physical therapy is included during off periods
 Devices are often portable and battery
operated to allow patients to be functionally
active
ROM Through Functional Patterns
 Assists in teaching ADLs and IADLs
 Helps patient realize purpose and value of
ROM exercises
 Assists in developing motor patterns

Independent Learning Activities
 Critical Thinking and Discussion
 Laboratory Practice

Stretching for Impaired
Mobility
Chapter 4

Techniques
Stretching: Definition and Purpose
 A general term used to describe any
therapeutic maneuver designed to increase
mobility of soft tissues and subsequently
improve ROM by elongating (lengthening)
structures that have adaptively shortened and
have become hypomobile over time

Definitions of Terms Related to
Mobility and Stretching
 Flexibility
– Dynamic flexibility
– Passive flexibility
 Hypomobility
– Hypomobility may be allowed selectively to
improve function

Mobility and Stretching (cont'd)
 Contracture
– Designation of contracture by location
– Contracture versus contraction
– Types of contracture
• Myostatic contracture
• Pseudomyostatic contracture
• Arthrogenic and periarticular contractures
• Fibrotic contracture and irreversible contractures

Mobility and Stretching (cont'd)
 Selective Stretching
– Hypomobile structures to develop to improve
function
 Overstretching and Hypermobility
– Hypermobility improves function in some
circumstances

Interventions to Increase Mobility
of Soft Tissues
 Manual or Mechanical Stretching
– Utilizes an external force
 Passive Stretching
– No patient assistance
 Assisted Stretching
– Patient assistance
 Self-Stretching
– Patient performs the stretch
Interventions to Increase Mobility
of Soft Tissues (cont'd)
 Neuromuscular Facilitation and Inhibition
Techniques
 Muscle Energy Techniques
 Joint Mobilization/Manipulation
 Soft Tissue Mobilization and Manipulation
 Neural Tissue Mobilization (Neuromeningeal
Mobilization)

Indications for Stretching Exercises
 Adhesions, Contractures, Scar Tissue Limit
ROM
 Potential for Structural Deformity d/t Limited
ROM
 Muscle Weakness, Shortening of Muscles
 Part of a Total Fitness Program
 Pre and Post Vigorous Exercise

Contraindications for Stretching
Exercises
 Bony Block
 Non-Union Fracture
 Acute Inflammation or Infection
 Sharp or Acute Pain With Elongation
 Hematoma or Tissue Trauma
 Hypermobility
 Hypomobility Provides Stability or Neuro-
muscular Control
Potential Benefits and Outcomes
for Stretching Exercises
 Increased Flexibility and ROM
 General Fitness
 Other Potential Benefits
– Injury prevention
– Reduced post-exercise soreness
– Enhanced performance

Properties of Soft Tissue: Response
to Immobilization and Stretch
 Contractile and Non-Contractile Tissue
Changes
– Elasticity
– Viscoelasticity
• Only non-contractile connective tissue
– Plasticity

Mechanical Properties of
Contractile Tissue
 Contractile Elements of Muscle
 Mechanical Response of the Contractile Unit
to Stretch and Immobilization
– Response to stretch
– Response to immobilization and remobilization
• Morphological changes
• Immobilization in a shortened position
• Immobilization in a lengthened position

Neurophysiological Properties of
Contractile Tissue
 Muscle Spindle
 Golgi Tendon Organ
 Neurophysiological Response of Muscle to
Stretch

Types of Connective Tissue
 Ligaments
 Tendons
 Joint Capsules
 Fasciae
 Non-Contractile Tissue in Muscles
 Skin

Mechanical Properties of Non-
Contractile Soft Tissue
 Composition of Connective Tissue
– Collagen fibers
– Elastin fibers
– Reticulin fibers
– Ground substance
 Mechanical Behavior of Non-Contractile
Tissue

Contractile Soft Tissue (cont'd)
 Interpreting Mechanical Behavior of
Connective Tissue: The Stress-Strain Curve
 Stress and Strain
– Tension
– Compression
– Shear
– Strain

