therapeutic exercise n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Therapeutic Exercise PowerPoint Presentation
Download Presentation
Therapeutic Exercise

Loading in 2 Seconds...

play fullscreen
1 / 55

Therapeutic Exercise - PowerPoint PPT Presentation


  • 150 Views
  • Uploaded on

Therapeutic Exercise. Natalia Fernandez, PT, MS, MSc, CCS University of Michigan Health Care System Department of Physical Medicine and Rehabilitation. Clinical Decision Making. Examination Evaluation Diagnosis Prognosis Set up Interventions. Clinical Decision Making.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Therapeutic Exercise' - johnavon-gavin


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
therapeutic exercise

Therapeutic Exercise

Natalia Fernandez, PT, MS, MSc, CCS

University of Michigan Health Care System

Department of Physical Medicine and Rehabilitation.

clinical decision making
Clinical Decision Making
  • Examination
  • Evaluation
  • Diagnosis
  • Prognosis
  • Set up Interventions
clinical decision making1
Clinical Decision Making
  • Med Dx: CAD Med Dx: COPD
  • Use of Hypothesis Testing and Algorithms
    • Med Dx and History of Cardiopulmonary Disease
    • Lab and Diagnostic Test Results
    • PT Dx
    • Type of activity, specifics of activity, time
    • Response to exercise/mobility/ADL
      • Vital signs – rest, activity, recovery
      • EKG changes
      • Need and time to stop, rest
      • Observed signs – color changes
    • Subjective responses
      • Concerns – Fatigue, SOB
      • Rate of Perceived Exertion

DeTurk & Cahalin - pg 368-369, Fig 12-4 & pg 370, Fig 12-5

musculoskeletal integument neuromuscular considerations
Musculoskeletal, Integument, & Neuromuscular Considerations
  • Musculoskeletal
    • Osteoporosis & Spinal Deformities
    • Ankylosing Spondylitis
    • Idiopathic Scoliosis
    • Pectus Deformities
    • Shoulder Hypomobility
  • Integument
    • Sarcoidosis
    • Systemic Lupus Erythematosus
    • Scleroderma
    • Sjogren Syndrome
  • Neuromuscular
    • Stroke
    • Traumatic Brain Injury
    • Spinal Cord Injury
    • Multiple Sclerosis
    • Parkinsons
    • Guillain-Barre Syndrome
    • Post Polio Syndrome
nagi disablement model
Nagi (Disablement) Model

Disability Inability to shop for family

Functional limitation Limited walking distance

Impairment Impaired aerobic capacity

Pathology Myocardial Infarction

therapeutic exercise for cardiopulmonary practice patterns
Therapeutic Exercise for Cardiopulmonary Practice Patterns
  • Aerobic capacity/endurance conditioning or reconditioning
  • Balance, coordination, and agility training
  • Body mechanics and postural stabilization
  • Flexibility exercises
  • Gait and locomotion training
  • Relaxation
  • Strength, power, and endurance training for head, neck, limb, pelvic-floor, trunk, and ventilatory muscles
pattern a prevention and risk inclusion criteria
Pattern A: Prevention and RiskInclusion Criteria
  • Risk Factors or Consequences of Pathology Diabetes

Family history of heart disease

Hypercholesterolemia or hyperlipidemia

Hypertension

Obesity

Sedentary lifestyle

Smoking

  • Impairments, Functional Limitations, or Disabilities

Decreased functional work capacity

Decreased maximum aerobic capacity

Dyspnea on exertion

Sedentary job role

pattern a prevention and risk ther ex
Pattern A: Prevention and RiskTher Ex
  • Aerobic capacity/endurance activities using ergometers, treadmills, steppers, pulleys, weights, hydraulics, elastic resistance bands, robotics, and mechanical or electromechanical devices

Aquatic programs

Gait and locomotion training - Walking and wheelchair propulsion programs

Increased workload over time

Task-specific performance training

  • Flexibility exercises

Muscle lengthening

Range of motion

Stretching

  • Body mechanic and ergonomics training
  • Breathing exercises
  • Posture awareness training
pattern a prevention and risk ther ex1
Pattern A: Prevention and RiskTher Ex
  • Relaxation

