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Therapeutic exercise prescription; How do we do it?
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How?
To create an effective therapeutic exercise program sound clinical reasoning skills, an understanding of tissue healing, exercise prescription principles, motor learning principles and knowledge of the intricate interplay between the cardiopulmonary, metabolic and nervous systems, biomechanical and psychological components are required (Brody & Hall, 2011).
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The clinician must analyse the interplay between relevant impairments and related activity/participation limitations using the WHO-ICF (WHO, 2002) as a template and concomitantly consider patient-therapist goals. It is essential to understand the environmental and personal factors that can aid decisions about appropriate interventions between patients that present with seemingly with similar musculoskeletal complaints. For example, a patient’s physical environment, workplace, or comorbidities, education and life experiences.
Impairments
An important skill in rehabilitation is to be able to identify appropriate impairments that are contributing to the activity limitation(s) since there is a poor relationship between impairment and activity limitations (Brody, 2012). This guides the exercise program and aids in prioritisation of exercises. If an impairment has been deemed to be linked to activity limitation(s), consider (Brody & Hall, 2011);
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is the impairment amenable by physiotherapy?,
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what are the potential negative effects of the exercise for that impairment?
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what is the cost:benefit ratio of the exercise for that impairment? and,
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can it lead to future impairment if left untreated?
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Creating a therapeutic exercise program can include targeting muscular strength, power, endurance, aerobic exercise, balance, agility, coordination, gait retraining, ROM or stretching (Anemaet & Hammerich, 2014) through the manipulation of the intensity, duration, frequency, mode volume, and specificity of activity completed in each rehabilitation session (Hoover, VanWye & Judge, 2016).