 Regions of the Stress-Strain Curve
– Toe region
– Elastic range/linear phase
– Elastic limit
– Plastic range
– Ultimate strength
• Necking
– Failure
– Structural stiffness
 Time and Rate Influences on Tissue
Deformation
– Creep
– Stress-relaxation
– Cyclic loading and connective tissue fatigue
 Summary of Mechanical Principles for
Stretching Connective Tissue

 Changes in Collagen Affecting Stress–Strain
Response
– Effects of immobilization
– Effects of inactivity (decrease of normal activity)
– Effects of age
– Effects of corticosteroids
– Effects of injury
– Other conditions affecting collagen

Determinants and Types of
Stretching Exercises
 Alignment and Stabilization
 Intensity of Stretch
 Duration of Stretch
– Static stretching
• Static progressive stretching
– Cyclic (intermittent) stretching

Determinants and Types of
Stretching Exercises (cont'd)
 Speed of Stretch
– Importance of a slowly applied stretch
– Ballistic stretching
– High-velocity stretching in conditioning programs
and advanced-phase rehabilitation
 Frequency of Stretch

Mode of Stretch
 Manual Stretching
 Self-Stretching
 Mechanical Stretching
– Duration of mechanical stretch

Proprioceptive Neuromuscular
Facilitation Stretching Techniques
 Types of PNF Stretching
– Hold–relax and contract–relax
– Agonist contraction
– Hold–relax with agonist contraction

Integration of Function into
Stretching
 Importance of Strength and Muscle Endurance
 Use of Increased Mobility for Functional
Activities

Procedural Guidelines for Application
of Stretching Interventions
 Examination and Evaluation of the Patient
 Preparation for Stretching
 Application of Manual Stretching Procedures
 After Stretch Procedures

Precautions for Stretching
 General Precautions
 Special Precautions for Mass-Market Flexibility Programs
– Common errors and potential problems
• Nonselective or poorly balanced stretching activities
• Insufficient warm-up
• Ineffective stabilization
• Use of ballistic stretching
• Excessive intensity
• Abnormal biomechanics
• Insufficient information about age-related differences
– Strategies for risk reduction

Adjuncts to Stretching
Interventions
 Complementary Exercise Approaches
– Relaxation training
• Common elements of relaxation training
• Examples of approaches to relaxation training
– Autogenic training
– Progressive relaxation
– Awareness through movement
• Sequence for progressive relaxation techniques
– Pilates
Adjuncts to Stretching
Interventions (cont'd)
 Heat
– Methods of warm-up
– Effectiveness of warm-up methods
 Cold
 Massage
– Massage for relaxation
– Soft tissue mobilization/manipulation techniques
 Biofeedback
 Joint Traction or Oscillation
Manual Stretching Techniques in
Anatomical Planes of Motion
 Upper Extremity Stretching
– Hand placement
– Patient position
– Procedure
 Lower Extremity Stretching
– Hand placement
– Patient position
– Procedure


Peripheral Joint Mobilization
for Impaired Mobility
Chapter 5

Techniques
Joint Mobilization/Manipulation
 Manual therapy techniques that are used to
modulate pain and treat joint impairments
that limit ROM by specifically addressing the
altered mechanics of the joint

Definition of Terms
 Mobilization/Manipulation
– Thrust manipulation/high-velocity thrust (HVT)
 Self-Mobilization (Auto-Mobilization)
 Mobilization With Movement (MWM)
 Physiological Movements
– Osteokinematics

Definition of Terms (cont'd)
 Accessory Movements
– Component motion
– Joint play: arthrokinematics
 Manipulation Under Anesthesia
 Muscle Energy

Basic Concepts of Joint Motion:
Arthrokinematics
 Joint Shapes
– Ovoid
– Sellar (saddle)

Basic Concepts of Joint Motion:
Arthrokinematics (cont'd)
 Types of Motion
– Swing: Movement of the bony lever about an axis
of motion
– Motion of the bone surfaces in the joint
• Roll
• Slide/translation
• Combined roll-sliding in a joint (glide)
• Spin

Convex-Concave Rule
 Basis for determining the direction of the
mobilizing force when joint mobilization
gliding techniques are used
– Sliding is in the opposite direction of the angular
movement of the bone if the moving surface is
convex
– Sliding is in the same direction if the moving
surface is concave