Breathing strategies

Movement strategies

Relaxation techniques

Standardized, programmatic, complementary exercise approaches

  • Strength, power, and endurance training

Active assistive, active, and resistive exercises (including concentric, dynamic/isotonic, isometric, and plyometric - manual resistance, pulleys, weights, hydraulics, elastic resistance bands, robotics and mechanical or electromechanical devices)

Aquatic programs

Standardized, programmatic, complementary exercise approaches

Task-specific performance training

pattern a prevention and risk patient education
Pattern A: Prevention and Risk Patient Education
  • Disease
    • Atherosclerosis
    • Hyperlipedemia
    • Hypertension
    • Diabetes
  • Diet
  • Exercise
  • Smoking
  • Health & Wellness
  • Fitness
pattern b deconditioning inclusion criteria
Pattern B: DeconditioningInclusion Criteria
  • Risk Factors or Consequences of Pathology

Acquired immune deficiency syndrome

Cancer

Cardiovascular disorders

Chronic system failure

Inactivity

Multisystem impairments

Musculoskeletal disorders

Neuromuscular disorders

Pulmonary disorders

  • Impairments, Functional Limitations, or Disabilities

Decreased endurance

Increased cardiovascular response to low level work loads

Increased perceived exertion with functional activities

Increased pulmonary response to low level work loads

Inability to perform routine work tasks due to shortness of breath

pattern b deconditioning ther ex
Pattern B: DeconditioningTher Ex
  • Aerobic capacity/endurance activities using ergometers, treadmills, steppers, pulleys, weights, hydraulics, elastic resistance bands, robotics, and mechanical or electromechanical devices

Aquatic programs

Gait and locomotion training - Walking and wheelchair propulsion programs

Increased workload over time

  • Balance, coordination, and agility training

Developmental activities training

Neuromuscular education or reeducation

Standardized, programmatic, complementary exercise approaches

  • Breathing exercises
  • Body mechanics, ergonomics, and postural stabilization

Body mechanics training

Postural control and awareness training

  • Flexibility exercises

Muscle lengthening

Range of motion

Stretching

pattern b deconditioning ther ex1
Pattern B: DeconditioningTher Ex
  • Gait and locomotion training

Developmental activities training

Gait training

Implement and device training

Standardized, programmatic, complementary exercise approaches

Wheelchair training

  • Relaxation

Breathing strategies

Movement strategies

Relaxation techniques

Standardized, programmatic, complementary exercise approaches

  • Strength, power, and endurance training for head and neck, limb, pelvic-floor, trunk, and ventilatory muscles

Active assistive, active, and resistive exercises (including concentric, dynamic/isotonic, isometric, and plyometric - using manual resistance, pulleys, weights, hydraulics, elastic resistance bands, robotics)

Aquatic programs

Conditioning and reconditioning - Strengthening or Resistive

Standardized, programmatic, complementary exercise approaches

pattern c airway clearance inclusion criteria
Pattern C: Airway ClearanceInclusion Criteria
  • Risk Factors or Consequences of Pathology

Acute lung disorders

Acute or chronic oxygen dependency

Bone marrow/stem cell transplants

Cardiothoracic surgery

Change in baseline breath sounds

Change in baseline chest radiograph

Chronic obstructive pulmonary disease (COPD)

Frequent or recurring pulmonary infection

Solid-organ transplants (eg, heart, lung, kidney)

Tracheostomy or microtracheostomy

  • Impairments, Functional Limitations, or Disabilities

Dyspnea at rest or with exertion

Impaired airway clearance

Impaired cough

Impaired gas exchange

Impaired ventilatory forces and flow

Impaired ventilatory volumes

Inability to perform self-care due to dyspnea

Inability to perform work tasks due to dyspnea

pattern c airway clearance ther ex
Pattern C: Airway ClearanceTher Ex
  • Aerobic capacity/endurance conditioning or reconditioning activities using ergometers, treadmills, steppers, pulleys, weights, hydraulics, elastic resistance bands, robotics, and mechanical or electromechanical devices

