ŠĻą”±į>ž’ cež’’’b’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ģ„Į9 šæk8bjbjżĻżĻ%hŸ„Ÿ„Q4’’’’’’l$$$$$$$8N)N)N)8†),²)Œ85ņJ*J*"l*l*l*l*l*l*—4™4™4™4™4™4™4$ 6 *8 ½4$l*l*l*l*l*½4ˆ.$$l*l*Ņ4ˆ.ˆ.ˆ.l*B$l*$l*—4ˆ.l*—4ˆ.€ˆ.4c4$$‹4l*>* Ą!Į‘lĶĮ8&N)®+{4‹4 č405ƒ4Ź8®+ŚŹ8‹4ˆ.88$$$$ŁScript For Video Comparing different types of stimuli; Demonstrating the effects of exercise therapy along the movement continuum Introduction(1:07m) Exercise therapy is the stimulis which many physiotherapists believe to be the most effective means for patient rehabilitation. The movement continuum is a broad theoretical concept developed to help define the physiotherapy practice. The theory looks at the relationship between the physiotherapist and movement rehabilitation, which involves all levels of the continuum. It incorporates knowledge of pathology from a holistic point of view, which includes physical, social and psychological factors. Essentially the purpose of the theory is to provide a framework for the entire profession that is applicable to education, research and clinical practice. Movment Continuum Cylinder (25s) The Movement Continuum is a model which represents levels where physiotherapy treatment can best be targeted, beginning at a micro-level and ending at a macro-level. The Movement Continuum levels are; Molecular Sub-cellular Cellular Tissue Organ System Body part Body Person in environment Person in society Picture of Knee(10s) In this video, examples of demonstrating the effects of exercise therapy along the movement continuum will be done on the quadriceps muscles. All of the exercises are focused, based on the muscle structure, functions, and physiological effects Molecular and Sub-cellular Level (2:00m) 1. Exercise: Vibration Target: Molecules Actin, Myosin, Troponin, and Tropomyosin Goal: Relaxation Patient Position: Sidelying Technique: Indirect 2. Exercise: Vibration Target: Molecules Actin, Myosin, Troponin, and Tropomyosin Goal: Relaxation Patient Position: Sidelying Technique: Direct 3. Exercise: Vibration Target: Molecules Actin, Myosin, Troponin, and Tropomyosin Goal: Relaxation Patient Position: Supine Technique: Indirect 4. Exercise: Vibration Target: Molecules Actin, Myosin, Troponin, and Tropomyosin Goal: Relaxation Patient Position: Supine Technique: Direct Target: The muscle fiber of the rectus femoris Goal 1: The healing process of phagocytosis is sped up by agitating muscle fibers in the tissue. Goal 2: The promotion of lymphatic and venous drainage 1. 40s Exercise: Gentle (Light) Contractions or Quad sets Patient Position: Long sitting The therapist places a towel under the affected knee of the patient. This allows slight flexion. The patient tightens the quadriceps pushing the towel into the table for a count of 5, and then relaxes. A typical early protocol may be 3sets of 10 and repeated 3-4 times a day. 2. 40s Exercise: Gentle Stretch Patient Position: Side-lying The therapist stands behind the patient, grabs the ankle and fixates the hip. Then gently brings the foot into knee flexion. 3. 60s Exercise: Traction Goal: To influence circulation of cells and to diminish pain. Patient Position: Seated at the edge of table. The therapist places a sandbag under the knee and puts the joint in the resting position or 30deg. flexion. The therapist then places his hands as close to the joint as possible, then pulls in the direction perpendicular to the joint. 4. 15s Exercise: Approximation Goal: To influence circulation of cells and to diminish pain Patient Position: Seated at the edge of the table. The therapist places the knee in the resting position, then proceeds to tap the foot in the direction perpendicular to the knee joint This is going to slightly compress the joint. 5. 15s Exercise: Approximation This exercise is the same except now the knee is in full extension. Tissue Level Target: Muscle fiber of the Rectus Femoris Goal: Increase length of shortened muscle and R.O.M 1. 60s Exercise: Quadriceps stretch (active) Patient Position: Side-lying This exercise is done by the patient, bringing the foot toward the buttocks. The stretch should be done for 1-2min., broken down into 20sec. repeated 3-6 times, 3-4times a day. 2. 60s Exercise: Quadriceps stretch (passive) Patient Position: Prone The therapist brings the foot toward the buttocks and slightly raises the knee off the table. 3. 65s Exercise: Quadriceps stretch (reciprocal inhibition) Patient Position: Prone The therapist facillitates an isometric contraction (5-8sec.) by not allowing the patient to bring her foot toward her buttocks. After which the therapist then brings the foot toward the buttocks and raises the knee slightly off the table. 