Fundamentals of Therapeutic Exercise Part Two

1. Body Position

Both the therapist's body position, and the position of the patient affect the quality of the patient’s response. There are a multitude of various positions in which to treat a patient and it’s important to alternate these treatment positions and postures during treatment. Join Dr. Wing as she discusses the importance of patient and therapist body positioning in this chapter.

2. Reflexes/Righting & Equilibrium Reactions

Early motor function is dominated by reflex activity while mature motor function is spontaneous. However, reflexes are programmed into the neuromuscular system and mature movement is reinforced by reflexes. After a stroke or other neurologic deficit, reflex activity may increase and influence the response of the patient.

3. Manual Contacts

The placement of the therapist’s hands is a powerful layer of facilitation. Whenever possible the therapist should place manual contacts over the skin, muscles, and tendons of the agonist. In this chapter Dr. Wing will identify the correct and incorrect contact placements and describe how these contacts on the body affect patient response to treatment.

4. Stretch

There are three forms of stretch to facilitate movement. The correct use of these three forms can initiate movement, increase the strength of the movement throughout the full range of motion, and improve the patient’s mobility overall.

5. Vision

The use of vision and visual cues as a layer of facilitation will virtually always improve performance. In addition to discussing the benefits of using visual cues, this chapter will discuss vision as an external focus of attention to improve performance. We'll also identify three neuromuscular mechanisms that describe the value of using visual cues and know how to effectively instruct patients using external cues.

6. Verbal Cues

Therapists often make the mistake of using too many words (verbal cues) when treating patients with neurological deficits. This can actually degrade performance rather than improve it. This chapter will present research that describes how to effectively use verbal instructions to enhance rather than worsen performance.

7. Resistance

The effective use of appropriate resistance in the hands of a skilled therapist can do more than just increase strength. This chapter will teach how the neuromuscular works in a unified manner, and correct neuromuscular concepts of resistance, and present these concepts with video examples for better understanding.

8. Summary

All patients have strengths. An effective therapist will be able to analyze a patient's movement patterns, identify strengths and weaknesses, and develop a treatment plan to utilize these strengths during therapy. In addition, the therapist will know how to apply appropriate layers of facilitation to enhance the patient's response.