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Principle of Physiotherapy Practice > Lecture 6 - Exercise Prescription > Flashcards

Lecture 6 - Exercise Prescription Flashcards

1
Q

Definition of Therapeutic Exercise

A 
(SPI)
S: Systematic
P. Planned performance:
- physical movements
- postures
- activities
I. Individualisation - meeting the unique needs of patient
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2
Q

Purpose of Therapeutic Exercise

A
  1. Remediate/ prevent impairments (body functions + structures)
  2. Improve and restore activities and participation
  3. Prevent/ reduce health-related risks
  4. Optimize overall health and fitness
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3
Q

Therapeutic Exercises Interventions

A
  1. Muscle performance (power + endurance)
  2. Cardiopulmonary endurance (aerobic + breathing ex.)
  3. Mobility / Flexibility (stretching techniques + joint mobilization)
  4. Neuromuscular control / coordination
  5. Stability
  6. Balance / postural equilibrium (ex. for balance and agility training)
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4
Q

4 body function impairments managed with Therapeutic ex.

A
  1. Musculoskeletal (pain, muscle weakness, decrease muscular endurance, limited ROM, faulty posture, muscle length imbalance)
  2. Neuromuscular (pain, impaired balance, postural stability or control, incoordination, delayed motor development, ineffective functional movement strategies)
  3. Cardiovascular/ Pulmonary (pain with sustained PA, decrease aerobic capacity, impaired circulation)
  4. Integumentary: skin hypomobility (immobile)
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5
Q

Common tasks related to Activity Limitations

A
  1. Reaching and grasping
  2. Bending and stooping
  3. Stand to sit (from and to chair/ floor)
  4. Moving around (crawling, walking, running) in various environments
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6
Q

How does body function affect participation?

Participation restrictions

A
  1. Self-care
  2. Mobility in the community –> socializing with friends and family
  3. Occupational tasks
  4. Home management (indoor and outdoor)
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7
Q

What makes a good patient management process?

A

Clinical decision making based on

  1. patient’s needs (selection, implementation, modification of ex. intervention)
  2. clinical reasoning and knowledge of PT practice
  3. evidence-based practice (use of current best evidence)
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8
Q

Clinical reasoning

What are the differences between PRIMARY and SECONDARY impairments?

A

Primary: directly from the health condition
Secondary: results of pre existing impairments
EX: Shoulder impingement syndrome
- Primary: structural issues
- Secondary: pre existing postural impairment (led to the use of upper extremity –> impingement from faulty mechanics)

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9
Q

Examples on task-specific functional training

A

Improve stair climbing ability of ambulatory older women

- climbing ups and downs stairs while wearing a weighted backpack

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10
Q

What are the benefits of task-specific functional training?

A
  • improve muscle performance (strength and endurance)

- directly enhanced the subject’s efficiency in stair climbing during daily activities

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11
Q

Active ROM

Purpose of assessment and treatment

A

Assessment:

  1. AROM
  2. Muscle strength
  3. Ability to perform ADL (activities of daily living)
Treatment:
Maintain/increase:
1. Joint ROM
2. Muscle strength
3. Ability to perform ADL (activities of daily living)

Exercise:

  • Active ROM (Grade 2-3)
  • Active assisted ROM (Grade 1-3)
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12
Q

Passive ROM

Purpose of assessment and treatment

A

Purpose:

  1. PROM
  2. End feel

Treatment:
maintain/increase
1. Joint ROM

Exercise: passive movement (Grade 0-1)

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13
Q

Muscle length

Purpose of assessment and treatment

A

Purpose:
- muscle length

Treatment:
maintain/increase
- muscle length

Exercise: stretching

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14
Q

Muscle strength

Purpose of assessment and treatment

A

Purpose:
- muscle strength

Treatment:
maintain/increase
- muscle strength

Exercise: resisted exercise (> Grade 3)

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15
Q

Universal Exercise prescription guide (5 points)

A
  1. Preparation (environment, equipment, explanation, patient position and exposure)
  2. Prescription procedure (provide correct exercise, instruction and demonstration)
  3. Therapist position (guide, support, protect, stabilise, observe)
  4. Exercise Intensity (FITT principle)
  5. Providing feedbacks (trick movement, unnecessary stress on other body parts)
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16
Q

4 Factors affect exercise safety

A
  1. medical history and current health status
  2. Medications
  3. Environment (inadequate space and support surface)
  4. Exercise equipment (not fit for the patient; not working)
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17
Q

How to improve exercise safety?

