Designing a Home exercise program - A practical approach

MUSCULO-SKELETAL REHAB

CLASSICAL PHYSIOTHERAPY MODEL -70S

1.Decrease symptom,such as pain using

heat/cold,electrotherapy or traction. 2.Increase ROM through passive /active mobilisation/stretchings. 3.Finally strengthen the affected structures and then normalise functions(graded exercises).

Current model

Step 1 - Tissue Normalisation First we bring the injury under control, so your tissues can begin to heal. This helps the injured part to function smoothly with the rest of the body. Step 2 - Muscle Activation An injury is extremely painful, and makes movement difficult. By activating injured muscles early, you'll recover sooner. Step 3 - Static Control Develop sufficient strength and control of your injured body part to hold a neutral position whilst other parts are moving. Step 4 - Dynamic Control Develop the strength to control the injured body part during movement. By increasing endurance, you'll be able to maintain dynamic control. Step 5 - Functional Rehabilitation You're well on your way to full recovery. This stage customises your rehabilitation to your specific needs. Step 6 - Functional Fitness

This stage is ensures you have the necessary physical fitness, power, endurance, body awareness, strength and flexibility to perform physically.
Step 7 - Maintenance Program To make sure you don't experience a recurring injury, we tailor a program to keep you fighting fit, monitor your progress and continue to supervise rehabilitation.

Why & where did I MISS?

Effectiveness of HEP
Can be installed as a part of treatment-inbetween

manual therapy to maintain ROM. Using it as a complimentary therapy in time feasable conditions. Using it as a preventive stategy in recurrence. As a main course therapy for minor musculoskeletal sprains and strains. Using it for neuromuscular co-ordination.

Added benefits-cognitive

Physical work capacity-daily requirement vs reserve.

120
100 80

60
40 20

reserve workcapacity

0
Category 1

Effectiveness of home exercise on pain anddisability fromosteoarthritis of the knee: arandomised controlled trialSheila C OReilly, Ken R Muir, Michael Doherty
A simple program of home quadriceps exercises can significantly improve self reported knee pain and function. (Ann Rheum Dis 1999;58:1519)

Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise ProgramGail D Deyle, Stephen C Allison,Robert L Matekel, Michael G Ryder, John M Stang, David D Gohdes, JeremyPHutton, Nancy E Henderson and Matthew B Garber

The results indicate that a home exercise

program for patients with OA of the knee provides important benefit. Adding a small number of additional clinical visits for the application of manual therapy and supervised exercise adds greater symptomatic relief.

Comparison of the results of supervised physiotherapy program and home-based exercise program in patients treated with arthroscopic-assisted mini-open rotator cuff repair]. [Article in Turkish] Bker N, Kiti A, Akkaya S, Akkaya N.
RESULTS: There were significant improvements in all evaluation parameters in both

groups after rotator cuff repair.

CONCLUSION:
There were no statistical differences between the patients who received

exercise program under the supervision of the physiotherapist and the patients who were treated with standardized home-based exercise program for the efficacy of treatment in the evaluation of pain, functional status, quality of life, and depression status. When the rehabilitation programs were analyzed for cost effectiveness, the supervised physiotherapy group was found to have higher costs.

DIFFICULTIES

Space Feasibility

SUPERVISED AND UNSUPERVISED

time

Availability of medium (gadgets).

Construction of exercises

Economy

Exercising equipments

HOW TO APPROACH DIFFICULTIES

OBJECTIVES AND GUIDANCE

Priority

To accomplish its necessary to follow the objectives

1.Defined starting position of every exercise.

2.Defined ways of doing exercise without faulty

patterns. 3.Defined resistance body weight /angle of inclination. 4.Defined time-each set interval/session interval/day. 5.Defined repetitions-each exersise/sets. 6.Defined frequency-day/week. 7.Defined speed-easy verbal couting method. 8.Defined follow up interval/progression interval.

Practical ways
SIMPLE CONSTRUCT-availabilities of patients

home /list MINIMAL GADGETS-affordability /therabands tubings MINIMAL SPACE-at home MININMAL TIME CONSUMPTION-work timing ECONOMICAL-number of visits for progressions possible WAYS TO IMPLEMENT diary /mobile recordings WAYS TO MONITOR-once a week home monitoring by inmates.

Easy ways.

Stick diagram prescription

Mobile recordings

Exercise recording calendar

Android application-to do list with remainders available for free .

Home exercise program..