Passive-Angular Stretching Versus
Joint-Glide Stretching
 Passive-angular stretching may cause
increased pain or joint trauma
 Joint-glide is safer and more selective
– Controlled
– Replicates normal joint mechanics
– Force is specific to target tissues

Other Accessory Motions That
Affect the Joint
 Compression
 Traction: Longitudinal Pull
– Long axis traction
 Distraction: Separation of Joint Surfaces
– Joint traction or joint separation

Effects of Joint Motion
 Helps move synovial fluid to maintain cartilage
health
 Maintains extensibility and tensile strength of
articular and periarticular tissues
 Provides sensory input for proprioceptive
feedback important for balance response

Indications for Joint
Mobilization/Manipulation
 Pain, Muscle Guarding, and Spasm
– Neurophysiological effects
– Mechanical effects
 Reversible Hypomobility
 Positional Faults/Subluxations
 Progressive Limitation
 Functional Immobility
Limitations of Joint Mobilization/
Manipulation Techniques
 Cannot Change Disease Process
 Cannot Change Inflammatory Process
 Skill of the Therapist Affects the Outcome

Contraindications
 Hypermobility
 Joint Effusion
 Inflammation

Conditions Requiring Special
Precautions for Stretching
 Malignancy
 Bone Disease Detectable on Radiograph
 Unhealed Fracture (With Limitations)
 Hypermobility in Associated Joints
 Total Joint Replacements
 Newly Formed or Weakened Connective Tissue
 Elderly Individuals

Procedures for Applying Passive
Joint Techniques
 Examination and Evaluation
– Quality of pain
– Capsular restriction (specific pattern)
– Subluxation or dislocation

Joint Techniques (cont'd)
 Documentation
– Use of standardized terminology
– Characteristics of documentation
• Rate of application of movement
• Location of range in the available motion
• Direction of force applied by the therapist
• Target of force
• Relative structural movement
• Patient position

Non-Thrust Oscillation Techniques
 Grade I: Small Amplitude at Beginning of Range
– Pain inhibition and fluid movement
 Grade II: Large Amplitude Within the Range
– Pain inhibition and fluid movement
 Grade III: Large Amplitude Up to the Limit into
Resistance
– Stretching maneuver
 Grade IV: Small Amplitude at the Limit into Resistance
– Stretching maneuver

Non-Thrust Sustained Joint-Play
Techniques
 Grade I: Loosen: Small Amp Distraction
– Pain relief
 Grade II: Tighten: Distraction or Glide to
Tighten Tissue
– Pain relief, assess joint sensitivity, maintain joint
play
 Grade III: Stretch: Distraction or Glide
– Increase joint play

Comparison of Oscillation and
Sustained Techniques
Representation of Oscillation Representation of Sustained
Techniques Joint-Play Techniques

Thrust Manipulation/High-Velocity
Thrust (HVT)
 Application
– Small-amplitude, high-velocity
– Performed only once
 Indications
– Snap adhesions
– Reposition joint surfaces

Joint Techniques
 Positioning and Stabilization
 Direction and Target of Treatment Force
– Treatment plane
 Initiation and Progression of Treatment
 Patient Response
 Total Program

Mobilization With Movement
(MWM): Principles of Application
 Principles and Application of MWM in Clinical
Practice
– Comparable sign
– Passive techniques
– Accessory glide with active comparable sign
– No pain
– Repetitions
– Description of techniques

Mobilization With Movement (MWM):
Principles of Application (cont'd)
 Patient Response and Progression
– Pain as a guide
– Self treatment
– Total program
 Theoretical Framework
– Brian Mulligan

Peripheral Joint Mobilization
Techniques
 Shoulder Girdle Complex
 Elbow and Forearm Complex
 Wrist and Hand Complex
 Hip Joint
 Knee Joint Complex
 Leg and Ankle Joints


Resistance Exercise for
Impaired Muscle Performance
Chapter 6

Techniques
Muscle Performance and Resistance
Exercise: Definitions and Guiding Principles
 Strength, Power, and Endurance
– Strength
• Strength training
– Power
• Power training
– Endurance
• Endurance training

