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Isotonic Resistive Exercises

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Concentric and Eccentric Contraction to increase strength, completed once per day for 4-5 days a week. Must have at least Ft strength

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Activities for Isotonic Resistive Exercise

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*Weights *Springs *Pulleys *Therabands-elastic bands *Theraputy *Sandbags *Special devices

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Progressive Resistive Exercise

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Taxing muscles beyond usual activities to increase strength, completed once per day for 4-5 days a week. Must have at least Ft strength

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Order of reps for Progressive Resistive Exercise

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*1st 10 reps at 50% resistance *2nd 10 reps at 75% resistance *3rd 10 reps at 100% resistance

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Activities for Progressive Resistive Exercise

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*Leather Lacing-slight resistance *Sanding with weighted sand block *Sawing *Hammering *Kneading dough/clay activities *Woodworking

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Isotonic Active Exercise

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Concentric and Eccentric Contraction. Isometric muscle contraction to increase strength. Completed when the patient moves the joint through its available ROM against no resistance, for poor to fair strength and to maintain ROM. Can also be used with higher muscle grades for the maintenance of strength and ROM when resistance is conraindicated

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Activities for Isotonic Active Exercise

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Can be used with or without gravity. Gravity eliminated: *Skateboard *Powder on table *Towel exercises *Use of suspension slings Activity: Needlework activity (gravity decreased) to Latch hooking (gravity)

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Active Assistive Exercise

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Concentric and Eccentric Contraction, to increase strength and maintain ROM (from trace to poor and up to fair minus). In the case of trace muscles the patient may contract the muscle, and therapist completes the entire ROM. Use of slings, pulleys, weights, spring or elastic bands may be used to apply mechanical resistance.

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Activities for Active Assistive Exercise

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*Sanding, sponge wiping and sweeping, and sawing. A. Patient moves as far as they can and therapist or mechanical device completes the rest of the motion in a pain free range. B. Bilateral activities can be useful (glove with sander)

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Passive Exercises (PROM)

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NO contraction, client unable to move, to maintain ROM-completed by a therapist or caregiver, for absent or minimal muscle strength. Can complete passive bilateral activity if the opposite limb is unaffected.

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PROM procedure

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Therapist moves through available ROM and holds momentarily applying gentle but firm force at the end range. Can also be completed by a device such as a pulley or counterbalance sling-the joint proximal to the joint should be stabilized during the exercise procedure.

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Passive Stretch

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Therapist moves the joint through the available ROM and holds momentarily, applying a gentle but firm force or stretch at the end of the ROM. No residual pain should occur when the stretching is discontinued. Passive stretch or forced exercise is meant to increase ROM. It is used with the loss of joint ROM and when stretching is not contraindicated.

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Precautions for Passive Stretch

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*Requires medical approval-contraindicated with joint replacement and tendon repair *Muscle should be relaxed and warm *Never force a painful joint unless ok by doctor *Use of slow, gentle, firm pressure-not quick *Stabilize proximal and distal *Should be no residual pain

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Procedure for Passive Stretch

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Stabilize part around area to be stretched. Prevent compensatory movement; make sure muscle is relaxed before stretching; apply gentle, firm prolonged stretch, holding for several seconds (up to 45 seconds)

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Active Stretch

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Same as passive stretch, to increase ROM-must have good to normal strength of the antagonist, to stretch the agonist with good coordination and patient motivation.

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What does patient do in active stretch?

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Patient contracts antagonist to stretch agonist-contracting biceps to stretch triceps.

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Activities for Active Stretch

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Slowly sawing wood-requires forceful contraction of the triceps with a concomitant stretch of the biceps

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Isometric Exercise

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Can be with or without resistance for strengthening

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Isometric Exercise without resistance

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to maintain strength or movements that are prohibited (use of isometric contration-muscle or group of muscles is actively contracted and relaxed without producing motion of the joint that is ordinarily mobilized. Purpose is to maintain muscle strength when active motion is not possible or is contraindicated. CAN BE USED WITH ANY MUSCLE GRADE ABOVE TRACE.

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Isometric Exercise without resistance is primarily used with clients ...