4. 30s Exercise: Quadriceps stretch Patient Position: Standing The patient brings her foot toward her buttocks. The stretch is felt on the lower thigh. 5. 30s Exercise: Quadriceps stretch Patient Position: Shooting Position The patient facillitates this stretch by bending over the forward leg, and maintaining hip extension in the back leg. The stretch is felt on the upper thigh. 6. 45s Exercise: Quadriceps stretch Patient Position: Standing on knees The patient facillitates the stretch by sitting on her feet. The stretch is felt on the lower thigh. Organ System Level Target: Rectus Femoris/Quadriceps Goal: To strengthen the weak muscle 1. 45s Exercise: Short Arc Quads Patient Position: Long sitting The therapist places a towel under the knee of the patient. The patient then tightens the quadriceps muscle, extending the knee, and bringing the foot off the table. Hold the position for 5 sec., then relax. A typical early protocol may be 3sets of 10 and done 3-4 times a day. 2. 35s Exercise: Knee extension Patient Position: Seated with knees at the edge of the bench. The patient is instructed to lift her leg from 90deg. flexion to full extension, then to slowly move back to the start position. 3. 75s Exercise: Knee extension w/ankle weight Patient Position: Seated with knees at the edge of the bench. The same as above, but with resistance. Making the exercise more difficult and may add the principle of isokinetics which is maintaining the same speed throughout the motion. 4. 60s Exercise:Wall Slides Patient Position: Back against the Wall and feet out 30cm in front. The patient then proceeds to squat down no further than 90deg. for a count of 5. Once again a typical starting protocol may be 3sets of 10 and done 3-4 times a day. Body Part Level Closed Chain Exercises Target: Knee region Goal: Stabilization of the knee region 1. 60s Exercise: Standing Patient Position: Standing The patient stands in normal position, feet shoulder width apart. Then the patient is blind folded Finally, the therapist applies external disturbances to the patient. The therapist is looking for balance, control and appropriate reactions to external disturbances. 2. 20s Exercise: Standing Patient Position: Feet Together 3. 10s Exercise: Standing Patient Position: Narrow standing (one foot in front of the other) The patient is also asked to stand with blindfold on. 4. 30s Exercise: Standing Patient Position: On Toes The patient stands on toes creating a smaller surface, requiring more control. Again with blindfold. 5. 40s Exercise: Standing Patient Position: On one leg This requires more balance and control and is also done width eyes closed and external disturbances applied by the patient. 6. 30s Exercise: Bouncing, Jumping on Trampoline Patient Position: Standing and Jumping The first part of the exercise is just standing on the trampoline which is acts as an unstable surface. The second part to the exercise requires coordination and stability by jumping on the unstable surface. Open Chain Exercises 7. 30s Exercise: Stabilization of the knee Patient Position: Seated w/affected foot off the floor The therapist takes the foot and applies external disturbances, pushing and pulling the foot in various directions. The second part is adding a blindfold. 8. 10s Exercise: Stabilization of the knee Patient Position: Supine The therapist takes the foot and applies external disturbances, pushing and pulling the foot in various directions. The second part is adding a blindfold. 9. 150s (2:30m) Exercise: P.N.F. Patient Position: Sitting The direction: from knee flexion, hip extension, internal rotation and abduction to knee extension, hip flexion, external rotation and adduction 3 techniques Concentric Contraction (normal) 60s The therapist passively does the movement and the pre-stretch to familiarize the patient. Then the therapist applies resistance to the movement, and asks the patient to hold the leg for 5-8sec. at the end of the movement and then to relax and return to the starting position. 2) Combination of Isotonics 60s This time the patient brings the leg to the end of the movement, with resistance, and holds for 5-8seconds. Then on the way back toward the starting position the therapist applies resistance and ask the patient to maintain a tension in the muscle. 