Muscle Performance and Resistance
Exercise: Definitions and Guiding Principles
(cont'd)
 Overload Principle
– Description
– Application of the Overload Principle
 SAID Principle
– Specificity of training
– Transfer of training
 Reversibility Principle

Factors That Influence Tension
Generation in Normal Skeletal Muscle
 Energy Stores and Blood Supply
 Fatigue
– Muscle (local) fatigue
– Cardiopulmonary (general) fatigue
– Threshold for fatigue
– Factors that influence fatigue
 Recovery From Exercise

Factors That Influence Tension Generation
in Normal Skeletal Muscle (cont'd)
 Age
– Early childhood and preadolescence
– Adolescence
– Young and middle adulthood
– Late adulthood
 Psychological and Cognitive Factors
– Attention
– Motivation and feedback

Physiological Adaptations to
Resistance Exercise
 Neural Adaptations
 Skeletal Muscle Adaptations
– Hypertrophy
– Hyperplasia
– Muscle fiber type adaptation

Physiological Adaptations to
Resistance Exercise (cont'd)
 Vascular and Metabolic Adaptations
 Adaptations of Connective Tissues
– Tendons, ligaments, and connective tissue in
muscle
– Bone

Determinants of Resistance
Exercise
 Alignment and Stabilization
– Alignment
• Alignment and muscle action
• Alignment and gravity
– Stabilization

Exercise (cont'd)
 Intensity
– Submaximal versus maximal exercise loads
– Initial exercise load (amount of resistance) and
documentation of training effects
• Repetition maximum
– Use of repetition maximum
• Alternative methods of determining baseline strength
or an initial exercise load
• Training zone

Exercise (cont'd)
 Volume
– Repetitions
– Sets
– Training to improve strength or endurance: impact
of exercise load and repetitions
• To improve muscle strength
• To improve muscle endurance

Exercise (cont'd)
 Exercise Order
 Frequency
 Duration
 Rest Interval (Recovery Period)
– Purpose of rest intervals
– Integration of rest into exercise

Exercise (cont'd)
 Mode of Exercise
– Type of muscle contraction
– Position for exercise: weight-bearing or non-
weight-bearing
– Forms of resistance
– Energy systems
– Range of movement: short-arc or full-arc exercise
– Mode of exercise and application to function

Exercise (cont'd)
 Velocity of Exercise
– Force-velocity relationship
– Application to resistance training
 Periodization and Variation of Training
 Integration of Function
– Balance of stability and active mobility
– Balance of strength, power, and endurance
– Task-specific movement patterns with resistance exercise

Types of Resistance Exercise
 Static (Isometric) and Dynamic
 Concentric and Eccentric
 Isokinetic
 Open-Chain and Closed-Chain
 Manual and Mechanical
 Constant and Variable

Manual and Mechanical Resistance
Exercise
 Manual Resistance Exercise
 Mechanical Resistance Exercise

Isometric Exercise (Static Exercise)
 Rationale for Use of Isometric Exercise
 Types of Isometric Exercise
– Muscle-setting exercises
– Stabilization exercises
– Multiple-angle isometrics

Isometric Exercise (Static Exercise)
(cont'd)
 Characteristics and Effects of Isometric
Training
– Intensity of muscle contraction
– Duration of muscle activation
– Repetitive contractions
– Joint angle and mode specificity
– Sources of resistance

Dynamic Exercise: Concentric and
Eccentric
 Rationale for Use of Concentric and Eccentric
Exercise
 Special Considerations for Eccentric Training
– Exercise-induced muscle soreness

Dynamic Exercise: Concentric and
Eccentric (cont'd)
 Characteristics and Effects of Concentric and
Eccentric Exercise
– Exercise load and strength gains
– Velocity of exercise
– Energy expenditure
– Cross-training effect
– Exercise-induced muscle soreness

Dynamic Exercise: Constant and
Variable Resistance
 Dynamic Exercise-Constant External
Resistance (DCER)
 Variable-Resistance Exercise
 Special Considerations for DCER and Variable-
Resistance Exercise
– Excursion of limb movement
– Velocity of exercise

Isokinetic Exercise
 Characteristics of Isokinetic Training
– Constant velocity
– Range and selection of training velocities
– Reciprocal versus isolated muscle training
– Compressive forces on joints
– Accommodation to fatigue
– Accommodation to a painful arc