A
  1. Ensure accuracy of the performing exercise
  2. proper posture/ alignment of the body
  3. correct movement patterns
  4. appropriate intensity, speed, and duration
  5. Inform the patient (signs of fatigue; risk of injury due to fatigue; importance of rest after ex.)
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18
Q

How can a therapist minimise the risk of work-related injury?

A
  1. use proper body mechanics

2. Joint protection when applying resistance or a stretch force to improve patient/s strength or ROM

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19
Q

Practical suggestions for effective Exercise Instruction (give at least 3 suggestions)

A
  1. non-distracting environment
  2. Clear and concise verbal and written cues
  3. Demonstrate first
  4. Guide the patient through the desired movement
  5. Allow the patient demonstrate the exercise to you
  6. Provide specific feedback
  7. Home exercise with illustrations of the exercise
  8. Progress gradually
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20
Q

Factors that influence adherence to exercise program

A
  1. Patient related factors: age, sex, exercise habit, interest, motivation
  2. Health condition/impairment related (pain; the presence of comorbidities)
  3. Program-related: complexity and duration of the exercise program; interest of the patients
    * Therefore, it is important to prescribe an exercise program that a patient and carer will follow
21
Q

Strategies to foster patient adherence to exercise

A

(DEEP)

  1. Appreciate patient’s belief –> exercise to “get better”
  2. Help patient to identify personal benefits
  3. Design exercises that meet specific patient centered goals/functional outcomes
  4. Explain the rationale and importance of each exercise
  5. Engage patient in the exercise program design process
  6. Practical and functionally oriented ways –> patient can do it in daily life
  7. Keep an exercise log
  8. Follow-up visits (review/modify exercises)
  9. Point out the progress
  10. Identify barriers and offer suggestions (time? discomfort? no equipment?)
22
Q

Clinical factors leads to decrease ROM

A
  1. Systemic, joint, neurological, muscular diseases
  2. Surgical or traumatic insuits
  3. Inactivity or immobilization
23
Q

Aim of doing ROM activities

A

Maintain + Minimize

  1. Maintain joint and soft tissue mobility
  2. Minimize loss of tissue flexibility and contracture formation
24
Q

Precautions and contraindications to ROM exercises

A
  1. Patient response or the condition is life-threatening
  2. During early phases of healing, motion should be within the limits of pain-free
  3. PROM for major joints; AROM for ankles and feet to minimize venous stasis and thrombus formation (**NOT after thrombosis is formed)
  4. Careful monitoring for patients with heart diseases
  5. Patients on mechanically ventilated: AROM and progression to sitting, standing and walking may initiate early
25
Q

7 procedures for applying ROM

A
  1. Evaluate patient’s conditions
  2. Determine patient’s ability (PROM, A-AROM, or AROM)
  3. What movement patterns can best meet the goals
  4. The amount of motion
  5. Patient’s responses (vital signs, pain)
  6. Documentation of findings and intervention
  7. Re-evaluate and modify the intervention
26
Q

How to apply ROM techniques?

A
  1. Control movement - grab the extremity (be careful of patient’s comfort)
  2. Support areas of poor structural integrity (EX. recent fracture site)
  3. Move the segment through its pain-free range
  4. Perform the motions smoothly
27
Q

Definition of PROM exercise

A
  • Movement of a segment within the unrestricted ROM produced entirely by an external force
  • little to no voluntary muscle contraction
28
Q

Main goal of PROM exercise

A

reduce complications due to immobilization

29
Q

Sub goal of PROM exercise

A

MADE

  1. Maintain joint and connective tissues mobility; maintain patient’s awareness of movement
  2. Assist circulation and vascular dynamics
  3. Decrease pain
  4. Enhance synovial movement for cartilage nutrition
30
Q

Indications for PROM exercise?

