Therapeutic Exercise - Foundational Concepts
PTA 104 Orthopedic Dysfunctions
Therapeutic exercise is the systematic, planned performance of bodily movements, postures, or physical activities intended to provide a patient/client with the means to
(Kisner and Colby, Therapeutic Exercise, p. 2)
Be sure to try this multiple times: Different options and terms populate the puzzle with multiple attempts.
Box 1.1 in Kisner and Colby provides categories of interventions that may be considered therapeutic exercise. See if you can match the general description of a therapeutic exercise with a selected clinical example:
In PTA 101, we started with learning the Nagi and WHO-ICF Disablement models. As you will note from your multiple text book resources in the program, the Nagi model had been the preferred method to address the role of physical therapy along the continuum of individual to community-based engagement. You can anticipate a shift in future text book additions and the Guide to Physical Therapist Practice to the ICF model. By including specific contextual factors for each patient/client, physical therapy can more effectively include activity, participation, environmental and personal factors in the plan of care.
For now, we will continue to use the Nagi Model of pathology, impairments, functional limitations, and disability.
A PTA should be able to accurately apply disablement terminology to a case example. Test your recall of terms and your ability to correctly classify impairments, functional limitations and disabilities.
Therapeutic exercise is used in physical therapy to prevent disability, to minimize the progression of factors which result in disabilities, and to provide rehabilitation from pathological processes which result in loss of function and participation in the community. The PT/PTA team consider risk factors which may impact successful progression through a plan of care. Biological, lifestyle, environmental, and socioeconomic factors which impact treatment planning and progression are an integral part of PT/PTA -patient- centered approach to treatment.
In many of our case simulations, we have provided patient and family education in exercise techniques and safety considerations. How do we optimize our patient/client's chances for mastering the task? How do we evaluate if our instruction led to the intended result? With adequate preparation and applying concepts of motor learning, we can evaluate our effectiveness as patient and family educators.
Suggestions for exercise instruction
Taxonomies are classification systems to categorize items, animal, activities, etc., using progressively specific terminology. In motor learning, taxonomies are used to help distinguish levels of complexity between movement-based activities.
Environmental factors
Closed environments are less complex than open environments. Closed environments are static: objects, people and surfaces do not move. Open environments are dynamic: objects, people and surfaces can move and change between episodes.
Intertrial Variability: is absent when there is no change to the environmental conditions; is present when environmental demands change with each attempt
Desired Outcome of the Action
Body stable actions are less complex than body transport actions. Body stable includes maintaining a stationary/stable position while executing a motor task. Body transport includes activities where the patient/client is moving and changing positions through space
Tasks which do not inlcude object manipulation are less complex than tasks where the person is required to move/manipulate an object
There are three specific stages of motor learning identified in your text. Check your understanding of these stages in preparation for your exam on foundations of therapeutic exercise.
Practice and feedback strategies are selected by the PT/PTA based on the instructional readiness of the patient/client and the complexity of the task demands (person/environment). Your text distinguishes between:
Consider the intended outcome of the instruction. Performance is enhance by repeated blocked practice, however, skill retention and transferability of skills to multiple conditions and environments benefits most from task variations. The key is to assess each patient/client and select the most appropriate level of practice to allow for incremental, progressive success in motor performance and skill development.
Feedback is categorized by timing, outcome focus (knowledge of performance vs. knowledge of result), and source. Your text cites some recent evidence which favors knowledge of results versus knowledge of performance as most effective in facilitating long term retention of motor skills
Test your knowledge of effective instructional strategies for therapeutic exercise by matching the strategy with the most likely stage of motor learning
Your group discussion topic is based on your understanding of motor task taxonomies. Consult with your group facilitator to begin contributing to the discussion.