Isokinetic Exercise (cont'd)
 Training Effects and Carryover to Function
– Limitations in carryover
 Special Considerations for Isokinetic Training
– Availability of equipment
– Appropriate set up
– Initiation and progression of isokinetic training
during rehabilitation

Open-Chain and Closed-Chain
Exercise
 Background
 Controversy and Inconsistency in Use of Open-Chain
and Closed-Chain Terminology
 Alternatives to Open-Chain and Closed-Chain
Terminology
 Characteristics of Open-Chain and Closed-Chain
Exercises
– Open-chain exercises
– Closed-chain exercises

Exercise (cont'd)
 Rationale for Use of Open-Chain and Closed-Chain
Exercises
– Isolation of muscle groups
– Control of movements
– Joint approximation
– Co-activation and dynamic stabilization
– Proprioception, kinesthesia, neuromuscular control, and
balance
– Carryover to function and injury prevention

Exercise (cont'd)
 Implementation and Progression of Open- and
Closed-Chain Exercises
– Introduction of open-chain training
– Closed-chain exercises and weight-bearing
restrictions: use of unloading
– Progression of closed-chain exercises

General Principles of Resistance
Training
 Examination and Evaluation
 Preparation for Resistance Exercises

Implementation of Resistance
Exercises
 Warm Up
 Placement of Resistance
 Direction of Resistance
 Stabilization
 Intensity of Exercise/Amount of Resistance
 Number of Repetitions, Sets, and Rest Intervals
 Verbal or Written Instructions
 Monitoring the Patient
 Cool Down
Precautions for Resistance Exercise
 Valsalva Maneuver
– At-risk patients
– Prevention during resistance exercise
 Substitute Motions
 Overtraining and Overwork
– Overtraining
– Overwork

Precautions for Resistance Exercise
(cont'd)
 Exercise-Induced Muscle Soreness
– Acute muscle soreness
– Delayed-onset muscle soreness (DOMS)
• Etiology of DOMS
• Prevention and treatment of DOMS
 Pathological Fracture
– Prevention of pathological fracture

Contraindications to Resistance
Exercise
 Pain
 Inflammation
 Severe Cardiopulmonary Disease

Manual Resistance Exercise
 Definition and Use
 Guidelines and Special Considerations
– Body mechanics of the therapist
– Application of manual resistance and stabilization
– Verbal commands
– Number of repetitions and sets: rest intervals
 Techniques: General Background
 Upper Extremity Techniques
 Lower Extremity Techniques
Proprioceptive Neuromuscular
Facilitation: Principles and Techniques
 Diagonal Patterns
 Basic Procedures With PNF Patterns
– Manual contacts
– Maximal resistance
– Position and movement of the therapist
– Stretch
• Stretch stimulus
• Stretch reflex

Proprioceptive Neuromuscular Facilitation:
Principles and Techniques (cont'd)
 Basic Procedures With PNF Patterns (cont’d)
– Normal timing
– Traction
– Approximation
– Verbal commands
– Visual cues

Proprioceptive Neuromuscular Facilitation:
Principles and Techniques (cont'd)
 Upper Extremity Diagonal Patterns
 Lower Extremity Diagonal Patterns
 Specific Techniques With PNF
– Rhythmic initiation
– Repeated contractions
– Reversal of antagonists
– Alternating isometrics
– Rhythmic stabilization
Mechanical Resistance Exercise
 Application in Rehabilitation Programs
 Application in Fitness and Conditioning
Programs
 Special Considerations for Children and Older
Adults
– Children and resistance training
– Older adults and resistance training

Selected Resistance Training
Regimens
 Progressive Resistance Exercise
– Delorme and Oxford regimens
– DAPRE regimen
 Circuit Weight Training

Selected Resistance Training
Regimens (cont'd)
 Isokinetic Regimens
– Velocity spectrum rehabilitation
• Selection of training velocities
• Repetitions, sets, and rest
• Intensity
– Eccentric isokinetic training: special considerations

Equipment for Resistance Training
 Free Weights and Simple Weight-Pulley
Systems
– Types of free weights
– Simple weight-pulley systems
– Characteristics of free weights and simple weight-
pulley systems
– Advantages and disadvantages of free weights and
simple weight-pulley systems