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in casts, after surgery, and with arthritis and burns-have patient set muscle and hold for 5-10 seconds, therapist places finger on muscle to help

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Isometric Exercise without resistance procedure

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Patient is taught to set or contract the muscles voluntarily and to hold the contraction for 5 to 6 seconds. Therapist may move the joint to the desired point in the ROM and ask the patient to hold the position-also known as PLACE AND HOLD.Completed 1 session per day

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Isometric Exercise with resistance

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INCREASE STRENGTH (Fair plus or better)

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Isometric Exercise with Resistance procedure

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Set muscle against resistance(applies resistance manually either by a therapists hand or table) and holds for 5 to 6 seconds. The patient may also hold a weight or resist against a solid surface depending on the muscle group being exercised. Used for holding tools-holding arm elevated while painting, may notice fatigue when contraction is sustained

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Purposeful Activities

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goal directed behaviors or tasks that commprise occupations. An activity is purposeful if the individual is an active, voluntary participant and if the activity is directed toward a goal that the individual considers meaningful.

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Purposeful Activities are used or adapted to meet one of the following objetives

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1.Develop or maintain strength, endurance, work tolerance, ROM, AND coordination 2. Practice and use voluntary and automatic movements in goal directed tasks 3.Provide for purposeful use of and general exercise .affected part 4.Explore vocational potential or training in work skills 5. Improve sensation, perception, and cognition 6.Improve socialization skills and enhance emotional growth/development 7. Increase independence in occupational role performance

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Principles of Activity Analysis

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1.Goal directed 2.Meaningful to the patient 3.Matched to the individual needs in relation to social roles 4.Capable of eliciting the mental or physical participation of the patient 5.Designed to prevent or reverse dysfunction and developing life skills to enhance performance in life roles 6. Relate to the patients interest 7.Adaptable, gradable, and age appropriate 8.Selected through knowledge and professional judgement 9.Selected in corporation with the patient

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Why do we adapt activities?

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1. To accommodate for the patients residual abilities (utensil holder) 2.Positioning of the person or to the environment (reading stand and prism glasses)

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Grading of activities

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Pacing the activity appropriately and modifying it to obtain the patients maximal performance

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Strength grading

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May be graded by increasing resistance. Methods include: Changing planes of movement, gravity versus gravity decreased, adding weight to the client, or using tools with weights.

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Range of motion grading

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Graded by positioning materials or equipment to demand greater reach or excursion of joints or by adapting equipment with lengthening handles, putting things overhead

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Endurance and Tolerance grading

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Graded by moving from light to heavy work and increasing duration of the work. endurance: how long. tolerance: are you motivated to do it? how much can you do?

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Coordination grading

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Graded by decreasing the gross resistive movements and increasing the fine controlled movements. Dexterity and speed of movement can be graded by practicing at increasing speeds.

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Perceptual, Cognitive, and Social skills grading

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Graded by simple 1 and 2 step directions. For socialization, increase the responsibilities of the client from particpant to leader.

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Selection of activity

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Selected for their potential to improve functioning in sensory,movement related and mental factors to help sustain motivation to engage in activity. Activities should enable to patient to transfer the motion, strength, and coordination gained in adjunctive and enabling modalities to useful, normal daily activities.

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Three rules for selection of activity

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1. Activities should provide action and should allow for alternating contraction and relaxation of muscles 2. Activities should provide repetition of motion, indefinite, but control number of repetitions of movement patterns sufficient to benefit the client 3.Activities should allow for 1 or more kinds of grading: such as resistance, range, coordination, and endurance complexity

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Simulated Activity

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If the clinical environment is not fully equipped to meet the exact occupational needs of a client, simulating appropriate active occupation by adapting the environment or activity to meet the patients need may be necessary (cones, adl boards, and inclined stander)

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Enabling activity

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Considered not purposeful and generally do not have an inherent goal, but they may engage the patient mentally and physically-they are usually for practicing specific motor patterns, and to practice motor and process skills (puzzles and games)

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Biomechanical approach

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Lower motor neuron, and orthopedic dysfunction-works on strength, ROM, muscle endurance, focuses on muscles, joints, motor patterns required for the activity. MOVING TO GET SOMETHING TO WORK

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Sensorimotor approach

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Upper motor neuron-CP, Stroke, head injury. Sensory perception and movement patterns required in treatment approach-balance, posture, muscle tone and facilitation or inhibition of abnormal reflexes and movements. BRAIN POWER

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When to work on biomechanical vs. sensoriomotor

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If had injured arm, work on biomechanical for unaffected and sensoriomotor for affected

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Definition of therapeutic exercise

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Therapeutic exercise is defined as any body movement or muscle contraction to prevent or correct a physical impairment, improve musculoskeletal function, and maintain a state of well being. When used in OT should be used to remediate sensory and motor dysfunction, augment purposeful activity, and prepare the patient for performing a functional occupation.