Aquatic programs

Gait and locomotion training - Walking and wheelchair propulsion programs

Increased workload over time

  • Body mechanics, ergonomics, and postural stabilization

Posture awareness training

Postural control training

  • Flexibility exercises

Muscle lengthening

Range of motion

Stretching

  • Relaxation

Breathing strategies

Movement strategies

Relaxation techniques

Standardized, programmatic, complementary exercise approaches

pattern c airway clearance ther ex1
Pattern C: Airway ClearanceTher Ex
  • Strength, power, and endurance training for head and neck, limb, pelvic-floor, trunk, and ventilatory muscles

Active assistive, active, and resistive exercises (including concentric, dynamic/isotonic, isometric,and plyometric – using manual resistance, pulleys, weights, hydraulics, elastic resistance bands, robotics and mechanical or electromechanical devices)

Aquatic programs

Standardized, programmatic, complementary exercise approaches

Task-specific performance training

  • Balance and coordination training
  • Developmental activities
  • Neuromuscular relaxation, inhibition, and facilitation
pattern d cv pump dysfunction inclusion criteria
Pattern D: CV Pump DysfunctionInclusion Criteria
  • Risk Factors or Consequences of Pathology/Pathophysiology (Disease, Disorder, or Condition)

Angioplasty

Atrioventricular block

Cardiomyopathy

Cardiothoracic surgery

Complex ventricular arrhythmias

Complicated MI (failure); uncomplicated MI (dysfunction)

Coronary artery disease

Decrease in ejection fraction (EF) on exercise testing (EF of 30-50% with dysfunction; < 30% with failure)

Diabetes

Hypertensive heart disease

Valvular heart disease

  • Impairments, Functional Limitations, or Disabilities

Abnormal heart rate response to increased oxygen demand

Abnormal pulmonary response to increased oxygen demand

Decreased ability or the inability to perform activities of daily living (ADL) because of symptoms

Change in baseline breath sounds with activity

Flat or falling blood pressure response to increased oxygen demand (failure)

pattern d cv pump dysfunction ther ex
Pattern D: CV Pump DysfunctionTher Ex
  • Aerobic capacity/endurance activities using ergometers, treadmills, steppers, pulleys, weights, hydraulics, elastic resistance bands, robotics

Aquatic programs

Gait and locomotion training - Walking and wheelchair propulsion programs

Increased workload over time

  • Balance, coordination, and agility training

Developmental activities training

Motor function (motor control and motor learning) training or retraining

Neuromuscular education or reeducation

Standardized, programmatic, complementary exercise approaches

Task-specific performance training

  • Breathing exercises
  • Body mechanics, ergonomics, and postural stabilization

Body mechanics training

Postural awareness training

  • Flexibility exercises

Muscle lengthening

Range of motion

Stretching

pattern d cv pump dysfunction ther ex1
Pattern D: CV Pump DysfunctionTher Ex
  • Gait and locomotion training

Developmental activities training

Gait training

Implement and device training

Standardized, programmatic, complementary exercise approaches

Wheelchair training

  • Relaxation

Breathing strategies

Movement strategies

Relaxation techniques

Standardized, programmatic, complementary exercise approaches

  • Strength, power, and endurance training

Active assistive, active, and resistive exercises (including concentric, dynamic/isotonic, isometric, and plyometric - using manual resistance, pulleys, weights, hydraulics, elastic resistance bands, robotics and mechanical or electromechanical devices )

Standardized, programmatic, complementary exercise approaches

Task-specific performance training

pattern e resp pump dysfunction inclusion criteria
Pattern E: Resp Pump DysfunctionInclusion Criteria
  • Risk Factors or Consequences of Pathology

Elevated diaphragm and volume loss on chest radiograph

Neuromuscular disorders

Partial or complete diaphragmatic paralysis

Poliomyelitis

Pulmonary fibrosis

Restrictive lung disease

Severe kyphoscoliosis

Spinal cord injury

  • Impairments, Functional Limitations, or Disabilities

Abnormal or adventitious breath sounds

Abnormal increased respiratory rate and decreased tidal volume at rest

Airway clearance dysfunction secondary to ventilatory pump impairment

Decreased to severely impaired strength and endurance of ventilatory muscles

Dyspnea with self-care

Dyspnea with work tasks

Dys-synchronous or paradoxical breathing at rest or with activity

pattern e resp pump dysfunction ther ex
Pattern E: Resp Pump DysfunctionTher Ex
  • Aerobic capacity/endurance activities using ergometers, treadmills, steppers, pulleys, weights, hydraulics, elastic resistance bands, robotics,

