Preterm: Therapeutic exercises

What is the goal of therapeutic exercises?

achievement of symptoms free movement and function

What is the NAGI model?

pathology, impairment, functional limitation, disability

what is the NAGI model: pathology?

disease, disorder, condition

what is the NAGI model: impairment?

consequence of pathology, any loss, or abnormality of psychological, physiologic or anatomic structure or function

What is the NAGI model: functional limitation?

a limitation from an impairment that is not disabling yet interferes with daily function

What is the NAGI model: disability?

an inability to undertake normal ADL’s OR TASKS AT HOME WORK RECREATION OR IN THE COMMUNITY

also encompasses societal function or lack therof

What is the PT diagnosis?

the relationship of a pt’s impairment to their functions limitations

What is the objective?

systematic administration of test or movements to define impairments and its relationship to the functional limitation

What is prognosis?

prediction of the pts optimal level of function expected at the end of treatment

anticipated length of time needed to reach the specified functional outcome

What are some factors that influence prognosis?

complexity, severity, acuity or chronicity of problem

general health

pt goals, motivation

safety issues

extent of support

What are some factors the influence decision in developing a plan?

impairments, functional limitations or disabilities

psychological status

what is short term goal?

measurable behaviors objectives affecting the documented impairments

• may reflect component abilities or skills to achieve functional goals

What should you do when evaluating a plan?

compare original data with current data at frequent intervals

identify goals that have been met, change those that need further modifcation

What is strength/ muscle performance?

the ability of a muscle or muscle groups to produce tension

how is strength/ muscle performance assessed?

through MMT or

functionally by having pt lift an equivalent weight or object as in their functional limitation

What are some factors that influence strength?

cross sectional size, length tension relationship, recruitment of motor units, type of muscle contraction, fiber type, energy store and blood supply, speed of contraction, motivation of pt

How do we increase strength?

hypertrophy

What is hypertrophy?

increase in protein, density of capillary beds, size of type 2 fibers

increased recruitment of motor units (early strength gain is often motor learning)

What is hyperplasia?

more cells

What does strength change in non contractile tissue?

strength in bone, tendon, ligament

skeletal tissue can increase which Is good for osteoporosis

What are the guidelines for increased strength?

overload principle

high loads low reps to fatigue

varying type and structure of exercise program

What are the two types of endurance and why is it important?

muscle endurance, general body endurance

necessary for performing repeated motor tasks in daily living

What is muscular endurance?

ability of muscle to contract repeatedly or generate tension, sustain it and resist fatigue over a prolonged period

What is general body endurance?

ability of individual to sustain low intensity exercise such as walking; jogging over an extended period

aka: aerobic conditioning

What are some immediate changes in muscular/ cardiovascular/ pulmonary?

inc. blood flow, HR, arterial BP, SV, CO, O2 demand and consumption, RR and depth

What are some adaptive changes in muscular/ cardiovascular/ pulmonary systems?

muscles: capillary bed density increase

cardiac and vascular changes: CO and SV increase, Resting HR decreases and return to resting from exercise quicker

What are some guidelines for developing endurance: muscular?

active exercise performed repeatedly against a moderate load to the point of fatigue

What are some guidelines for developing endurance: general?

direct exercise @ large muscle groups

prolonged > 20 mins

Why is mobility of contractile and non contractile tissue important?

for normal function

What is normal motion?

constant elongation and contraction

What is restricted motion?

adaptive shortening

What does muscle do when stimulated?

shortens; relaxes after contraction and can be passively stretched

Does connective tissue contract?

no, it can adaptively shorten with immoblization

What are some characteristics of scar tissue?

does not yield to stretch

non resilient

non elasctic

avoid prolonged immoblization

What are some characteristics of skin?

suppleness important: it must stretch for joint motion to occur

may develop motion limitations after trauma, burns, surgeries

early mobilization is important

What structures is stability important for? and what may it cause if not present?

proximal; decreased stability proximally may cause excess stress on certain structures stress on certain structures with distal mobility

What is important when developing stability?

pt must learn to control proximal area; maintain stable well aligned posture

What should you do while caring out functional task in developing stability?

start in single plane motions

progress to controlled diagonals

endurance must be developed in stabilizers

work in components then progress to full functional activity

What is relaxation?

conscious effort tp relieve tension in muscles

After active contraction of muscle, does reflex relaxation occur?

yes

What are some guidelines for relaxation?

place pt in comfortable position, all body parts well supported

pt taught to progressively contract and relax musculature

How are coordination, balance, and functional skills related? and what do they depend on?

they are interrelated

dependent on sensory system (somatosensory ad proprioception)

What is balance?

ability to maintain the center of gravity over the base of support; usually when upright

What are functional skills?

refere to varie motor skills necessary to function independently n all aspects of daily living

What are the first 3 guidelines for developing coordination, balance, and functional motor skills?

constant repetition of simple—> more complex motor activities

use of sensory cues

progress from single straight plane to combined motions and diagonals

What are the second 3 guidelines for developing coordination, balance, and functional motor skills?

4. emphasize proximal stability before distal mobility

5. stimulate real specific functional activities

6. as quality improves, speed and timing should be increased

What is motor learning?

complex set of internal processes

relatively permanent acquisition and retention of a skilled movement/ task

What are 3 types of motor tasks?

discrete, serial, continuous

What is discrete task?

movement with a recognizable beginning and end

ex: pushup

What is a serial task?

composed of a series of discrete tasks combined in a particular sequence

ex: eating with a fork

what is a continuous task?

repetitive, uninterrupted movements with no distinctive beginning or end

ex: cycling

What are the stages of motor learning?

cognitive, associative, autonomous

What is the cognitive stage?

requires a great deal of thinking

pt thinks about sequence or each component

errors in performance common

pt easily distractible

requires a lot of feedback

What is associative stage?

pt makes infrequent erros

concentrates on fine-tuning the motor task

pt tries to become more efficient and consisten

use of problem solving skills

decreased need for feedback

What is autonomous stage?

movements are automatic

pt can do multiplee tasks at once

very little feedback or instruction

At what stage are pt discharged before they reach it?

autonomous stage

What variables influence motor learning?

preparative considerations

practice

feedback

What is pre-practice considerations?

understanding why they are doing it

ability to pay attention

demonstration of task for pt

verbal instruction that is clear and succinct

What is part practice?

when the skill is broken down into its smaller parts and each part is practiced in isolation before being joined together.

short squat

what is whole practice?

skill/movement is taught all in one piece, without it being broken down into smaller chunks.

What is blocked practice?

typical of some drills in which a skill is repeated over and over, with minimal interruption by other activities.

what is random practice?

practice sessions where multiple skills are incorporated into the same practice session

What is intrinsic feedback?

sensory cue inherent in task

arises from performance of task

usually proprioceptive, kinesthetic, tactile, visual

What is augmented feedback

sensory cue external from task

from mechanical source or a person

what is concurrent feedback

feedback in real time

what is terminal feedback?

after task

what is immediate feedback?

right after completion of task

What is delayed feedback?

allows time for reflection before feedback is given after task completion

What is summary feedback?

on average performance of several repetitions of task

what type of feedback is knowledge of performance?

either intrinsic or augmented feedback

usually regarding quality or nature of performance of task

What type of feedback is knowledge of results?

immediate, post task feedback about outcome of a motor task