(cont'd)
 Variable-Resistance Machines
– Variable resistance weight-cable systems
– Hydraulic and pneumatic resistance devices
– Advantages and disadvantages of variable-
resistance machines

(cont'd)
 Elastic Resistance Devices
– Types of elastic resistance
– Properties of elastic resistance: implications for
exercise
• Effect of elongation of elastic material
• Determination and quantification of resistance
• Fatigue characteristics

(cont'd)
 Elastic Resistance Devices (cont’d)
– Application of elastic resistance
• Selecting the appropriate grade of material
• Selecting the appropriate length
• Securing bands or tubing
• Setting up an exercise
• Progressing exercises
– Advantages and disadvantages of exercise with
elastic resistance

(cont'd)
 Equipment for Dynamic Stabilization Training
– BodyBlade®
– Swiss balls (stability balls)

(cont'd)
 Equipment for Closed-Chain Training
– Body weight resistance: multipurpose exercise
systems
– Slide boards
– Balance equipment
– Mini-trampolines (rebounders)

(cont'd)
 Reciprocal Exercise Equipment
– Stationary exercise cycles
– Portable resistive reciprocal exercise units
– Stair-stepping machines
– Elliptical trainers and cross-country ski machines
– Upper extremity ergometers

(cont'd)
 Isokinetic Testing and Training Equipment
– Features of isokinetic dynamometers
– Advantages and disadvantages of isokinetic
equipment


Principles of Aerobic Exercise
Chapter 7

Techniques
Key Terms and Concepts
 Physical Activity  Aerobic Exercise
 Exercise Training (Conditioning)
 Physical Fitness  Adaptation
 Maximum Oxygen  Myocardial Oxygen
Consumption Consumption
 Endurance  Deconditioning

Energy Systems, Energy
Expenditure, and Efficiency
 Energy Systems
– Phosphagen, or ATP-PC system
– Anaerobic glycolytic system
– Aerobic system
– Recruitment of motor units
– Functional implications

Energy Systems, Energy
Expenditure, and Efficiency (cont'd)
 Energy Expenditure
– Quantification of energy expenditure
– Classification of activities
 Efficiency

Physiological Response to Aerobic
Exercise
 Cardiovascular Response to Exercise
– Exercise pressor response
– Cardiac effects
– Peripheral effects
• Net reduction in total peripheral resistance
• Increased cardiac output
• Increase in systolic blood pressure

Physiological Response to Aerobic
Exercise (cont'd)
 Respiratory Response to Exercise
 Responses Providing Additional Oxygen to
Muscle
– Increased blood flow
– Increased oxygen extraction
– Oxygen consumption

Signs & Symptoms of Excessive
Effort
 Persistent dyspnea  Lack of SBP increase
 Hypertensive BP >
 Dizziness/confusion 200/110
 Pain  Progressive fall in SBP by
10-15mmHg
 Severe leg claudication
 Change in rhythm
 Excessive fatigue Delayed Responses:
 Pallor, cold sweat Prolonged fatigue
 Ataxia Insomnia
Sudden weight gain due to
 Pulmonary rales fluid

Testing as a Basis for Exercise
Programs
 Fitness Testing of Healthy Subjects
 Stress Testing for Convalescing Individuals and
Individuals at Risk
– Principles of stress testing
– Purpose of stress testing
– Preparation for stress testing
– Termination of stress testing
 Multistage Testing
Determinants of an Exercise
Program
 Frequency
 Intensity
– Overload principle
– Individuals at risk
– Variables
– Specificity principle
 Time (Duration)
 Type (Mode)
– Reversibility principle

General Recommendations for
Aerobic Physical Activity
 ACSM, AHA, CDC, Surgeon General
– Children: Age 6–17
– Adults: Age 18–65
– Older adults: Age 65 or older
– Adults age 50–65 with chronic health conditions

Exercise Program
 Warm-Up Period
 Aerobic Exercise Period
– Continuous training
– Interval training
– Circuit training
– Circuit-interval training
 Cool-Down Period
 Application

Physiological Changes That Occur
With Training
 Cardiovascular
 Respiratory
 Metabolic
 Other Systems

