Intro to therapeutic exercise (week 2)

International Classification of Functioning, Disability, and Health (ICF)

Changed from focus on the disease to how the disease affects someone’s life

Provides a common language for healthcare professionals (describing, classifying and coding the functions and structures of all body systems)

Impairment based diagnosis guides treatment

Used with ICD – used for classifying and coding medical conditions

ICD 10 codes

Key Terms in the ICF Model

Functioning and Disability – Part 1

1. Impairments in body function and structure

2. Activity limitations and Participation restrictions

Contextual factors – Part 2

1. Environmental factors

2. Personal factors

Functioning and Disability – Part 1

Impairments (consequences of a pathological condition)

Types of impairment

•Impairments in body function

1. Ex:  decrease strength, decrease balance, abnormal reflexes, reduced ventilation

•Impairments in body structure – can be seen on visual inspection or palpation;

1. Ex:  joint edema, open wounds, muscle spasm, joint crepitus

•Primary impairment– the direct result of a health condition (asthma)

•Secondary impairment -  a result of preexisting impairments (open wound not healing due to DM)

•Composite impairments – result of multiple underlying causes and has primary and secondary impairments

Activity Limitations/Functional Limitations

Difficulties doing a task or is unable to do a task or ADL

Example: washing your hair

Participation Restrictions and Disability

restrictions someone has fulfilling personal and social responsibilities and obligations in relation to societal expectations in the home, workplace, community

•Ex: not being able to pay the rent because you can’t work

Prevention of Disability

Primary – prevent disease

Secondary – early diagnosis and reduction of the severity or duration of existing disease

Tertiary – use of rehab to reduce the severity or limit the progression of the disability and improve function with someone who has a chronic, irreversible condition

Contextual factors – Part 2

•Environmental factors – external influences on someone (physical, social, attitudinal) that inhibit or facilitate function in someone’s life (ex. Someone having $ for a RW)

•Personal factors – internal influences of someone (gender, age, habits, culture, education, etc); ex. Motivation, coping skills

Risk factors

characteristics that predispose a person to impaired function and potential disability

•Example: smoking, sedentary lifestyle, obesity

Summary of ICF Model

•It’s a classification system that helps with clinical decision-making which in turn helps you do effective, efficient, and meaningful physical therapy for patients

•It looks at the whole person and realizes that all aspects of the person can affect function.

Exercise parameters

•Frequency

•Intensity

•Duration

•Movement quality

Types of Therapeutic Exercise Interventions

Aerobic conditioning/re-conditioning

Strengthening exercises

Stretching ex

Inhibition/facilitation tech

Postural awareness

Relaxation tech

Breathing ex

Functional tr

Balance ex

Goals of therapeutic exercise

•Increase strength

•Increase flexibility

•Increase endurance

•Decrease pain

•Increase coordination

•Increase balance

•Increase relaxation

Factors That Influence Compliance to an Exercise Program

•Pt motivation

•Pt behavior

•Cultural values and beliefs

•Severity of the problem

•Your own knowledge and experience

•Pt’s health condition

•Pt’s trust

•Consistency of therapist

•HEP(complexity, feedback, asst)

•Pain

•Logistics (getting to therapy)

•Social support

STRATEGIES TO INCREASE COMPLIANCE

•Identify benefits and importance of exercise (knowledge is power)

•Let patient have input on exercise

•Make exercise program brief

•Work with the patient to figure out finances if equipment needs to be bought

•Make exercise fun

Exercise Safety

•SAFETY FIRST!!!!!

•This includes YOU!

•Keep in mind: 

1.    patient’s health history

2.    affect of illness 

3.    sedentary life style of patient

4.    medications

5.    environment 

6.    monitoring of exercise

Strategies for Effective Exercise

•Preparation for Exercise Instruction

1. How can you tell if a patient’s attitude toward exercise and therapy will lead to successful outcomes?

2. Instruct the easiest or less stressful exercises first and end with an exercise that the patient likes or is fun to do

3. Build rapport – chit chat

4. Don’t make the exercise program too complicated or too long

Exercise Basics

•Frequent rest breaks

•Remind patient not to hold breathe

•Begin with 5-10 reps and gradually increase reps

•If patient is very weak, begin with 3-5 reps

•Add in sets of reps as patient gets stronger

Clinical Decision making

•Evidence-based practice

•Patient management model

Evidence-Based Practice

•Using current studies to show the best evidence on how to treat a specific problem and then using it to assist in determining treatment.

•How do you do this?

1. By accessing evidence by reading journals, clinical practice guidelines, and clinical expertise and judgment

Patient Management Model

Guide to Physical Therapist Practice – 5 components

•Examination

•Evaluation

•Diagnosis

•Prognosis and plan of care

•Intervention

Functional outcomes

must be meaningful, practical, and sustainable

Measuring outcomes

•Why?

1. To justify therapy to third party payers

2. To note patient progress

•How?

1. Patient satisfaction surveys

2. Re-evaluation that shows quantifiable data

therapeutic exercise

Systematic, planned performace of physical movement, posture, or activites intended to provide a patient with the means to

·      Remediate

·      Improve

·      Prevent

·      Optimize

Cardiopulmonary/endurance(aerobic, conditioning, re-conditioning)

The ability to perform moderate-intensity repetitive, total body movements over an extended period of time

mobility

Ability of structures or segments of the body to move or be moved in order to achieve the ROM

flexibility

Ability to move freely, without restrictions; used interchangeably with mobility

muscle performance

Capacity of muscle to produce tension and do physical work

coordination

Correct timing and sequencing of muscle firing combined with the appropriate intensity of muscular contraction leading to the effective initiation, guiding and grading of movement

Neuromuscular control

Interaction of the sensory and motor system that enables synergists, agonists, and antagonists, as well as stabilizers and neutralizers to anticipate or respond to proprioceptive and kinesthetic information and subsequently to work in correct sequence and magnitude to create coordination movement.

stability

Ability of the neuromuscular system through synergistic muscle actions to hold a proximal or distal body segment in a stationary position or to control a stable base during superimposed movement.

Balance (postural control, postural stability, equilibrium)

Ability to align body segment against gravity to maintain or move the body within the available base of support without falling

Strengthening

make or become stronger

postural awareness

subjective conscious awareness of body posture that is mainly based on proprioceptive feedback from the body periphery to the central nervous system