07-01: Introduction to Therapeutic Exercise

Question 1

Definition of Therapeutic Exercise

Answer 1

• Systematic and planned performance of bodily movement, postures, or physical activities
• True goal: Optimize function

Question 2

Purpose of Therapeutic Exercise (4)

Answer 2

• Remediate or prevent impairments
• Improve, restore or enhance physical function
• Prevent or reduce health-related risk factors
• Optimize overall health status, fitness, or sense of well-being

Question 3

Interrelated aspects of physical function (6)

Answer 3

• Muscle performance
• Cardiopulmonary/Endurance
• Mobility/Flexibility
• Neuromuscular Control/Coordination
• Stability
• Balance/Postural Equilibrium

Question 4

Therapeutic Exercise Interventions

Answer 4

• Aerobic conditioning
• Muscle performance (strength, power, endurance)
• Stretching techniques
• Neuromuscular control
• Posture control, body mechanics, stabilization
• Balance exercises and agility training
• Relaxation exercises
• Task-specific functional training
• Safety is always key
• Intervention vary according to patient, not cookie-cutter

Question 5

Nagi (Disablement) Model

Answer 5

• Pathology
• Impairment
• Functional Limitation
• Disability
• Quality of Life = Functional Limitation & Disability

Question 6

Pain (Treatment Approach)

Answer 6

• Modalities
• Activity modification
• Pt Education

Question 7

Decreased Strength (Treatment Approach)

Answer 7

• Strengthening: Isometric, Isotonic
• Rotator cuff
• Scapular stabilizers

Question 8

Decreased ROM (Treatment Approach)

Answer 8

• P/A/AAROM to shoulder complex
• Active/Passive stretching to pecs, subscap, UT
• HEP

Question 9

Decreased Jt. Mobility (Treatment Approach)

Answer 9

• Posterior GH glides
• Inferior GH glides
• Lateral and LAD

Question 10

Postural Deficits (Treatment Approach)

Answer 10

• Postural education

Question 11

ICF Model

Answer 11

• International Classification Function
• Created by WHO (World Health Organization)
• Focuses on function and what patient is ABLE to do or needs to be ABLE to do
• Health condition
• Impairment (Body function, structures)
• Activities
• Participation
• Personal factors
• Environment

Question 12

Patient Management Model

Answer 12

• Help patient achieve highest function possible
• Collaboration between PTA/PT and patient
• Comprehensive examination
• Evaluation of data collected
• Determination of a diagnosis based on impairments, functional limitations and disability
• Establishment of a prognosis and plan of care based on patient- oriented goals
• Implementation of appropriate interventions

Question 13

Examination (PM)

Answer 13

• Pt history
• Systems review
• Tests and measures

Question 14

Evaluation (PM)

Answer 14

• Interpret findings to determine diagnosis, prognosis and plan of care

Question 15

Diagnosis (PM)

Answer 15

• Identification of dysfunctions
• Signs & Symptoms
• Impairments
• Functional limitations
• Disabilities

Question 16

Prognosis/POC (PM)

Answer 16

• Projection of optimal level and time frame for improvement
• Description of patient/client management
• Anticipated goals/expected outcome
• Frequency and duration of interventions and discharge plans

Question 17

Intervention (PM)

Answer 17

• Coordinate, communicate and document
• Patient/client instructions: Active participation, written instructions, PT demos (HEP, Teach inpatient)
• Procedural interventions: Ther-Ex needs to be functional - task specific)

Question 18

Functional Outcomes (3)

Answer 18

• Meaningful: Ability to function at work, home, community; important to pt, family, caregivers, employers, etc.
• Practical: Efficient and cost-effective; time management is key (Exercises, SOAP Notes)
• Sustainable: Improvements maintained over time after discharge
• All goals must be measurable or quantifiable

Question 19

Discharge

Answer 19

• Anticipated goals and expected outcomes have been attained

- HEP, referral to community resources, transfer of care, or services no longer warranted

Question 20

Discontinuation

Answer 20

• Occurs prior to achievement of goals

- Due to status change, pt request, non-compliance, unjustified services per third party payers (denial)

Question 21

Effective Exercises Instruction

Answer 21

• Nondistracting environment for instruction
• Teach exercises that replicate movement patterns of simple functional tasks
• Demonstrate proper exercise performance, have pt model movements
• Initially guide pt through desired movement
• Clear and concise verbal/written directions
• Complement written exercises for HEP with illustrations of the exercise
• Have pt demonstrate exercise; supervise and provide feedback
• Specific, action-related feedback (Explain why something was correct or incorrect)
• Teach entire exercise program in small increments
• Optimize exercises with motor learning principles

Question 22

Motor performance

Answer 22

• Process of learning to do (acquiring) task

Question 23

Motor learning

Answer 23

• Process of acquiring AND retaining task

Question 24

Types of motor tasks (3)

Answer 24

• Discrete task
• Serial task
• Continuous task

Question 25

Discrete Task

Answer 25

• Simple, non-variable tasks
• Has a recognizable beginning and end
• Ex: Lifting and lowering weight, grasping objects

Question 26

Serial Task

Answer 26

• A series of discrete tasks

- Ex: Eating steak = grasping, piercing, cutting, lifting, chewing

Question 27

Continuous Task

Answer 27

• No distinct beginning or end

- Ex: Running, walking, cycling

Question 28

Taxonomy of Motor Tasks

Answer 28

• Environmental conditions + Desired outcome of action
• Simple: Body Stable without manipulation; no intertrial variability
• Complex: Body transport with manipulation; intertrial variability

Question 29

Stages of Motor Learning

Answer 29

• Cognitive Stage: How do you learn? What to do, how to do it?
• Associative Stage: Pt finetunes what they learn; Task in different environments
• Autonomous Stage: Pt can do movement automatically

Question 30

Adherence to Exercise

Answer 30

• Adherence = more active involvement of pt
• Best HEP = exercises pt will do
• Help pt see link between exercise and functional goals/outcomes
• Simple; don’t overload, progress slowly but surely
• Figure out how to work into schedule
• Keep a log
• Point out progress
• Identify barriers to adherence; find ways to make exercises work