Application of Principles of an
Aerobic Conditioning Program
 For the Patient With Coronary Disease
– Inpatient phase (Phase I)
– Outpatient phase (Phase II)
– Outpatient program (Phase III)
– Special considerations
– Adaptive changes

Applications of Aerobic Training
 For the Deconditioned Individual and the
Patient With Chronic Illness
– Deconditioning
– Reversal of deconditioning
– Adaptations for participation restrictions
(disabilities), activity restrictions (functional
limitations), and deconditioning
– Impairments, goals, and plan of care

Age Differences
 Children  Heart Rate
 Young Adults  Stroke Volume
 Cardiac Output
 Older Adults
 Arteriovenous Oxygen
Difference
 Maximum Oxygen Uptake
 Blood Pressure
 Respiration
 Muscle Mass and Strength
 Anaerobic Ability

Hypertension
 Prehypertensive  SBP 120-130; DBP 80-89
 Stage I  SBP 130-140; DBP 90-
100
 Stage II  SBP 140-160; DBP 100-
110
 Stage II  SBP > 160; DBP >110

PT Intervention for Pts with CAD
 General Goals of PT intervention
– Increase aerobic capacity
– Increase ability to perform physical tasks related
to self care, home management, community &
work integration & leisure activities
– Improve physiological response to increased O2
demand
– Increased strength, power & endurance
– Decreased symptoms associated with increased
O2 demand
PT Intervention - continued
 Increase ability to recognize recurrence &
intervention is sought sooner
 Reduce risk of recurrence
 Acquire behaviors that foster healthy habits,
wellness, & prevention
 Enhance decision making regarding health,
use of health care resources by pt, family,
caregivers, etc.
Contraindications to Aerobic
Exercise
 Unstable Angina
 Symptomatic heart failure
 Uncontrolled arrythmias
 Moderate to severe aortic stenosis
 Uncontrolled diabetes
 Acute systemic illness/fever
 Uncontrolled tachycarida (HR >100 bpm)
 Resting SBP > 200 mmHG; DBP >110 mmHg
 Thromophlebitis

Clinical Signs & Symptoms
CAD/CHF
 Chest pressure
 Dyspnea
 Fatigue
 Syncope
 Palpitations
 Edema – pulmonary/Peripheral – CHF
 Fluid weight gain – CHF
 S3 Heart Sound – CHF
 Renal dysfunction - CHF

PT Intervention for CHF - Goals
 Improve physiological reponse to increased O2
demand
 Improvement of self management of symptoms
 Increased ability to perform physical tasks
 Acquire behaviors that foster healthy habits, wellness
& prevention
 Reduction of disability associated with acute or chronic
illness
 Reduction of secondary impairments
 Improved awareness & use of community resources
 Increased performance of & independence with ADL’s

Pt Education for Pts with CHD
 Activity Guidelines
 Self Monitoring – pulse; RPE
 Symptom recognition & response
 Nutrition
 Medications – prescription & OTC
 Lifestyle issues
 Psychological/Social Issues
 Other
Aquatic Exercise
Chapter 9

Techniques
BACKGROUND AND PRINCIPLES
FOR AQUATIC EXERCISE

Background and Principles for
Aquatic Exercise
 Definition of Aquatic Exercise
 Goals and Indications for Aquatic Exercise

Precautions and Contraindications
to Aquatic Exercise
 Precautions
– Fear of water
– Neurological disorders
– Respiratory disorders
– Cardiac dysfunction
– Small open wounds and lines
 Contraindications

Properties of Water
 Physical Properties of Water
– Buoyancy
– Hydrostatic pressure
– Viscosity
– Surface tension
 Hydromechanics
– Components of flow motion
– Clinical significance of drag

Properties of Water (cont'd)
 Thermodynamics
– Specific heat
– Temperature transfer
 Center of Buoyancy

Aquatic Temperature and
Therapeutic Exercise
 Temperature Regulation
 Mobility and Functional Control Exercise
 Aerobic Conditioning

Pools for Aquatic Exercise
 Traditional Therapeutic Pools
 Individual Patient Pools