Aquatic programs

Gait and locomotion training - Walking and wheelchair propulsion programs

Movement efficiency and energy conservation training

Increased workload over time

  • Balance, coordination, and agility training

Developmental activities training

Motor function (motor control and motor learning) training or retraining

Neuromuscular education or reeducation

Standardized, programmatic, complementary exercise approaches

Task-specific performance training

  • Breathing exercises
  • Body mechanics, ergonomics, and postural stabilization

Body mechanics training

Postural control training

Postural stabilization activities

Postural awareness training

  • Flexibility exercises

Muscle lengthening

Range of motion

Stretching

pattern e resp pump dysfunction ther ex1
Pattern E: Resp Pump DysfunctionTher Ex
  • Gait and locomotion training

Developmental activities training

Gait training

Implement and device training

Perceptual training

Standardized, programmatic, complementary exercise approaches

Wheelchair training

  • Relaxation

Breathing strategies

Movement strategies

Relaxation techniques

Standardized, programmatic, complementary exercise approaches

  • Strength, power, and endurance training for head and neck, limb, pelvic-floor, trunk, and ventilatory muscles

Active assistive, active, and resistive exercises (including concentric, dynamic/isotonic, isometric, and plyometric - using manual resistance, pulleys, weights, hydraulics, elastic resistance bands, robotics

Standardized, programmatic, complementary exercise approaches

Task-specific performance training

pattern f respiratory failure inclusion criteria
Pattern F: Respiratory FailureInclusion Criteria
  • Risk Factors or Consequences of Pathology

Adult respiratory distress syndrome

Abnormal alveolar to arterial oxygen tension differences

Cardiothoracic surgery

Chronic obstructive pulmonary disease (COPD)

Multisystem failure

Pneumonia

Pre- and post-lung transplant or rejection

Rapid rise in arterial carbon dioxide at rest or with activity

Sepsis

Thoracic or multisystem trauma

  • Impairments, Functional Limitations, or Disabilities

Abnormal or adventitious breath sounds

Abnormal vital capacity

Airway clearance dysfunction

Dyspnea at rest

Dyssynchronous or paradoxical breathing pattern

Impaired gas exchange

pattern f respiratory failure ther ex
Pattern F: Respiratory FailureTher Ex
  • Aerobic capacity/endurance activities using ergometers, treadmills, steppers, pulleys, weights, hydraulics, elastic resistance bands, robotics

Aquatic programs

Gait and locomotion training - Walking and wheelchair propulsion programs

Movement efficiency and energy conservation training

Increased workload over time

  • Balance, coordination, and agility training

Neuromuscular education or reeducation

Posture awareness training

  • Body mechanics, ergonomics, and postural stabilization

Body mechanics training

Postural control training

Postural awareness training

  • Flexibility exercises

Muscle lengthening

Range of motion

Stretching

pattern f respiratory failure ther ex1
Pattern F: Respiratory FailureTher Ex
  • Relaxation

Breathing strategies

Movement strategies

Relaxation techniques

Standardized, programmatic, complementary exercise approaches

  • Strength, power, and endurance training for head and neck, limb, pelvic-floor, trunk, and ventilatory muscles

Active assistive, active, and resistive exercises (including concentric, dynamic/isotonic, isometric, and plyometric - using manual resistance, pulleys, weights,

hydraulics, elastic resistance bands, robotics and mechanical or electromechanical devices )

