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Therapeutic Exercise (definition)
-4 goals
- The systematic, planned, performance of body movement, 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 overal health status, fitness or sense of well being
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Function as the key: what is the goal of Physical Therapy & how does it occur?
- To assist patients in resuming previous roles
- Occurs on a continuum dependent on the pathological processes that are occurring
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Components of Function (9)
- Cardiopulmonary Fitness: oxygentation is necessary for a functional neuromuscular system. Lifestyle choices & age can lead to deconditioning which decreases efficiency of oxygen production
- Coordination
- Flexibility
- Mobility
- Muscle Performance
- Neuromuscular Control
- Postural Control, Stability, & Equilibrium
- Stability
- Balance
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Balance
- The ability to maintain the COG over the BOS
- The ability to move the body w/in the AVAILABLE BOS w/o falling
- The ability to maintain the upright against gravity w/o falling
- Postural control & stability (proper allignment of the head, neck & trunk)
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Cardiopulmonary Fitness
- Endurance & Fitness= synonyms
- The ability to perform low to moderate level activity over a period of time (ex) marathon
- Different from musculoskeletal endurance
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Coordination
- The ability to move w/ accuracy in speed, sequencing and grading of movement
- Almost entirely automatic (senses take in info, info is processed, action is taken)
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Flexibiity
- Mobility
- ROM (passive:the ability to be moved, requires external force vs. active: the ability to move, requires muscle contraction) active assisted: need passive assistance at some point to complete motion
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Name the order of ROM from most to least assistance
Passive-->Active Assisted-->Active-->Active Resisted (against external force) such as an isometric exercise
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Name the 3 components of Muscle Performance?
- Strength: the ability to produce tension (hypertrophy muscle fibers & make them bigger from activity against resistance: strengthens w/ low repetition)
- Muscular Endurance: Ability to contract repeatedly and resist fatigue (swimmers)
- Power: Ability to create tension in a given period of time
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Neuromuscular Control
- Integration of sensory and motor systems that allows appropriate response to kinesthetic information
- Inner ear & proprioception of joints in space
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Therapeutic Exercise Intervention
- Procedural intervention that is used for the purpose of resolving impairments and functional limitations
- Prescribed and implemented in response to patient centered goals that are measurable & time frame limited
- Results of PT Examination & Evaluation will dictate the type of exercise intervention that is indicated
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Is skilled observation objective or subjective?
Objective & comes with experience.
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What is Therapeutic Exercise Intervention used for?
-what is the purpose?
Resolve impairments & functional limitations
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How is Ther Ex selected, prescribed & implemented?
-in response to what?
Response to patient centered goals that are measurable & time limited
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How is the type of Ther Ex Intervention indicated?
--dependent upon what?
The results of the physical therapy examination & evaluation
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Types of Exercise Intervention (7)
- Aerobic Conditioning (walking program should be progressive, w/ increasing demands at reg. intervals)
- Strength, power, & endurance exercises
- Stretching (active/passive)
- Stabilization Exercises (core)
- Postural Control & Balance Training (neuromuscular training)
- Relaxation Exercises
- Breathing exercises & Ventilatory Muscle training
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Disablement as a Driving Force in Patient Management & Intervention
-The purpose of the disablemet models NAGI & ICF
- Describe the functional consequences of acute or chronic conditions
- Treatmet is based on the impact of disease rather than on the disease itself
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NAGI (4 things)
- Pathology
- Impairment
- Functional Limitation
- Disability
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ICF (4 bullets)
- Impairment of body structure or function
- Activity limitation
- Participation restriction
- Impact of contextual factors on functioning, disability and health
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Which type of impairments must physical therapy recognize and focus on?
Functionally Relevent
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In order for patients to have maximal attainment of goals, the ___________ _________ of impairments must be managed. Who manages this?
UNDERLYING CAUSES
- Medical management
- PT management
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Common Functional Tasks (14 listed)
- Reaching and Grasping (first form: infancy as a reflex)
- Lifting & Carrying (ADL, recreation)
- Pushing & Pulling (household management, occupation)
- Bending & Stooping
- Turning & Twisting
- Throwing & Catching (children who can't play considered disabled)
- Rolling (trunk dominant activity that prepares babies for crawling)
- Standing
- Squatting & Kneeling
- Standing up & Sitting down (toiletting, chairs)--sitting is an eccentric activity w/ a balance component
- Getting in & out of bed (ROM, trunk stability, CORE strength)
- Crawling, Walking & Running
- Ascending & Descending Stairs (eccentric dominant)
- Hopping and Jumping, Kicking
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Abilities/Disabilities (8)
- Self-care/ADL
- Mobility in the community
- Occupation
- School (children must be able to get to school under the law)
- Home Management (take the trash out & care for pets)
- Caring for Dependents
- Recreation & Leisure (sports, arts, pistons game, ect)
- Community Responsibilities & Service
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How is Therapeutic Exercise used in the Prevention of Disability
- Reduce impact of functional limitations, preventing high levels of disability in high risk populations
- Health Promotion (exercise component), Early Intervention, Management of Chronic Disease (neuromuscular & musculoskeletal tune ups)
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Risk Factors for Disability
--all of these are considered in the ICF model of disablement--
- Biological Factors (genetic/inherited)
- Behavior Factors (substance abuse, relationship issues)
- Environmental Factors
- Socioeconomic Factors (huge impact, includes support systems, emotionally healthy motivation)
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Goal Setting
-goals provide a _______
-_________ are the roads traveled to arrive at the goal
- It is difficult to chart a course without a destination.... patient goals provide the destination
- The selected interventions are the roads traveled to arrive at the goal
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How are goals established? (4 bullets)
- After patient data is collected and evaluated
- Must decide if PT can treat indentified impairments & functional limitations
- Determine the patient view of their current functional state
- What are the patients priorities for recovery
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Goal issues to consider (3 bullets)
- How long will it take
- What should the patient expect from us and what should we expect from our patients? (set very early on)
- Are caregivers available for follow-up, transportation and other forms of assistance?
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Goals...Patient Centered (4 bullets of questions to ask)
- What specific functional changes can the patient expect to see at the end of the episode of care?
- What changes will be necessary at the structural level in order for the patient to reach their end of episode goals?
- How will you know when you have arrived at the goal? What will be measured?
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Effective Patient Management for the PTA
- Developing a trusting rapport with the patient
- Convey confidence and capability
- Continual monitoring of the patients resonse to treatment with close observation
- Data collection as necessary to measure response to treatment
- Responsive action to clarify and enhance the effectiveness of selected interventions
- Frequent and regular contact with supervising PT and rapid report of adverse or unexpected changes in patient status before, during or after treatment
- Accountability is a necessary part of safe and effective PT intervention
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Health Condition
Disease, injury, trauma and special circumstances
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Body Functions
Physiological functions of body systems including mental functions
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Body Structures
Anatomical Components of the body
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Impairments
Problems of body function or structure
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Activity
Execution of a task or action
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Participation
Involvement in a life situation
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Activity Limitation
Difficulty an individual may have in executing activities
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Participation Restrictions
Problems an individual may experience in life situations. Compares and individuals ability to participate with others w/in that cultural group.
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Environmental Factors
Components of the physical, social and attitudinal environment
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Facilitators
Factors in a persons environment tht improve function and reduce disability
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Barriers
Factors in a persons environment that limit function and create disability
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