OCTH 246 - Therapeutic Exercises

Training

One type of intervention to support occupations. Facilitation of acquisition of concrete skills for meeting specific goals in a real-life, applied situation. Usually in clinical or simulated setting.

Examples: Resistive bands, active stretching for ROM, opening/closing jars, dexterity activities

Modalities, devices, and techniques

Types of intervention to support occupations. Prepares client for performance. Client typically passive, not active.

Examples: Physical agent modalities, continuous passive motion machine, TENS, manual techniques (e.g., joint mobilization, PROM)

Therapeutic activity

Remediates sensory-motor dysfunction, augments occupation. Intervention: Simulated activities, fine motor practice, components of activities

Therapeutic exercise

Systematic, planned performance of physical movements, postures, or activities to:

1) remediate or prevent impairments of body functions and structures

2) Improve, restore, or enhance activities and participation

3) Prevent or reduce health-related risk factors

4) Optimize overall health, fitness or sense of well-being.

Remediates sensory-motor dysfunction, augments purposeful activity. Interventions: exercise, ROM, endurance, flexibility

Similarities between therapeutic exercise and therapeutic activity

Develop/restore movement patterns

Improve voluntary motor responses

Improve coordination

Increase muscle power

Increase endurance

Remediate ROM deficits

Increase work tolerance

Prevent/eliminate contractures

Concentric contractions

Muscle fibers generate force, shortening the muscles and creating joint motion

Eccentric contractions

Muscle fibers generate force that changes joint angle; muscle is elongating instead of shortening

Isometric contractions

Muscle fibers contract but no joint motion occurs, muscle length remains the same

Contraindications of therapeutic exercises

Unstable medical state; recent joint surgery; tendon or nerve repair; inflamed joints; some cardiopulmonary diagnoses/surgical interventions. For all diagnoses, you don't want to do concentric/eccentric exercises. For some, you can do isometric exercises.

Eccentric vs. concentric exercise

Eccentric exercise appears to be superior in helping increase muscle strength and mass. Eccentric exercise may also place muscle at greater risk for injury. Further research needs to be done.

Open chain exercises

Distal segment moves in space. Independent joint movement. Non-weight bearing position. Resistance applied to the moving distal segments.

Examples: Biceps curl, raising arm overhead.

Better at isolating a specific muscle

Closed chain exercises

Distal surface fixed on stationary support. Interdependent joint movements; movement of body segment distal and/or proximal to the moving joint. Muscle activation of multiple joint muscles’.

Examples: Lunges, squats, pull-up, push up

Manual resistance exercise

Can't be measured quantitatively, but might be useful in early training; resistance limited by therapist strength

Mechanical resistance

Use of machines like in gym - can be measured quantitatively and increased progressively

Progressive Resistance Exercise (PRE)

Dynamic exercise in which constant external load is applied to a contracting muscle and incrementally increased. Exercises graded by increasing the maximum amount of resistance as strength improves. Repetitions remain the same - weight/resistance increases. High load, low repetitions. In contrast, training for endurance: Low-load, high repetitions

Oxford Method

One method of PRE. Progressively lighter. 10 repetitions, 100% max -> 75% max -> 50% max. Maximum weight should increase every 4-7 sessions. Both methods are effective.

DeLorme Method

One method of PRE. Progressively heavier. 10 repetitions, 50% max -> 75% max -> 100% max. Maximum weight should increase every 4-7 sessions. Both methods are effective.

Daily Adjustable Progressive Resistance Exercise (DAPRE)

Muscle grade and type of exercise

5 - Do not need to see patient for strengthening

3+/5 or 4/5 - against gravity + resistance*

3 - AROM, isometric, active-assisted

Isometric to build muscle strength

2 - gravity neutral, active-assisted

1 - e-stim; biofeedback

No muscle movement

*Note: This is for isotonic (concentric and eccentric) exercise. Sometimes isometric exercises are indicated (pain, fractures, tendon repair)