Therapeutic Exercise I Chapter 1

1. Therapeutic Exercise IChapter 1 Foundational Concepts Lecture

2. GOAL To achieve optimal level of symptom free movement during basic to complex physical activities Geared towards the restoration of meaningful function/activities of ADL’s for the patient and their families/caregivers Recently has been a focus on evidence based practices Patient verses Client An individual with impairment and is receiving PT for improved function and prevent disability is a patient A client is an individual without dysfunction and engages in PT to promote wellness/health to prevent dysfunction Therapeutic Exercise

3. Aspects of Physical Function • Balance • Cardiopulmonary Fitness • Coordination • Flexibility (used interchangeably with mobility) • Mobility • Muscular Performance • Neuromuscular Control • Postural Control, Postural Stability, and Equilibrium (used interchangeably with static or dynamic balance) • Stability

4. Types of Therapeutic Exercise Interventions Include: • PROM • AAROM • AROM • Resisted Exercises - see Box 1.1 Page 3 REMEMBER: ALL MUST BE RELATIVE TO FUNCTIONAL IMPROVEMENT

5. Know the patient’s health history and current health status Understand medication side effects Have medical clearance Have adequate space and cleanliness environment Must have accurate performance (MOST IMPORTANT SAFETY ASPECT) Be aware of fatigue signs Ensure good therapist body mechanics Be knowledgeable of specific pathologies, impairments, and functional limitations Exercise Safety!!!!Clinical Environment Must be Safe

6. Therapeutic Exercise Intervention(Model of Disablement) • Risk Factors • Pathology • Impairments • Functional Limitations • Disability

7. 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 Base Practice Refers to the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of an individual patient. It involves the combination of research studies and clinicians expertise, along with the value, goals, and circumstances of the patient Patient Management and Clinical Decision Making

8. PT The PT Should continually communicate via verbal/written to all individuals in the care of the patient, including: Evals-PT only POC’s-PT only Progress Notes-PT/PTA D/C’s-PT only HEP-PT/PTA as per the POC Keeping records-PT/PTA Billing-third party payers-PT/PTA Other health care providers-PT/PTA Conferences and meetings-PT/PTA PTA The PTA is required to: Communicate with the supervising PT Determine when treatment should not be provided Explain the changes in the patient status to the supervising PT Identify interventions that are beyond the appropriate level for the PTA Communicate/clarify their understanding to the supervising PT Understand what is normal/abnormal in a patient’s response Be able to adjust interventions per the POC Report any/all changes to the supervising PT PT/PTA Coordination, Communication, and Documentation

9. Patient-Related Instructions • 3 domains of learning: cognitive, affective, and psychomotor • PT/PTA should provide adequate background information to the patient and caregiver • Multiple methods to deliver information to the patient: one to one therapist-directed instruction, videotape instruction, written instructions (with or without pictures), with the patient’s permission-educate family member/caregiver/friend and supply them with the specific materials pertaining to information that is being delivered

10. Adherence to Exercise • Implies Active involvement by patient • Three Factors • Patient characteristics • Factors related to pt’s health condition/impairments • Program related variables • Strategies to Foster Adherence • See Box 1.22 page 37

11. HEP Compliance PT/PTA should suggest and educate the patient on the purpose of a HEP However…….. Neither the PT/PTA can force any patient to do what is being asked of them.