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Purposes of Therapeutic Exercise

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Trying to make normal as possible. 1. Develop awareness of normal movement patterns and improve voluntary automatic movement response 2. Develop strength and endurance in patterns of movement that are acceptable and necessary and do not produce deformity 3. Improve coordination regardless of strength 4.Increased the power of specifc isolated muscles or muscle groups 5. Aid in overcomig ROM deficits 6. Increase strength of muscles that will power hand splints, mobile arm supports, and other devices 7. Increase work tolerance and physical endurance through increased strength 8. Prevent or eliminate contractures from developing because of imbalanced muscle power by strengthening the antagonistic muscles

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Indications for use of therapeutic exercise

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Orthopedic disorders, lower motor neuron problems, client must be able to understand directions

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Contraindications for use of therapeutic exercise

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Clients with poor general health, inflamed joints, recent surgeries, permanent contractures, spasticity, lack of voluntary control, upper motor neuron disorders

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Muscle strengthening

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Consists of active assistive, active, and resistive isotonic and isometric exercises are used to increase strength *After partial or complete denervation of muscle and during inactivity or disuse muscle strength decreases *When strength is inadequate substitution patterns can develop *Clients will substitute for loss or weakness of muscles normally to perform the movements *Muscles must contract at or near its maximal capacity and for enough repetitions and time to increase strength

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isotonic

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moving joint

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isometric

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not moving the joint

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what is strengthening based on

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contracting muscles against a large resistance for a few repetitions

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when is strengthening ineffective

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if the contractions is insufficient and too much strengthening may result in muscle fatigue, pain, and temporary reduction of strength. If a muscle is overworked, it becomes fatigued and is unable to contract

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Muscle Endurance

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The muscles ability to work for prolonged periods and resist fatigue.

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High load and low repetitions

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effective for muscle strengthening

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Low load and high repetitions

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effective for endurance

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Resistance and the number of repetitions can be varied from day to day to promote..

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gains in both strength and endurance

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Physical conditioning and Cardiovascular Fitness

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Improving general physical endurance and cardiovascular fitness requires the use of large muscle groups in sustained, rhythmic aerobic exercise or activity.

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range of Motion and Joint Flexibility

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Active and passive ROM exercises are used to maintain joint motion and flexibility

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When is stretching or forced exercise necessary?

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sometimes to increase ROM. Some type of force is applied to the part where soft tissue (muscles, tendons, and ligaments) is at or near its available length. A low resistance stretch of sustained duration is preferred.

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Coordination and Neuromuscular Control

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Coordination is the combined activity of many muscles into smooth patterns and sequences of motion

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Isometric or Static Contraction

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No joint motion occurs, and the muscle length remains the same. The limb is set or held taut as agonist and antagonist muscles are contracted at a point in the ROM to stabilize a joint. (stabilizing the arm in a locked position to carry a shopping bag slung over the forearm)

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Isotonic or Concentric Contraction

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There is joint motion and the muscle shortens. The contraction may be done with or without resistance. Can be performed with or without gravity according to the patients muscle grade. (isotonic contraction of the biceps is used to lift a fork to the mouth for eating).

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Eccentric Contraction

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The tension in the muscle increases or remains constant as the muscle lengthens. This can be completed with or without resistance. (no resistance-lowering the arm to the table when placing a napkin next to the plate-the biceps contracts eccentrically in this example) (Against resistance-controlled return of a pail of sand lifted from the ground-the biceps is contracting eccentrically to control the rate and coordination of the elbow extension in setting the pail on the ground)

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isotonic muscle contraction against a specific amount of weight to move the load through a certain ROM.

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isotonic resistive exercise

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patient uses the force of the agonist muscle to increase the length of the antagonist

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active stretch

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patient moves the joint through partial ROM and therapist or mechanical device complete the range

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active-assisted exercise

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joint motion and the muscle shortens-with or without resistance

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isotonic or concentric contraction

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therapist moves the joint through the available ROM and holds momentarily applying a gentle but firm force or stretch at the end of the range

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passive stretch

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active exercises performed when the patient moves the joint through its available ROM against no outside resistane

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isotonic active exercise

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maintain ROM, preventing contractures, adhesions, deformity

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passive exercise

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NO joint motion occurs , muscle length remains the same

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isometric contraction

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muscle or group of muscles is actively contracted and relaxed w/out producing motion of the joint that it ordinarily mobilizes

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isometric exercise without resistance

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exercise with applied resistance uses isometric muscle contraction peformed against some outside resistance

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isometric exercise with resistance

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