Therapeutic Exercise

therapeutic exercise

used to improve sensory and motor dysfunction

strength, endurance, ROM, coordination, flexibility in OT intervention

What kinds of things does therapeutic exercise address?

• Fragile medical clients

• Recent joint surgery

• Recent tendons or nerve repair

• Inflamed joints

• Certain cardiopulmonary diagnoses

• Certain surgical interventions

• The client has severe spasticity and/or lack of controlled movement.

contraindications for therapeutic exercise

1) Joint ROM

2) Muscle strength and endurance

3) Coordinated movement

progression of exercise programs (3 steps)

passive ROM

something else is moving the limb (their arm or the therapist)

Active-Assistive ROM (AAROM)

therapist or device is helping but not doing it for them

Active ROM (AROM)

moving the limb themselves

• to maintain joint ROM

• prevent joint contractures or joint capsule adhesion

What is the purpose of passive ROM?

passive ROM

client does not exert any effort to move independently

if a limb is paralyzed

Why might someone need to do passive ROM?

AAROM

Client can move their own extremity but needs assistance of an outside force to complete the range.

• Outside force can be a person (the thearpist, family) or mechanical (pulleys)

AROM

What is the best way to maintain good joint ROM?

AROM

Client can generate enough muscle force to complete full active range of motion.

when a client is missing full active or passive ROM abilities

When is passive stretching performed?

passive stretching

performed to remediate a loss of joint motion

passive stretching

therapist or client themselves takes the joint to the limit and holds it there with gentle but firm force (15 seconds to 2 minutes)

active stretching

used when client has at least good ability to take joint through the available range

1) forceful contraction of an agonist to stretch the antagonist (ex. biceps stretches the triceps)

2) contract-relax, the therapist passively brings the muscle to the point of stretch, then asks the client to isometrically flex, followed by relaxation or what isometric contraction and manual stretch towards end of range

What are the two techniques of active stretching?

isometric, concentric, eccentric

three ways to strengthen

isometric strengthening

strengthening when agonist and antagonist muscles co-contract at the same time

• ex. holding a phone, cup of coffee 

isometric strengthening

used when motion is contraindicated, as in certain tendon repairs or unhealed fracture, better for fragile healing hones, or gentle strengthening is required

Concentric Strengthening

strengthening where the client’s muscle generates force, shortens muscle and creates joint movement.

resistance

Concentric contractions for strengthening can be done with or without _____________.

1) move joint through full range with gravity resistance eliminated

2) move joint through full range with gravity resistance

3) move joint through full range against gravity with added force like dumbbells

Hierarchy of concentric contractions for strengthening

eccentric contraction strengthening

during muscle contraction, the muscle is lengthening

progressive resistive exercise

done by incrementally increasing or decreasing the amount of resistance during the exercise

progressive resistive exercise

Ex. the therapist gradually increases weight resistance with same number of repetitions

high-load over few repetitions

With progressive resistive exercises, do therapists prefer high-load over few repetitions or low-load over more repetitions? (for strength)

low-load, high-repetition over extended time

What should you use for improving muscular endurance?