9/13 - Ther-ex Foundational Concepts Flashcards
what is therapeutic exercise
systematic, planned performance of bodily movements, postures, or physical activities intended to provide patient/client means to achieve goals
what are the 4 goals of therapeutic exercise
- remediate or prevent impairment
- improve, restore, or enhance physical function
- prevent or reduce health related risk factors
- optimize overall health status, fitness, or sense of well-being
what are 8 components that contribute to physical function
balance
cardiopulmonary fitness
coordination
flexibility / mobility
muscle performance
neuromuscular control
postural control / stability & equilibrium
stability
balance
align body segments against gravity to maintain/move body within base of support
cardiopulmonary fitness
perform moderate intensity, repetitive total body movements over an extended period of time
coordination
correct timing/sequencing of muscle firing & intensity of muscular contraction leading to effective movement
what are reasons that people have impaired ROM
impaired joint integrity
impaired ms length
weakness
pain
flexibility / mobility
ability to move without restriction
- ms vs joints
muscle performance
capacity of ms to produce tension & do physical work
- strength
- power
- endurance
neuromuscular control
interaction of sensory & motor systems that enables muscles to anticipate/respond to proprioceptive/kinesthetic info to create coordinated movement
why would someone with adequate strength and ROM still have difficulty moving
poor motor control / NM control
postural control/stability & equilibrium
static or dynamic balance
stability
ability of NM system to maintain body in a stationary position or control stable base during superimposed movement
what are 9 types of ther-ex interventions
aerobic conditioning/reconditioning
muscle performance
stretching techniques
NM control
postural control
balance exercises/agility training
relaxation exercises
breathing exercises
task-specific functional training
what type of exercises are included in a muscle performance intervention
strength
power
endurance
what are stretching techniques
muscle length
joint mobilization / manipulation
what are examples of exercises utilized in a neuromuscular control intervention
inhibition and facilitation techniques
stabilization exercises
what do breathing exercises as an intervention typically incorporate
ventilatory muscle training
when working on task-specific functional training what is an important strategy to use
break down into smaller components that will be necessary for motion when put all together
what are 7 ways to set the patient up for success
1.limit distractions
2. incorporate patient’s learning style
3. begin w “simple” tasks and movements
4. clear & concise instructions w pictures
5. demonstrate proper form
6. manually guide patient thru movement
7. provide feedback during/after pt performance
how should you provide feedback to the patient to be most effect
don’t give feedback on all the things doing wrong in a novel task
- too overwhelming
give feedback on biggest thing
- and then bits and pieces from there when pt can process it
what is motor learning
complex set of internal processes that involves acquisition and relatively permanent retention of a skilled movement or task thru practice
what are two important components included in motor learning
performance
learning
what is motor performance
acquisition of ability to carry out a skill
what is motor learning
acquisition of ability to carry out a skill and retention of that skill
what is a discrete task
action or movement with distinct beginning and end
- ex: stretching hamstrings
what is a serial task
series of discrete movements combined into a specific sequence
- ex: getting up from floor
what is a continuous task
repetitive uninterrupted movement with no distinct beginning or end
- ex: gait
what are 4 things included in task dimensions
- environment where task performed
- inter-trial variability of environment imposed on task
- body stable or body transport (movement) during task
- manipulation of objects during task
- absent or present
what is included in the environment in terms of ther-ex
objects or people around pt
surface task is performed on
closed vs open environment
closed
- objects/people around pt and surface don’t move
open
- objects/people around pt are in motion and/or support surface is unstable
absent vs present inter-trial variability in environment
absent - task occurs in CONSTANT environment from one performance to the next
- can motor plan easily
present - task occurs in VARIABLE environment from one performance to the next
what is the body stable or body transport dimension of a task
body stable - pt maintains stable body position during task
body transport - pt moving from one place to another during task
what is a manipulation of objects task dimension
performing a task requiring or not requiring UE manipulation activities
- ex: throwing ball to a patient outside BOS
- ex: passing medicine ball around trunk
what are the stages of motor learning
cognitive
associative
autonomous
what is the cognitive stage of motor learning
what to do & how to do it safely/effectively
errors are common
significant feedback
what is the associative stage of motor learning
focused on consistency & fine tuning
infrequent errors
minimal feedback
what is the autonomous stage of motor learning
movements are automatic
patient easily adapts to more challenging environments
what are pre-practice considerations that impact learning and retention (4)
understand the purpose of exercise/task
interest in exercise/task
attention to exercise/task
demonstration will enhance learning
what is a pre-practice consideration that can improve patient compliance
task needs to be meaningful to the patient
- connect to their goals
describe part practice
task is broken down into separate dimensions and practiced
sequence combined after mastery of segments
effective in early stage of learning
describe whole practice
entire task performed from beginning to end
effective for acquiring continuous skills
blocked order practice
same task performed repeatedly under same conditions in predictable order
each rep is the same
- ex: step up on 6’’ step
appropriate during cognitive (initial) stage of learning
random order practice
slight variations of same task carried out in unpredictable order
each rep is different
- ex: step up to variable heights
leads to better skill retention and generalizability of skills
random/blocked order practice
variations of same task performed in random order
each variation is performed more than once
- ex: step up to variable height steps, 2 reps at each step
helpful w autonomous stage
what is physical practice
movements of exercise or functional task that are actually performed
what is mental practice
aka visualization, motor imagery practice
cognitive rehearsal of how motor task is to be performed that occurs prior to executing task
- reinforces cognitive component of learning
- enhances skill acquisition at a faster rate than physical practice alone
what patient population has mental practice been found particularly helpful with
anxious/apprehensive
- preplan motor activities so know what will happen
- ex: pts w hx of falls, post-op
what is feedback
sensory info received & processed by learner during or after performing/attempting to perform a motor skill
what is intrinsic feedback
from sensory systems of learner
arises from performing/attempting to perform task
involves proprioceptive, kinesthetic, tactile, visual, or auditory cues
provides KP and KR
what is augmented feedback
extrinsic feedback
supplemental to intrinsic feedback
PT provided during or after task to provide KP or KR
verbal, tactile, auditory, visual
why is augmented feedback important
patient might be seeing things more grossly
- we can see more specific to what the components of the movements look like
knowledge of performance (KP) vs knowledge of results (KR)
KP: nature or quality of performance of a motor task
- intrinsic feedback during a task or immediate post-task augmented feedback
KR: outcome of a motor task
- immediate post-task augmented feedback
concurrent vs postresponse timing of feedback
concurrent - during performance in real time
postresponse - after completing or attempting to complete a motor skill
immediate vs delayed vs summary feedback
immediate - directly after task completed
delayed - short interval for pt reflection
summary - feedback ab avg performance following several reps
variable vs constant feedback
variable - occurs intermittently during practice of motor task
constant - occurs regularly during practice of motor task
what is a good way to motivate patient adherence
connect to what they’ve learned
what are patient related factors that impact adherence to exercise
understanding of condition
understanding of exercise program
level of motivation
what are 3 things that influence patient adherence to exercise
patient related factors
factors related to health condition or impairments
program-related variables
what are program-related variables that impact adherence to exercise
complexity of program
quality of instruction/feedback
what does an exercise program need to address
all areas of physical function w deficits
the type of exercise selected should be consistent with what
individual needs of patient
what does a PT need to do to enhance learning
provide quality instruction and feedback
what is the MOST important thing about the patient’s experience
must be meaningful to the patient