Special Equipment for Aquatic
Exercise
 Collars, Rings, Belts, and Vests
 Swim Bars
 Gloves, Hand Paddles, and Hydro-tone® Bells
 Fins and Hydro-tone® Boots
 Kickboards

Pool Care and Safety
 Pseudomonas aeruginosa
 Cleaning and pH Level Tests
 Walking Surfaces
 Safety Rules and Regulations
 Life Preservers and CPR

EXERCISE INTERVENTIONS USING
AN AQUATIC ENVIRONMENT

Manual Stretching Techniques
 Practitioner Position
 Patient Position
– Buoyancy-assisted (BA) seated or upright
– Buoyancy-supported (BS) supine

Manual Stretching Techniques
(cont'd)
 Hand Placement
– Fixed (ipsilateral) hand stabilizes the patient,
positioned proximally on the affected extremity
– Movement (contralateral) hand, positioned
distally, guides patient’s extremity through desired
motion and applies the stretch force
 Direction of Movement
– Describes motion of the movement hand

Spine Stretching Techniques
 Cervical Spine: Flexion
 Cervical Spine: Lateral Flexion
 Thoracic and Lumbar Spine: Lateral
Flexion/Side Bending

Shoulder Stretching Techniques
 Shoulder Flexion
 Shoulder Abduction
 Shoulder External Rotation
 Shoulder Internal Rotation

Hip Stretching Techniques
 Hip Extension
 Hip External Rotation
 Hip Internal Rotation

Knee Stretching Techniques
 Knee Extension With Patient on Steps
 Knee Flexion With Patient on Steps
 Knee Flexion With Patient Supine
 Hamstring Stretch

Self-Stretching With Aquatic
Equipment
 Shoulder Flexion and Abduction
 Hip Flexion
 Knee Extension
 Knee Flexion

Manual Resistance Exercises
 Practitioner Position
 Patient Position
– Buoyancy-supported (BS) supine
 Hand Placement
– Guide (ipsilateral) hand directs patient’s body as muscles
contract to move the body through water
– Resistance (contralateral) hand is placed at the distal end
of the contracting segment
 Direction of Movement
– Describes motion of patient

Upper Extremity Manual
Resistance Techniques
 Shoulder Flexion/Extension
 Shoulder Abduction
 Shoulder Internal/External Rotation
 Unilateral Diagonal Pattern D1
 Unilateral Diagonal Pattern D2
 Bilateral Diagonal Pattern D2

Lower Extremity Manual
Resistance Techniques
 Hip Adduction
 Hip Abduction
 Hip Flexion with Knee Flexion
 Hip Internal/External Rotation
 Knee Extension
 Ankle Motions
 Ankle Dorsiflexion and Plantarflexion
 Ankle Inversion and Eversion

Dynamic Trunk Stabilization
 Frontal Plane
 Multidirectional

Independent Strengthening
Exercises
 Extremity Strengthening Exercises
 Lumbar Spine Strengthening
 Trunk-Strengthening Exercises
– Standing
– Semi-reclined
– Supine
– Prone
– In deep water
Aerobic Conditioning
 Treatment Interventions
– Deep-water walking/running
– Mid-water jogging/running (immersed treadmill
running)
– Immersed equipment
– Swimming strokes

Physiological Response to Deep-
Water Walking/Running
 Cardiovascular Response
 Training Effect

Proper Form for Deep-Water
Running
 Instruction for Beginners
 Accommodating Specific Patient Populations

Exercise Monitoring
 Monitoring Intensity of Exercise

– Rate of perceived exertion
– Heart rate
 Monitoring Beginners

Equipment Selection
 Deep Water Equipment  Mid-Water Equipment
– Flotation belt – Specially designed socks
– Vests – Forced current
– Flotation dumbbells – Elastic tubing
– Noodles – Noodles
– Fins – Kickboard
– Specially designed boots
– Bells
– Buoyant dumbbells

 Case Studies

Tugas PPT Ziz Exercise

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Tugas PPT Ziz Exercise

Uploaded by

Copyright:

Available Formats

Range of Motion

Part II: Applied Science of Exercise and

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Part II: Applied Science of Exercise and

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Part II: Applied Science of Exercise and

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company

Copyright © 2013. F.A. Davis Company