Improvement of muscle strength and endurance is particularly important in the rehabilitation of patients whose goal is to return to an active and productive life after a debilitating illness or disabling injury. Although it requires much effort on the part of the patient and the therapist, the attainment of muscle control and coordination is a satisfying reward. It involves a systematic program of sequential activities under the direction of a therapist knowledgeable in the technique. The development of conscious control over individual muscles is useful in the rehabilitation of patients with a variety of disorders, including physical trauma, diseases such as poliomyelitis that affect the motor neurons, and congenital disorders such as cerebral palsy. The sessions are held in a quiet, comfortable atmosphere to facilitate concentration by the patient. Muscle training or neuromuscular re-education demands full cooperation of the patient, who must be capable of understanding the purpose of the exercises, following directions, and giving full attention to the muscle isolated for retraining. By learning precise and conscious control over a specific muscle, the patient is able to strengthen and coordinate its movement with normal motor patterns and thus enhance mobility. Exercises of this type are taught to the patient who has lost some control over a major skeletal muscle. Procedures that stretch tight muscles to increase joint motion should be done only by a skilled therapist who understands the hazards of fracture and bleeding within the joint, which can occur if the exercises are done improperly or too strenuously. Inflammation of the joint, as in arthritis, may cause some pain on motion, and so passive exercises are done slowly and gently with the joint as relaxed as possible. If the patient is not able to carry out these exercises, he is assisted by a therapist or member of the family who has been instructed in the exercises. It is recommended that each joint should be put through its full range of motion three times at least twice daily. Prevention of the loss of joint motion is much less costly and time-consuming than correction of tissue changes that seriously impair joint mobility. It is for this reason that therapeutic exercises to prevent loss of joint motion are so important and should be begun as soon as possible after an injury has occurred or a disease process has begun. These changes begin to develop within four days after a joint has been immobilized and are evident even in a normal joint that has been rendered immobile. If, however, motion is restricted for any reason, the soft tissues become dense and hard and adaptive shortening of the connective tissues takes place. In the absence of a disability that prohibits mobility, the regular day-to-day activities of living maintain the normal movements of the joints. As the patient performs specific exercises, blood samples are drawn for blood gas analysis, and ventilatory function tests such as tidal volume, total lung capacity, and vital capacity are conducted. These procedures must be performed in a clinical setting where health care personnel are available in the event symptoms develop during exercise, such as dyspnea, vertigo, extreme fatigue, severe arrhythmias, or other abnormal EKG readings.Įxercise testing also may be used to assess the pulmonary status of a patient with a respiratory disease. The technique cannot determine the location of the lesion causing cardiac ischemia and therefore must be supplemented with angiocardiography when coronary occlusion is detected.Ĭommon forms of exercise used include the treadmill and the bicycle ergometer. Called also stress testing.Ĭlinical exercise testing has become an important tool in screening for and diagnosing early ischemic heart disease that cannot be detected by a standard resting EKG, and in predicting the probability of the development of the condition in later years. Exercise testing a technique for evaluating circulatory response to physical stress it involves continuous electrocardiographic monitoring during physical exercise, the objective being to increase the intensity of physical exertion until a target heart rate is reached or signs and symptoms of cardiac ischemia appear.
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