THERAPEUTIC

EXERCISE
Foundations and Techniques
 Chap:1
General Concepts and Techniques

 Definition of Therapeutic Exercise:

 It is systematic and planned performance of bodily
movements, postures or physical activities intended to
provide a patient or a client with the means to;
• Remediate or prevent impairments
• Improve, restore or enhance physical function
• Prevent or reduce heath related risk factors
• Optimize overall health status, fitness or sense of well-
being
 Who is patient and who is client?

 Person1; with
impairments and
limitations
 Person2; without
diagnosed dysfunction
 Its your task to
categorize these two
persons
Definitions of key terms
 Definitions of key terms

 Balance
 Cardiopulmonary fitness
 Coordination
 Flexibility
 Mobility
 Muscle performance
 Neuromuscular
 Postural control
 Stability
 control
Components of Physical
Function
Balance- The ability to align body segments
against gravity to maintain or move the
body within the available base of support
without falling.
Cardiopulmonary fitness- The ability to
perform moderate-intensity, repetitive,
total body movements over an extended
period of time. A synonymous term is
cardiopulmonary endurance.
Flexibility- The ability to move freely
without restriction.
Coordination- The correct timing and
sequencing of muscle firing combined
with the appropriate intensity of muscular
contraction leading to initiation, guiding
and grading of movement.
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 for functional activities.
Muscle performance- The capacity of
muscle to produce tension and do physical
Neuromuscular control- Interaction of sensory
and motor systems that enables synergists,
agonist and antagonist as well as stabilizers.
Postural control/Postural stability and
Equilibrium- Used interchangeably with static
or dynamic balance.
Stability- The ability of 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.
Aspects of Physical Function:
Definition of Key Terms
 Aspects of Physical Function:
Definition of Key Terms(Contd)
Aspects of Physical Function:
Definition of Key Terms(Contd)
Aspects of Physical Function:
Definition of Key Terms(Contd)
 Aspects of Physical Function:
Definition of Key Terms(Contd)
 Aspects of Physical Function:
Definition of Key Terms(Contd)
Muscle performance.
Aspects of Physical Function:
Definition of Key Terms(Contd)
Aspects of Physical Function:
Definition of Key Terms(Contd)
 Types of therapeutic exercise
intervention
 Aerobic Conditioning
 Muscle performance exercises
 Stretching techniques
 Neuromuscular control, inhibition and facilitation control
 Postural control
 Balance exercise relaxation exercises
 Breathing exercises
 Task-specific functional training
 Process and models of disablement
The Disablement Process:
 Implications in Health Care
•Social, emotional, and
cognitive disablement can
affect physical function and
vice versa
•Physical therapists most
commonly deals with physical
disability
 Process and Models of
Disablement
 Disablement: it refers to the impact and functional
consequences of acute or chronic conditions, such as
disease, injury and congenital or developmental
abnormalities, on specific body systems that compromise
an individual’s ability to meet necessary, customary,
expected and desired societal functions and roles.
 The process is not “Unidirectional”.
 Understanding of the disablement process shifts the
therapist’s focus from the treatment of the disease to the
treatment of the impact.
 Models of Disablement

 Nagi model
 International Classification of Impairments,
Disabilities, and Handicaps (ICIDH) model for
the World Health Organization
 The National Center for Medical Rehabilitation
Research (NCMRR)
 Models of Disablement

 APTA Model “Guide to Physical Therapist”

 All of the models basically focus on the relation among;
 Acute /chronic pathology
 Impairments
 Functional limitations
 Disabilities, handicaps or societal limitations
 Key components of process of
Disablement
1. Pathology/ Pathophysiology (disruption
of body’s homeostasis), lets us take the example of two
patients with RA…
 Key components of process of
Disablement
2. Impairments
Consequences of pathologic conditions
Musculoskeletal, neuromuscular, integumantary, cardiopulmonary
Primary/ Seconday/ Composite
 Common Physical Impairments
Managed with Therapeutic Exercise

Musculoskeletal
 • Pain
 • 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
Common Physical Impairments
Managed with Therapeutic
Exercise(contd)
Neuromuscular
• Pain
• Impaired balance, postural stability, or control
• Incoordination, faulty timing
• Delayed motor development
• Abnormal tone (hypotonia, hypertonia, dystonia)
• Ineffective/inefficient 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)
 Key components of process of
Disablement
3. Functional Limitations(occurs at the level of
whole person),(physical, social, psychological), ADL’s
/IADL’s
Can anyone tell what activities are needed to perform the
room painting?
Types of Functional Limitations
•ADL
•Bathing
•Dressing
•Feeding
•IADL :more complex tasks
•Occupational tasks
•School-related skills
•Housekeeping
•Recreational activities
•community mobility
 Common Functional Limitations
Related to Physical Tasks
Limitation of
• Reaching and grasping
• Lifting and carrying
• Pushing and pulling
• Bending and stooping
• Turning and twisting
• Throwing and catching
• Rolling
• Standing
• Squatting and kneeling
• Standing up and sitting down
• Getting in and out of bed
• Crawling, walking, running
• Ascending and descending stairs
• Hopping and jumping
• Kicking
 Disability

(it is the inability to perform or participate

in activities or tasks related to one’s self,
the home, work, recreation or the
communtiy as a whole).
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 and sequelae

•Tertiary 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 disease
Disablement Risk Factors
Biological Factors
• Age, sex, race
• Height/weight relationship
• Congenital abnormalities or disorders
• Family history of disease; genetic predisposition
Behavioral/Psychological/Lifestyle Factors
Disablement Risk Factors

• Sedentary lifestyle
• Use of tobacco, alcohol, other drugs
• Poor nutrition
• Low level of motivation
• Inadequate coping skills
• Difficulty dealing with change
• Negative affect
Disablement Risk Factors
• Physical Environment Characteristics
Architectural barriers in the home, community, and workplace
• Ergonomic characteristics of the home, work, or school
environments
Socioeconomic Factors
• Low economic status
• Low level of education
• Inadequate access to healthcare
• Limited family or social support
 What is Clinical Decision
Making?
 Requirements for skilled clinical
decision making…
Patient Management Model
Your comments!!!