A

A patient cannot actively move a segment(s) of the body:

  1. Inflammation after injury/ surgery (usually lasts for 2 to 6 days)
  2. when active motion would compromise the repaired muscle
  3. complete bed rest
31
Q

Limitations of Passive motion

A
  1. True PROM is difficult to obtain when muscle is innervated and the patient is conscious
  2. Passive motion does not:
    - prevent muscle atrophy
    - increase strength/endurance
    - assist circulation (unlike AROM)
32
Q

How do you perform shoulder flexion PROM exercise on patient?

A
  1. grasp the patient’s arm under the elbow with your lower hand
  2. With the top hand, cross over and grasp the wrist and palm of the patient’s hand
  3. Lift the arm through the available range and return
33
Q

How do you perform Hip and Knee PROM exercise on patient?

Flexion and Extension

A
  1. Support and lift the patient’s leg with the palm and fingers of the top hand under
    the patient’s knee and the lower hand under the heel
  2. As the knee flexes full range, swing the fingers to the side of the thigh
34
Q

Definition of Continuous Passive Motion (CPM)?

A
  1. Passive motion by mechanical device

2. Moves a joint slowly and continuously through a controlled ROM

35
Q

Definition of A-AROM and AROM exercises

A
  • movement of a segment within the unrestricted ROM produced by active contraction of the muscles crossing the joint
36
Q

Main goal of A-AROM and AROM exercises (same as PROM plus + ?)

A

reduce complications due to immobilization
plus:
- Stimulate bone and joint tissue integrity
- Increase circulation and prevent thrombus formation
- Develop skills for functional activities (coordination and motor)

37
Q

Indications for A-AROM and AROM

A
  • person can contract the muscles and move a segment with/without assistance
  • A-AROM: provide sufficient assistance to the muscles which allows it to function at its maximum level and be progressively strengthened
38
Q

Limitations of AROM

A
  • Does not maintain or increase strength for the muscle

- Does not develop skill/coordination (except for the movement patterns used)

39
Q

Transition from PROM to AROM (Cautions)

A
  1. Gravity
    - when the segment moves up against gravity –> provide assistance
    - when moving parallel to the ground (gravity eliminated) –> ONLY support the muscles take part through the range
    - When the segment moves downward (gravity “assisted”) –> muscle antagonist becomes active –> needs to support the muscle
  2. Be aware of the above effects and modify the patient’s position to meet the goals for A-AROM and AROM
40
Q

What are Self-assisted ROM techniques?

A

ROM exercises that patients can perform themselves

41
Q

What are important when therapist prescript self-assisted ROM techniques to patients?

A
  1. Educate patients on the value of the motion
  2. Teach patients on correct body alignment and stabilization
  3. Observe patient performance and correct any substitute or unsafe motions
  4. Make sure all hazards are eliminated (if equipment is used)
  5. Provide drawings and clear guidelines for exercise dosage
  6. Modify or progress the exercise program
42
Q

2 types of Self-assisted ROM techniques

A
  1. Manual
  2. Equipment
    – Wand
    – Wall climbing
    – Pulleys
    – Skate board /powder board
    – Reciprocal exercise devices
43
Q

Purpose of Wand (T-bar) Exercises

A

Patient usually has voluntary muscle control but needs guidance or motivation to complete the ROM

Actions:

  • shoulder flexion
  • horizontal abduction/adduction
  • rotation
44
Q

Purpose of Wall Climbing Exercise?

A
  • provide the patient with objective reinforcement and motivation for
    performing the task
  • visual feedback for the height reached
  • Steps closer to the wall as the arm is elevated
45
Q

Purpose of Overhead Pulleys Exercise

A
  • used when extremity is involved to perform ROM exercise
  • utilise more muscle activity than therapist-assisted ROM
  • Used only when muscle activity is desired
46
Q

Purpose of Skateboard/ powder board

A
  • Slide along the smooth surface of the board

- Friction-free surface encourage movement without gravity resistance/friction

47
Q

Purpose of Reciprocal Exercise Unit (bicycle, ergometer)

A
  • provide some flexion and extension to the involved limb while using the strength of the normal limb
48
Q

What is stretching exercise?

What is the 3-S Principle?

A
  1. force the motion passively beyond its available range
  2. Lengthens the targeted tissue beyond the point of tissue resistance

3=S Principle:
Slow
Sustained (>15 sec)
Stretch by therapist/ self stretching

Principle of Physiotherapy Practice (1 decks)

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