Task-specific performance training

therapeutic exercise1
Therapeutic Exercise
  • Aerobic capacity/endurance conditioning or reconditioning
    • Aquatic programs
    • Gait and locomotion training – Walk or W/C
    • Increased workload over time
    • Movement efficiency and energy conservation training
aerobic capacity endurance conditioning or reconditioning
Aerobic Capacity/Endurance Conditioning or Reconditioning
  • Activity, specific set up, time
    • Improve oxygen demand
    • Use of large muscle groups in a rhythmic fashion, over time
  • Mode
    • Marching, Walking, Bike, Gardening
  • Intensity
    • Max HR and take age adjusted
    • 50-70% depending on exercise test, age
  • Frequency
    • 4-5 days per week
  • Duration
    • 5-10 min bouts 3x/day
    • Work up to 30-40 min in one session

For Progression, see DeTurk & Cahalin, pg 447 & 448, Figs 15-7 & 15-8

aerobic capacity endurance evidence
Aerobic Capacity/Endurance -Evidence
  • Patient Education on Risk or Disease
    • Exercise, Diet
  • Deconditioning
    • Rate of VO2 max decreases greatest the first week of bedrest1
    • Longer the bedrest the more diminished the VO2 max1
    • Use of HR, RPE, and METs

1 Convertinao VA, Med Sci Sports Exer, 1997:29:191

aerobic capacity endurance evidence1
Aerobic Capacity/Endurance -Evidence
  • Group-based (8-12 patients) simple aerobic dance movements (with music)
  • 2 days a week for 4 months
  • Each session lasted 50 minutes (including warm-up and cool-down), followed by 15-30 minutes of counseling
  • The exercise program included three intervals of high intensity, during which patients were encouraged to reach 15-18 on the Borg scale for 5-10 minutes.
  • 6 min walk, resistance on bike, bike time, MN Living with Heart Failure QOL all increased with significance as compared to the control group for 4 and 12 mn.

Nilsson et al, Long-term effects of a group based high intensity aerobic interval training program in patients with chronic heart failure, Am J Cardiol 2008; 102(9):1220-1224

therapeutic exercise2
Therapeutic Exercise
  • Balance, coordination, and agility training
    • Developmental activities training
    • Posture awareness training
    • Standardized, programmatic, complementary exercise approaches
    • Task-specific performance training
balance coordination and agility training
Balance, Coordination, and Agility Training
  • Mode
    • Massery Technique
  • Intensity
  • Duration
  • Frequency
  • No set parameters
balance evidence
Balance - Evidence
  • Sensory-specific balance classes were held 3 times per week, for 1 hour each session, over 8-week
  • Tasks included
    • standing or walking on various support surfaces, such as a rocker board, foam, or narrow beam
    • Standing in a tandem position, a semitandem position, on one leg, or in a feet together
  • Progressions to these tasks included simultaneous alterations of visual and vestibular inputs
    • Instructed to close their eyes, to engage vision with a reading or tracking secondary task
    • Perform balance tasks with a distracting background
    • Instructed to tilt their head backward or to quickly move their head side to side and up and down.
  • Results
    • Less destabilization within the first 5 seconds following vibration with or without a secondary task than there was at baseline or in the falls prevention education group
    • Training effects were not maintained at the 8-week follow-up.

Westlake & Culham.Sensory-Specific Balance Training in Older Adults: Effect on Proprioceptive Reintegration and Cognitive DemandsPhysical Therapy. Oct 2007. Vol. 87, Iss. 10; p. 1274

therapeutic exercise3
Therapeutic Exercise
  • Body mechanics and postural stabilization
    • Body mechanics training
    • Postural control training
    • Postural stabilization activities
    • Posture awareness training
body mechanics and postural stabilization
Body Mechanics and Postural Stabilization
  • Mode
  • Intensity
  • Duration
  • Frequency
  • No set parameters
body mechanics evidence
Body Mechanics -Evidence
  • Perfusion study in prone and supine
  • Pts were under conditions of
    • Normal breathing of room air
    • Unassisted breathing of 45% O2
    • Assisted PEEP
  • Ventral, Middle, Dorsal measurements with ventral more perfuse in prone and dorsal more perfuse in supine

Suki et al, Perfusion, Science Letter. Atlanta: Mar 25, 2008. pg. 2580

body mechanics evidence1
Body Mechanics -Evidence
  • Pt with ischemia of stable and unstable angina
  • Valsalva and measured QT of EKG
  • With valsalsa showed significant difference of EKG changes of QT segment
  • Authors related to carrying or lifting restrictions of heavy objects with CAD

