PT Procedures 2: Lecture 1 (Therapeutic Exercise)
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Therapeutic Exercise (definition)
- 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
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
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
- Muscle Performance
- Neuromuscular Control
- Postural Control, Stability, & Equilibrium
- 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)
- Endurance & Fitness= synonyms
- The ability to perform low to moderate level activity over a period of time (ex) marathon
- Different from musculoskeletal endurance
- 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)
- 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
Name the order of ROM from most to least assistance
Passive-->Active Assisted-->Active-->Active Resisted (against external force) such as an isometric exercise
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
- Integration of sensory and motor systems that allows appropriate response to kinesthetic information
- Inner ear & proprioception of joints in space
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 limitedResults of PT Examination & Evaluation will dictate the type of exercise intervention that is indicated
Is skilled observation objective or subjective?
Objective & comes with experience.
What is Therapeutic Exercise Intervention used for?
-what is the purpose?
Resolve impairments & functional limitations
How is Ther Ex selected, prescribed & implemented?
-in response to what?
Response to patient centered goals that are measurable & time limited
How is the type of Ther Ex Intervention indicated?
--dependent upon what?
The results of the physical therapy examination & evaluation
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
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
NAGI (4 things)
- Functional Limitation
ICF (4 bullets)
- Impairment of body structure or function
- Activity limitation
- Participation restriction
- Impact of contextual factors on functioning, disability and health
Which type of impairments must physical therapy recognize and focus on?
In order for patients to have maximal attainment of goals, the ___________ _________ of impairments must be managed. Who manages this?
- Medical management
- PT management
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)
- 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
- Mobility in the community
- 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
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)
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)
-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
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
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?
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?
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
Disease, injury, trauma and special circumstances
Physiological functions of body systems including mental functions
Anatomical Components of the body
Problems of body function or structure
Execution of a task or action
Involvement in a life situation
Difficulty an individual may have in executing activities
Problems an individual may experience in life situations. Compares and individuals ability to participate with others w/in that cultural group.
Components of the physical, social and attitudinal environment
Factors in a persons environment tht improve function and reduce disability
Factors in a persons environment that limit function and create disability
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