1. Therapeutic Exercise Foundations and Techniques Part I General Concepts Chapter 01 Therapeutic Exercise: Foundational Concepts

2. Therapeutic Exercise Definition Therapeutic exercise is the systematic, planned performance of bodily movements intended to provide a patient/client with the means to prevent impairments Improve, restore, enhance physical function Prevent or reduce health-related risk factors Optimize overall health status

3. patient and client Patient is an individual with impairments and functional limitations Client is an individual without diagnosed dysfunction who engages in physical therapy services to promote health

4. Aspects of Physical Function: Definition of Key Term

5. Aspects of Physical Function: Definition of Key Terms Balance.

6. Aspects of Physical Function: Definition of Key Terms(Contd) Cardiopulmonary fitness.

7. Aspects of Physical Function: Definition of Key Terms(Contd) Coordination

8. Aspects of Physical Function: Definition of Key Terms(Contd) Flexibility.

9. Aspects of Physical Function: Definition of Key Terms(Contd) Mobility.

10. Aspects of Physical Function: Definition of Key Terms(Contd) Muscle performance. PowerEndurance

11. Aspects of Physical Function: Definition of Key Terms(Contd) Neuromuscular control.

12. Aspects of Physical Function: Definition of Key Terms(Contd) Stability.

13. Types of Therapeutic Exercise Intervention  Aerobic conditioning  Muscle performance exercises:  Joint mobilization techniques  Neuromuscular control, inhibition, and facilitation  posture awareness training  Postural control, body mechanics, and stabilization  Balance exercises  Relaxation exercises  Breathing exercises  Task-specific functional training

14. Exercise Safety FACTORS FOR EXERCISE SAFETY Patient’s health Medications can adversely affect a patient’s balance and coordination Environment Execution of the correct movement patterns i.e. intensity, speed, and duration.

15. Models of Disablement The first two schema developed were Nagi model International Classification of Impairments, Disabilities, and Handicaps (ICIDH) model for the World Health Organization The National Center for Medical Rehabilitation Research (NCMRR) integrate above both model, develop own model

16. ICF MODEL

17. ICF model Bio psycho social model It has two parts 1.Functioning and disability – body function and structure – activities and participation 2.Other factors – Environmental factors – Personal factors

18. ICF model

19. Health conditions( pathological conditions) Impairment Functional limitation Disability

20. Impairments Impairments are the consequences of pathological conditions; that is, signs and symptoms that reflect abnormalities at the body system, organ, or tissue level Types of Impairment Anatomical Physiological Psychological

21. Impairment(contd) Musculoskeletal Neuromuscular Cardiovascular/pulmonary Integumentary

22. Common Physical Impairments Managed with Therapeutic Exercise Musculoskeletal Pain Muscle weakness/reduced torque production Decreased muscular endurance Limited range of motion due to Restriction of the joint capsule Restriction of periarticular connective tissue Decreased muscle length Joint hypermobility Faulty posture Muscle length/strength imbalances

23. Common Physical Impairments Managed with Therapeutic Exercise(contd) Neuromuscular Pain Impaired balance, postural stability, or control Incoordination, faulty timing Delayed motor development Abnormal tone (hypotonia, hypertonia, dystonia) Ineffective/inefficient movement strategies Cardiovascular/Pulmonary Decreased aerobic capacity (cardiopulmonary endurance) Impaired circulation (lymphatic, venous, arterial) Pain with sustained physical activity (intermittent claudication) Integumentary Skin hypomobility (e.g., immobile or adherent

24. Functional Limitations They are the result of impairments characterized by the reduced ability of a person to perform actions or components of motor skills in an efficient or typically expected

25. Types of Functional Limitations ADL Bathing Dressing Feeding IADL more complex tasks Occupational tasks School-related skills Housekeeping Recreational activities community mobility

26. Common Functional Limitations Related to Physical Tasks Limitation of Reaching and grasping Lifting and carrying Pushing and pulling Bending and stooping Turning and twisting Throwing and catching Rolling Standing Squatting and kneeling Standing up and sitting down Getting in and out of bed Crawling, walking, running Ascending and descending stairs Hopping and jumping Kicking

27. Disability Disability is the inability to perform or participate in activities or tasks related to one’s self, the home, work, recreation, or the community Physical impairments and functional limitations directly contribute to disability

28. General Categories of Activities Relevant to Disability Self-care Mobility in the community Occupational tasks School-related tasks Home management Caring for dependents Recreational and leisure activities Community responsibilities and service