Balbay et al, Effects of valsalva maneuver on QT dispersion in patients with ischemic heart...Angiology; Nov 2001; 52, 11

therapeutic exercise4
Therapeutic Exercise
  • Flexibility exercises
    • Improve motion of the chest wall, lengthen anterior chest wall, improve hip and knee flexor shortening
    • Muscle lengthening
    • Range of motion
    • Stretching
flexibility exercises
Flexibility Exercises
  • Mode
    • Isolate muscle or limited joint
  • Intensity
    • After warmup
  • Duration
    • Hold with no pain for 30 sec
  • Frequency
    • 3-5 days/week
flexibility evidence
Flexibility - Evidence
  • Pt with ankylosing spondylosis
  • 3x/wk for 3 months
  • 18 stretching exercises of entire spine and extremities along with aerobic and chest expansion exercises
  • Significant improvement in cervical and thoracic spine movement AND chest expansion

Ince et al , Effects of a Multimodal Exercise Program for People With Ankylosing Spondylitis, Physical Therapy; Jul 2006; 86, 7

therapeutic exercise5
Therapeutic Exercise
  • Gait and locomotion training
    • Developmental activities training
    • Gait training
    • Implement and device training
    • Standardized, programmatic, complementary exercise approaches
gait and locomotion training
Gait and Locomotion Training
  • Mode
  • Intensity
  • Duration
  • Frequency
  • No set parameters
gait and locomotion evidence
Gait and Locomotion - Evidence
  • See aerobic exercise
  • Massery Pairing

Massery et al, Coordinating transitional movements and breathing in patients with neuromotor dysfunction, NDTA Network, Nov/Dec 1996

gait and locomotion evidence1
Gait and Locomotion - Evidence
  • Case Report of pt with C6 tetraplegia
  • Taught breathing strategy and reducing valsalva with tasks with w/c
    • Lean forward
    • Put foot on footplate
    • Posterior lean for pressure relief
  • Able to perform tasks with new breathing strategies

Henderson, Application of Ventilatory Strategies to Enhance Functional Activities for an...Journal of Neurologic Physical Therapy; Jun 2005; 29, 2

therapeutic exercise6
Therapeutic Exercise
  • Relaxation
    • Breathing strategies
    • Movement strategies
    • Relaxation techniques
    • Standardized, programmatic, complementary exercise approaches
relaxation
Relaxation
  • Mode
  • Intensity
  • Duration
  • Frequency
  • No set parameters
relaxation evidence
Relaxation -Evidence
  • Five 60 minute individual treatments with the Papworth method from a respiratory physiotherapist
  • No significant differences were found between the groups at baseline
  • SGRQ Symptom mean scores were lower in the Papworth method group than in the control group after treatment and at 12 months
  • The Nijmegen and HADS scores were also significantly lower in the intervention group than in the control group
  • Objective respiratory measures did not differ significantly across the groups, apart from breathing rate.

Holloway and West, Integrated breathing and relaxation training (the Papworth method) for adults with asthma in primary care: a randomised controlled trial , Thorax 2007; 62(12): 1039-1042

