1. Therapeutic Exercise I Chapter 1
Foundational Concepts Lecture

2. Therapeutic Exercise GOAL Patient verses Client
To achieve optimal level of symptom
free movement during basic to
complex physical activities
Geared towards the restoration of
meaningful function/activities of
ADL’s for the patient and their
families/caregivers
Recently has been a focus on
evidence based practices
Patient verses Client
An individual with impairment and is
receiving PT for improved function
and prevent disability is a patient
A client is an individual without
dysfunction and engages in PT to
promote wellness/health to prevent
dysfunction

3. Aspects of Physical Function
Balance
Cardiopulmonary Fitness
Coordination
Flexibility (used interchangeably with mobility)
Mobility
Muscular Performance
Neuromuscular Control
Postural Control, Postural Stability, and Equilibrium (used interchangeably with static or dynamic balance)
Stability

4. Types of Therapeutic Exercise
Interventions Include:
PROM
AAROM
AROM
Resisted Exercises
- see Box 1.1 Page 3
REMEMBER: ALL MUST BE RELATIVE TO FUNCTIONAL IMPROVEMENT

5. Exercise Safety!!!! Clinical Environment Must be Safe
Know the patient’s health history and current health status
Understand medication side effects
Have medical clearance
Have adequate space and cleanliness environment
Must have accurate performance (MOST IMPORTANT SAFETY ASPECT)
Be aware of fatigue signs
Ensure good therapist body mechanics
Be knowledgeable of specific pathologies, impairments, and functional limitations

6. Therapeutic Exercise Intervention (Model of Disablement)
Risk Factors
Pathology
Impairments
Functional Limitations
Disability

7. Patient Management and Clinical Decision Making
Refers to a dynamic, complex
process of reasoning and
analytical (critical) thinking that
involves making judgments and
determinations in the context of
patient care
Evidence Base Practice
Refers to the conscientious,
explicit, and judicious use of
current best evidence in making
decisions about the care of an
individual patient. It involves the
combination of research studies
and clinicians expertise, along
with the value, goals, and
circumstances of the patient

8. PT/PTA Coordination, Communication, and Documentation
The PT Should continually communicate
via verbal/written to all individuals in the
care of the patient, including:
Evals-PT only
POC’s-PT only
Progress Notes-PT/PTA
D/C’s-PT only
HEP-PT/PTA as per the POC
Keeping records-PT/PTA
Billing-third party payers-PT/PTA
Other health care providers-PT/PTA
Conferences and meetings-PT/PTA
PTA
The PTA is required to:
Communicate with the supervising PT
Determine when treatment should not be provided
Explain the changes in the patient status to the supervising PT
Identify interventions that are beyond the appropriate level for the PTA
Communicate/clarify their understanding to the supervising PT
Understand what is normal/abnormal in a patient’s response
Be able to adjust interventions per the POC
Report any/all changes to the supervising PT

9. Patient-Related Instructions
3 domains of learning: cognitive, affective, and psychomotor
PT/PTA should provide adequate background information to the patient and caregiver
Multiple methods to deliver information to the patient: one to one therapist-directed instruction, videotape instruction, written instructions (with or without pictures), with the patient’s permission-educate family member/caregiver/friend and supply them with the specific materials pertaining to information that is being delivered

10. Adherence to Exercise Implies Active involvement by patient
Three Factors
Patient characteristics
Factors related to pt’s health condition/impairments
Program related variables
Strategies to Foster Adherence
See Box 1.22 page 37

11. HEP Compliance However…….. Neither the PT/PTA can force any
PT/PTA should suggest and educate
the patient on the purpose of a HEP
However……..
Neither the PT/PTA can force any
patient to do what is being asked
of them.