Therapeutic exercise: foundations and techniques / Carolyn Kisner, Lynn Allen Colby; illustrations by Jerry L. Kisner.—4th ed. p. cm. Includes bibliographical. Therapeutic exercise: foundations and techniques / Carolyn Kisner, Lynn Allen Colby. — 5th ed. Preface. You will notice a new “face” with the fifth edition of. Therapeutic exercise: foundations and techniques / Carolyn Kisner, Lynn Allen Carolyn Kisner, Lynn Allen Colby. - 5th ed. Philadelphia: F.A. Davis, - STAT!.
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These trends include entry-level physical therapist education rapidly progressing toward the Doctor of Physical Therapy degree, basic and clinical research lending evidence for critical analysis and support for therapeutic exercise interventions, and the practice of physical therapy moving toward direct access and autono- my enabling physical therapists with the assistance of physical therapist assistants to provide services to individu- als with movement disorders that impair function.
Although there are a number of new features in this edition directed toward the changes in education, clinical practice, and the healthcare environment, this text contin- ues to provide a foundation of concepts, principles, and techniques on which an individualized program of thera- peutic exercise can be built. This foundation remains an important component of the text.
In addition to principles of exercise and background information on various pathologies and musculoskeletal surgeries, descriptions of exercise interventions and management guidelines are included to assist the reader in the development and pro- gression of individualized and comprehensive therapeutic exercise programs.
Major changes we have made in this fifth edition include: The reader will find brief descrip- tions of research that highlight evidence related to various concepts and therapeutic exercise interventions.
The content of the text has been expanded to include several new areas and has also been completely reorgan- ized.
There are now five major sections. Highlights of each of the sections are as follows.
She has done considerable graduate work and teaches in this area. The content of the chapter describes the importance of these topics in physical therapy practice. Their chapter has a rich blend of neu- rological and orthopedic perspectives to the manage- ment of impaired balance.
In each of these chapters we fea- ture a table that links physical therapist preferred practice patterns to each of the pathologies and sur- geries presented. As with previous editions, we hope that our efforts in planning and developing this edition will provide a useful resource for the continued professional growth of students and health practitioners who utilize therapeutic exercise. Obstetrics and Pelvic Floor. Anne D.
A special thank you goes to Berta Steiner of Bermedica Production Ltd, who spearheaded the copyediting and pro- duction process. Once again F. Davis has brought their energy and resources to the development of yet another edition of this textbook.
We are so grateful for their continued support for more than two decades. As with the fourth edition, Mar- garet Biblis, Publisher, has brought her vision, keen insight and style to the fifth edition. We also thank Jennifer Pine, our Development Editor, for always moving the project along and keeping us focused, as well as Deborah Thorp, Manager of Content Development for her help and input during our planning stages. Influence on Movement and Stability Neuromuscular Function: Management—Protection Phase Joint Hypomobility: Joint Hypomobility: Protection Phase Nonoperative Management: Protection Phase Management: Controlled Motion Phase Management: Management—Protection Phase Patellofemoral Symptoms: Management—Protection Phase Overuse Syndromes: Health-care consumers patients and clients typically seek out or are referred for physical therapy services because of physical impairments associated with movement disorders caused by injury, disease, or health-related conditions that interfere with their ability to perform or pursue any num- ber of activities that are necessary or important to them.
Physical therapy services may also be sought by individu- als who have no impairment but who wish to improve their overall level of fitness or reduce the risk of injury or dis- ease. An individually designed therapeutic exercise pro- gram is almost always a fundamental component of the physical therapy services provided.
This stands to reason because the ultimate goal of a therapeutic exercise program is the achievement of an optimal level of symptom-free movement during basic to complex physical activities.
To develop and implement effective exercise interven- tions, a therapist must understand how the many forms of exercise affect tissues of the body and body systems and how those exercise-induced effects have an impact on key aspects of physical function. Therefore, the purpose of this chapter is to present an overview of the scope of therapeutic exercise interven- tions used by physical therapists.
A patient is an individual with impair- ments and functional limitations diagnosed by a physical therapist who is receiving physical therapy care to improve function and prevent disability. We believe that all individuals receiving physical therapy services must be active participants rather than passive recipients in the rehabilitation process to learn how to self-manage their health needs.
Aspects of Physical Function: Definition of Key Terms The ability to function independently at home, in the workplace, within the community, or during leisure and recreational activities is contingent upon physical as well as psychological and social function. The multidimensio- nal aspects of physical function encompass the diverse yet interrelated areas of performance that are depicted in Figure 1. These aspects of function are characterized by the following definitions.
The ability to align body segments against gravi- ty to maintain or move the body center of mass within the available base of support without falling; the ability to move the body in equilibrium with gravity via interaction of the sensory and motor systems.
The ability to perform low- intensity, repetitive, total body movements walking, jog- ging, cycling, swimming over an extended period of time1,81 ; a synonymous term is cardiopulmonary endurance. The correct timing and sequencing of mus- cle firing combined with the appropriate intensity of mus- cular contraction leading to the effective initiation, guiding, and grading of movement.
It is the basis of smooth, accu- rate, efficient movement and occurs at a conscious or auto- matic level. The ability to move freely, without restriction; used interchangeably with mobility. The ability of structures or segments of the body to move or be moved in order to allow the occurrence of range of motion ROM for functional activities functional ROM.
Muscle performance. The capacity of muscle to produce tension and do physical work. Muscle performance encom- passes strength, power, and muscular endurance. Patient safety, of course, is paramount; nonetheless, the safety of the therapist must also be consid- ered, particularly when the therapist is directly involved in the application of an exercise procedure or a manual therapy technique. A patient unaccustomed to physical exertion may be at risk for the occurrence of an adverse effect from exercise asso- ciated with a known or an undiagnosed health condition.
Therefore, risk factors must be identified and weighed carefully before an exercise program is initiated. The environment in which exercises are performed also affects patient safety.
Adequate space and a proper support surface for exercise are necessary prerequisites for patient safety. If exercise equipment is used in the clinical setting or at home, to ensure patient safety the equipment must be well maintained and in good working condition, must fit the patient, and must be applied and used properly.
Specific to each exercise in a program, the accuracy with which a patient performs an exercise affects safety, including proper posture or alignment of the body, execu- tion of the correct movement patterns, and performing each exercise with the appropriate intensity, speed, and duration. A patient must be informed of the signs of respond to proprioceptive and kinesthetic information and, subsequently, to work in correct sequence to create coordi- nated movement. Used interchangeably with static or dynamic bal- ance.
The ability of the neuromuscular system through synergistic muscle actions to hold a proximal or distal body segment in a stationary position or to control a stable base during superimposed movement. Additional forces, incurred during routine physical activi- ties, help the body maintain a functional level of strength, cardiopulmonary fitness, and mobility.
Imposed forces and physical stresses that are excessive can cause acute injuries, such as sprains and fractures, or chronic condi- tions, such as repetitive stress disorders.
For example, the absence of nor- mal weight bearing associated with prolonged bed rest or immobilization weakens muscle and bone. Therapeutic exercise interventions involve the application of carefully graded physical stress- es and forces that are imposed on impaired body systems, specific tissues, or individual structures in a controlled, progressive, safely executed manner to reduce physical impairments and improve function.
Types of Therapeutic Exercise Intervention Therapeutic exercise procedures embody a wide variety of activities, actions, and techniques. The types of thera- peutic exercise interventions presented in this textbook are listed in Box 1.
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