3)Timing for Emphasis (isometric hold at a 45 degrees) 60s The therapist applies resistance the patient moves the joint. If the therapist becomes aware of a weak point, he can apply resistance not allowing motion (isometric contraction) for 5-8sec. then asks the patient to go all the way to the end of the movement. 10. Exercise: P.N.F. Patient Position: Supine Same sequence as prior exercise just done in supine position. 3 techniques 1)Concentric Contraction (normal) 50s 2)Combination of Isotonics 30s 3)Timing for Emphasis (isometric hold at a 45degrees) 30s Body Level Target: The Whole Person Goal: Coordination Static exercises 1. 30s Exercise: “Touching the Therapist Hand” Patient Position: Standing on Strong Leg This exercise takes balance and coordination. Goal oriented by having the foot touch the hand of the therapist at various positions. 2. 15s Exercise: “Rolling Ball” Patient Position: Standing This exercise takes balance and coordination. The goal is to move the ball to designated marks on the ground. 3. 20s Exercise: “Ball around” Patient Position: Standing This exercise also requires balance and coordination. The goal is to move the ball around the standing leg. 4. 10s Exercise: Kicking the Ball Patient Position: Standing The exercise is a bit more dynamic, the patient must move to kick the ball, coordination is addressed by kicking the ball in a certain manner and direction. Dynamic Exercises 1. 60s Exercise: Circle Lunge Patient Position: From Standing to various lunge positions. The patient does lunges in various positions. It requires strength, stability, control and coordination. The patient should alternate legs, can be done in a pattern or random (verbal cues from the patient). 2. 10s Exercise: “Catching the Ball” Lunge Patient Position: From Standing to various lunge positions The therapist throws the ball in a certain direction, the patient must catch the ball in the various lunge positions. 3. 6s Exercise: Walking Patient Position: Standing The therapist is looking for normal gait. 4. 15s Zoom in on the foot to look at the 4 components of foot placement. 1) Heel-Strike Flat-Foot Mid-stance Toe-off 5. 5s Exercise: Walking Backwards 6. 5s Exercise: Karoke 7. 40s Exercise: Bouncing, Jumping on the Trampoline Patient Position: From Standing to various positions The patient jumps on the trampoline and does jumping jacks, scissor kicks, catches the ball, hits the ball, jump and turn, etc. Person in Environment Level Target: The whole person in her environment Goal: Functional Exercises (Individual Activities) 1. 13s Exercise: Reaching w/ physiotherapist Patient Position: Standing The patient is reaching up, with the therapist present to help correct body mechanics 2. 15s Exercise: Reaching in her environment Patient Position: Standing The patient is seen in her environment, reaching for items in her locker. 3. 20s Exercise: Pushing w/ physiotherapist present Patient Position: Standing The patient pushes objects and the therapist is present to watch for proper body mechanics. 4. 30s Exercise: Pushing in environment The patient is now seen in her environment, (Albert Hein), pushing a grocery cart And in the next clip a garbage bend. 5. 10s Exercise: Lifting & Carrying w/ physiotherapist The patient lifts and carries an item, showing proper body mechanics 6. 15s Exercise: Lifting & Carrying in environment The patient is seen, lifting an item, in her environment. Person in Society Level Target:The whole person in society Goal: Functional Activities in society 1. 6s Exercise: Walking w/physiotherapist 2. 10s Exercise: Walking the Dog The patient is doing a hobby of hers walking her dog. 3. 5s Exercise: Stationary Bike Preparation for riding a real Bike 4. 5s Exercise: Riding a real Bike 5. 15s Exercise: Lifting, Carrying, & Pushing w/ physiotherapist 6. 20s Exercise: Helping Person in WheelChair 7. 50s Exercise:Gardening This scene involves lifting, carrying and pushing, items in the garden, a hobby for many especially on a nice sunny day. 8. 5s Exercise: Riding a Bike with a Friend Movement Continuum Cylinder(25s) , The Movement Continuum levels are….. 1)Molecular 7)Body 2)Sub-cellular 8)Person in environment 3)Cellular 9)Person in society 4)Tissue 5)Organ System 6)Body part PAGE  PAGE 1 7‚–˜™*+,LMN&<C‡ˆž¹Ę’ “ ” ¶ ¾ Ź Ī × ę ūē×ŅĒĄ½¹²½²°®½²¤×ץ”‡|sjfb_Y_ 5CJ\CJCJ\5\5B*CJph5B*CJphB*CJmH phsH B*CJ\mH phsH B*CJ\ph 5>*CJ\5OJQJ\^J5\ B*CJph5CJCJ OJQJ^J5>*OJQJ\^J 5>*\5B*CJOJQJ\^Jph'5B*CJOJQJ\^JmH phsH >*CJ "7‚ƒ˜™+,MN&3<CPZ_u‡ˆžśķėééééēéėēėėėåėėćėėėėėėėė $„„^„`„a$$a$Q8j8žžž“ ” • ¾ Ź Ī ć å ! 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