COLLEGE OF PHYSICAL THERAPY

OLFU
Subject: Therapeutic Exercises 101
Semester: 2nd
SY: 2015- 2016
Notes on: Foundation of TX

 Relaxation exercises
 Breathing exercises and ventilatory muscle
training
Therapeutic Exercise: is the systematic, planned
 Task-specific functional training
performance of bodily movements, postures, or physical
Exercise Safety
activities intended to provide a patient/client with the Consider the following.
means to:  Health Status
• Remediate or prevent impairments  Environment
• Improve, restore, or enhance physical function  Equipment
• Prevent or reduce health-related risk factors  Execution
• Optimize overall health status, fitness, or sense  Education on fatigue
of  Therapist safety.
well-being
PROCESS AND MODELS OF DISABLEMENT

Patient vs. Client

Patient: An individual with impairments and functional
limitations
Client: Individual without diagnosed dysfunction who
engages in physical therapy services to promote health
and wellness and to prevent dysfunction.
Aspects of Physical Function
The ability to align body segments
against gravity to maintain or move the
body (center of mass) within the
Balance. available base of support without
falling
Cardiopulmonary The ability to perform low intensity,
fitness/Cardiopulmonary repetitive, total body movements
(walking, jogging, cycling, swimming)
endurance
over an extended period of time.
The ability of structures or segments of
the body to move or be moved in order
to allow the occurrence of range of
Flexibility/Mobility motion (ROM) for functional activities
(functional ROM).
The ability of the neuromuscular
system through synergistic muscle
actions to hold a proximal or distal
Stability body segment in a stationary position
or to control a stable base during
superimposed movement
The correct timing and sequencing of
muscle firing combined with the
Neuromuscular appropriate intensity of muscular
contraction leading to the effective
control/coordination initiation, guiding, and grading of
movement. It is the basis of smooth,
accurate, efficient movement and
occurs at a conscious or automatic
Muscle performance The capacity of muscle to produce
tension and do physical work.
Includes: Strength, Power and
Endurance
Types of Therapeutic Exercise Intervention
 Aerobic conditioning and reconditioning
 Muscle performance exercises: strength, power,
and endurance training
 Stretching techniques including muscle-
lengthening procedures and joint mobilization
techniques
 Neuromuscular control, inhibition, and
facilitation techniques and posture awareness
training
 Balance exercises and agility training
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Disablement:
A term that refers to the impact(s) and functional
consequences of acute or chronic conditions, such as disease,
injury, and congenital or developmental abnormalities, on
specific body systems that compromise basic human
performance and an individual’s ability to meet necessary,
customary, expected, and desired societal functions and
roles.
Disablement risk factors
1. Biological Factor
2. Behavioral/Psychological/Social factors
3. Physical Environmental Factors
4. Socioeconomic factors
Patient Management:
Clinical Decision Making
Refers to a dynamic, complex process of reasoning and
analytical (critical) thinking that involves making
judgments and determinations in the context of patient
care.
Evidence-Based Practice
“The conscientious, explicit, and judicious use of
current best evidence in making decisions about the care
of an individual patient.”
The process of patient management has five basic
components.
1. A comprehensive examination: The patient’s
health history A relevant systems review,
Specific tests and measures.
2. Evaluation of data collected: a process
characterized by the interpretation of collected
data.
3. Determination of a Diagnosis based on
impairments, functional limitations, and
disability
4. Establishment of a prognosis and plan of care
based on patient-oriented goals : ; A prognosis
is a prediction of a patient’s optimal level of
function expected as the result of a course of
treatment and the anticipated length of time
needed to reach specified functional outcomes.
The plan of care, an integral component of the
prognosis, delineates the following anticipated
goals
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5. Implementation of appropriate interventions:
Intervention, a component of patient
management, refers to any purposeful interaction a
therapist has that directly relates to a patient’s care
stage the movements in the task, thus making it
possible to do other tasks simultaneously.
 (+) Variations
VARIABLES THAT INFLUENCE MOTOR LEARNING

OUTCOMES PRE- PRACTICE CONSIDERATION

 This is stated as the result  Attention
 Monitored all throughout the course of PT  Demonstration
 Outcomes are measured through:
1. Physical Function
 Pre-practice verbal instructions
2. Prevention of risk
3. Level of health and wellness PRACTICE
4. Patient’s satisfaction  Partial practice VS. Whole practice
STRATEGIES FOR EFFECTIVE EXERCISE INSTRUCTION
 BLOCKED VS. RANDOM VS. RANDOMBLOCKED

MOTOR LEARNING:
 Physical practice VS. Mental practice
A complex set of internal processes that involves the relatively permanent
acquisition and retention of a skilled movement or task through practice. FEEDBACK
-Knowledge of performance (KP) : immediate, post-task,
Motor Learning Vs. Motor Performance augmented feedback (usually verbal) about the
(+) Acquisition (+) Acquisition nature or quality of the performance of a motor
(+) Retention (-) Retention task

-Knowledge of results (KR): Immediate, post-task,

MOTOR TASK augmented feedback about the outcome of a motor
Types of Motor task task
 A discrete task involves a movement
with a recognizable beginning and end.
Discrete  Grasping an object, doing a push-
 Intrinsic :
up, or locking a wheelchair are examples  Augmented
of discrete motor tasks.  Concurrent
Serial task is composed of a series of discrete  Post response
Serial task movements that are combined in a particular
 Immediate
sequence
 Continuous task involves repetitive,  Delayed
Continuous uninterrupted movements that have no  Summary
task. distinct beginning and ending.  Intermittent
 Examples include walking,
 Continous
ascending and descending stairs, and
cycling.
Conditions and Progression of Motor Tasks ADHERENCE:
1. The environment in which the task is performed;
2. The inter-trial variability of the environment thatis Factors affecting adherence
imposed on a task
3. The need for person’s body to remain stationary or to
 Patient characteristics
move during the task;  Health condition/impairment
4. The presence or absence of manipulation of objects  Program related variables
during the task.

STAGES OF MOTOR LEARNING

Stage Description END
 The patient needs to think about each
component or sequence of the skilled movement.
Cognitive stage  The patient tries to get the “feel” of the
Suggestion:
exercise.
 Distraction may hinder learning.
Read the Therapeutic Exercise 6th edition by Kisner and Colby for a
 Errors are common.
 The patient makes infrequent errors and more detailed discussions
concentrates on fine-tuning the motor task.
 The patient explores slight variations and
modifications of movement strategies while doing the
Associative task under different environmental conditions (inter-
stage trial variability)
 The patient requires infrequent feed-back
from the therapist and, instead, begins to anticipate
necessary adjustments and make corrections even
before errors occur.
 Movements are automatic.
 The patient does not have to pay attention to
Autonomous

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