Therapeutic exercise:

foundational concepts
Chapter 1
STRATEGIES FOR EFFECTIVE EXERCISE
AND TASK-SPECIFIC INSTRUCTION
• Preparation for Exercise Instruction
• A positive relationship between therapist and patient is a
fundamental aspect for creating a motivating environment
that fosters learning.
• Effective exercise instruction is also based on knowing a
patient’s learning style; that is, if he or she prefers to
learn by watching, reading about, or doing an activity.
• METHOD FOR PROMOTING MOTIVATION
Design the exercise program so the least complicated or
stressful exercises are taught first.
Concepts of Motor Learning

• 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.
• Motor learning is not directly observable, measured
analysis of how an individual performs a skill.
• Performance involves acquisition of a skill.
• Learning involves both acquisition and retention.
Types of Motor Task
• Three basic types of motor tasks are:
• Discrete task
• Serial task.
• Continuous task

• DISCRETE TASK:
• It involves a movement with a recognizable beginning
and end.
• EXAMPLES:
• Grasping an object, doing a push-up, lifting weight
Contd…
• SERIAL TASK:
• Is composed of a series of discrete movements that are
combined in a particular sequence.
• EXAMPLES:
• Wheelchair transfers

• CONTINUOUS TASK:
• It involves repetitive, uninterrupted movements that have
no distinct beginning and ending.
• EXAMPLES:
• Walking, cycling
Conditions and Progression
of Motor Tasks
• A taxonomy of motor tasks, proposed by Gentile is a
system for analyzing functional activities and a
framework for understanding the conditions under which
simple to complex motor tasks can be performed.
• There are four main task dimensions addressed in the
taxonomy:
• ENVIRONMENTS:
• Closed: environment is one in which objects around the
patient and the surface on which the task is performed do
not move.
Contd…
• EXAMPLE:
• Walking in an empty hallway

• OPEN: environment is one in which objects, other

people, or the support surface are in motion during the
task.
• Movement that occurs is not under the control of the
patient.
• EXAMPLE:
• Standing on a moving train or bus
Contd…
• INTERRATER VARIABILITY IN ENVIRONMENTS MAY BE:
• ABSENT
• PRESENT

• WHEN ABSENT:
• Environment in which a task is set is unchanging from one
performance of a task to the next.
• E.g. walking on just one type of surface.

• WHEN PRESENT:
• Demands change from one attempt or repetition of a task to the
next.
• E.g. walking over varying terrain
Contd…
• BODY STABLE OR TRANSPORT
• Tasks that involve maintaining the body in a stable
(stationary) position such as maintaining an upright
posture, are considered simple tasks
• Task requirements involve the patient moving from one
place to another (body transport).

• MANIPULATION OF OBJECTS:
• When a task is performed without manipulating an
object, it is considered less complex and vice versa.
Stages of Motor Learning
• There are three stages of motor learning:
• Cognitive
• associative
• Autonomous

• Cognitive stage:
• When learning a skilled movement, a patient first must
figure out:
• what to do
• how to do
• Patient needs to think about each component or sequence of
the skilled movement.
Contd…
• During this stage of learning errors in performance are
common
• Associative Stage
• The patient makes infrequent errors and concentrates on
fine-tuning the motor task during the associative stage of
learning, patient also uses problem solving to correct
errors when they do occur.
• At this stage, the patient requires infrequent feedback
and make corrections even before errors occur.
Contd…
• Autonomous Stage
• Movements are automatic in this final stage of learning.
The patient does not have to pay attention to the
movements in the task, thus making it possible to do
other tasks simultaneously
• The patient easily adapts to variations in task demands
and environmental conditions.
Variables That Influence Motor
Learning
• Motor learning is influenced by many variables, some of
which can be manipulated by a therapist during exercise
instruction
• These variables include:
Pre-practice considerations
Practice
Feedback
Pre-Practice Considerations
• A number of variables can influence motor learning
during an exercise session even before practice begins.
• A patient’s understanding of the purpose of an exercise
or task, as well as interest in the task, affect skill
acquisition and retention.
• Attention is the ability to focus on the skill to be learned
without distracting influences in the environment
promotes learning.
Contd…
• Demonstration of a task prior to commencing practice
also enhances learning. It is often helpful for a patient to
observe another person, usually the therapist or possibly
another patient, correctly perform the exercise or
functional task and then model those actions
Practice
• Motor learning occurs as the direct result of practice that
is, repeatedly performing a movement or series of
movements in a task
• The amount, type, and variability of practice directly
affect the extent of skill acquisition and retention
Part versus whole practice
• PART PRACTICE
• A task is broken down into separate dimensions.
Individual and usually the more difficult components of
the task are practiced. After mastery of the individual
segments, they are combined in sequence so the whole
task can be practiced
• WHOLE PRACTICE
• The entire task is performed from beginning to end and is
not practiced in separate segments
Blocked, Random, and Random-
Blocked Practice
• Blocked practice. The same task or series is performed repeatedly under
the same conditions and in a predictable order
• EXAMPLE:the patient may consistently practice walking in the same
environment, standing up from the same height chair.
• Random practice. Slight variations of the same task are
• carried out in an unpredictable order
• Example: a patient could practice standing up from chairs of different
heights or styles in a random order; therefore, the task changes with each
repetition
• Random-blocked practice. Variations of the same task are performed in
random order, but each variation of the task is performed more than once
• Example: the patient rises from a particular height or style chair, and
then repeats the same task a second time before moving on to a different
height or style chair
 Physical Versus Mental Practice

• Physical practice. The movements of an exercise or

functional task are actually performed
• Mental practice. A cognitive rehearsal of how a motor
task is to be performed occurs prior to actually doing the
task; the terms visualization and imagery are used
synonymously with mental practice
Feedback
• Feedback is sensory information that is received and
processed by the learner during or after performance of a
movement or task.