therapeutic exercise7
Therapeutic Exercise
  • Strength, power, and endurance training for head, neck, limb, pelvic-floor, trunk, and ventilatory muscles
    • More efficient motion
    • Active assistive, active, and resistive exercises (including concentric, dynamic/isotonic, eccentric, isokinetic, isometric, and plyometric)
    • Aquatic programs
    • Standardized, programmatic, complementary exercise approaches
    • Task-specific performance training
strength power and endurance training for trunk extremities and ventilatory muscles
Strength, Power, and Endurance Training for Trunk, Extremities and Ventilatory Muscles
  • Mode
    • AAROM, AROM
    • Resistance
      • Manual
      • Weights
  • Intensity
    • Incorporate breathing with resistance
    • Resistance may start light and work up
      • 8-12 reps, 1-3 sets
    • Resistance of 1 rep max and then calculate
      • 8-10 reps at 70% of max, 6 reps at 80% of max, 4 reps at 90% of max, 2 reps at 95% max and finally 1 rep at max
    • High weight, low reps for strength
    • Low weight, high reps for endurance
  • Duration
  • Frequency
    • Every other day or rotate muscle groups
strength evidence
Strength - Evidence
  • Systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnoea and quality of life for adolescents and adults living with cystic fibrosis.
  • Articles were included if:
    • (1) participants were adolescents or adults with cystic fibrosis (413 years of age)
    • (2) an IMT group was compared to a sham IMT, no intervention or other intervention group
    • (3) the study used a randomized controlled trial or cross-over design
    • (4) it was published
  • Results: The search strategy yielded 36 articles
  • Meta-analyses were limited to forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC)
    • No difference in effect between the IMT group and the sham and/or control group.
    • Individual study results were inconclusive for improvement in inspiratory muscle strength
    • One study demonstrated improvement in inspiratory muscle endurance.
  • Conclusion:
    • The benefit of IMT in adolescents and adults with cystic fibrosis for outcomes of inspiratory muscle function is supported by weak evidence.
    • Its impact on exercise capacity, dyspnoea and quality of life is not clear

Reid et al, Effects of inspiratory muscle training in cystic fibrosis: a systematic review, Clinical Rehabilitation. London: Oct 2008. Vol. 22, Iss. 10-11

goals and outcomes impact on pathology
Goals and Outcomes Impact on Pathology

Atelectasis

Joint swelling, inflammation, restriction

Nutrient delivery

Osteogenic effects of exercise

Pain

Physiological response

Soft tissue swelling, inflammation, restriction

Increased oxygen demand symptoms

Tissue perfusion and oxygenation

goals and outcomes impact on impairments
Goals and Outcomes Impact on Impairments

Aerobic capacity is increased.

Airway clearance is improved.

Balance is improved.

Endurance is increased.

Energy expenditure per unit of work is decreased.

Gait, locomotion, and balance are improved.

Integumentary integrity is improved.

Joint integrity and mobility are improved.

Motor function (motor control and motor learning) is improved.

Muscle performance (strength, power, and endurance) is increased.

Postural control is improved.

Quality and quantity of movement between and across body segments are improved.

Range of motion is improved.

Relaxation is increased.

Sensory awareness is increased.

Ventilation and respiration/gas exchange are improved.

Weight-bearing status is improved.

Work of breathing is decreased

goals and outcomes impact on functional limitations and disabilities
Goals and Outcomes Impact on Functional Limitations and Disabilities
  • Functional Limitations

Ability to perform physical actions, tasks, or activities related to self-care, home management, work (job/school/play), community, and leisure is improved.

Level of supervision required for task performance is decreased.

Performance of and independence in ADL and IADL with or without devices and equipment are increased.

Tolerance of positions and activities is increased.

  • Impact on disabilities

Ability to assume or resume required self-care, home management, work (job/school/play), community, and leisure roles is improved.

goals and outcomes risk reduction prevention health wellness and fitness
Goals and Outcomes Risk Reduction/Prevention Health, Wellness, and Fitness
  • Risk Reduction/Prevention

Preoperative and postoperative complications are reduced.

Risk factors are reduced.

Risk of recurrence of condition is reduced.

Risk of secondary impairment is reduced.

Safety is improved.

Self-management of symptoms is improved.

  • Impact on Health, Wellness, and Fitness

Fitness is improved.

Health status is improved.

Physical capacity is increased.

Physical function is improved.

goals and outcomes impact on societal resources patient satisfaction
Goals and Outcomes Impact on Societal Resources& Patient Satisfaction
  • Societal Resources

Utilization of physical therapy services is optimized.

Utilization of physical therapy services results in efficient use of health care dollars.

  • Patient/client Satisfaction

Access, availability, and services provided are acceptable to patient/client.

Administrative management of practice is acceptable to patient/client.

Clinical proficiency of physical therapist is acceptable to patient/client.

Coordination of care is acceptable to patient/client.

Cost of health care services is decreased.

Intensity of care is decreased.

Interpersonal skills of physical therapist are acceptable to patient/client, family, and significant others.

Sense of well-being is improved.

Stressors are decreased.