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How do allied health professionals use therapeutic exercise?

This is an excerpt from Introduction to Kinesiology 7th Edition With HKPropel Access by Duane V Knudson,Timothy A Brusseau.

By Chad Starkey and Julie Cavallario

Integrating Exercise Into Medicine and Allied Health

Many medical and allied health professionals design and implement therapeutic exercise prescriptions to restore or improve motor function to a level that enables people to reach personal or occupational goals unencumbered by physical limitations. Medical and allied health professionals have additional training beyond undergraduate kinesiology to prescribe specific exercise that takes into account pathomechanical problems people have resulting from disease, injury, or disability. To develop therapeutic goals, clinicians must call on their knowledge of the effects of exercise on the muscular, nervous, skeletal, and cardiovascular systems and relate those effects to the patient’s needs and expectations. Depending on the patient, the workplace, and the conditions being treated, therapeutic goals may include restoring muscular function and strength, joint range of motion, proprioception, cardiovascular and pulmonary function, or metabolic function so that patients can participate in activities that they deem important.

Reassessing “Disability”

Historically, health care and medicine tended to focus on what patients and clients were unable to do as the result of injury, illness, or inactivity. This focus on limitations, reflected in the term disability, carries a stigma that emphasizes the negative aspects of the person’s state of well-being. In 2002, the World Health Organization (WHO) developed a system that places the emphasis on what the patient can do—the International Classification of Functioning, Disability, and Health (ICF) (World Health Organization, 2002). The ICF system incorporates both the medical approach of resolving pathology and the social model of reducing a condition’s negative effect on the person’s life (figure 12.1). This model illustrates the relationship between function and disability as the result of the interactions between health conditions (injury and disease) and contextual factors. Examples of contextual factors include external environmental factors (e.g., social attitudes), physical characteristics of the places where the person lives and works (e.g. availability of safe drinking water or presence of bike lanes or sidewalks in the person’s neighborhood), and personal factors (e.g., gender, profession, life experiences).

Therapeutic exercise specialists either help otherwise healthy people reach the level of activity they want or need in order to function (habilitative therapeutic exercise) or they help people who are ill or injured to return to their prior level of function (rehabilitative therapeutic exercise).

Kinds of Therapeutic Exercise: Rehabilitation and Habilitation

Therapeutic exercise uses a systematic and scientific application of exercise and programmed physical activity to either develop or restore muscular strength, endurance, or flexibility; neuromuscular coordination; cardiovascular efficiency; or other health and performance factors. In practice, therapeutic exercise is aimed at improving or restoring the quality of life. We draw a distinction between these two aspects of therapeutic exercise in order to help you understand the different types of professional work associated with this area.

KEY POINT
Therapeutic exercise can be classified as either rehabilitative (restoring lost function) or habilitative (helping to acquire normal function).

Broadly speaking, rehabilitation describes processes and treatments (interventions) that restore skills or function that were previously acquired but have been lost because of injury, disease, or behaviors, such as voluntary inactivity. If you have ever torn a muscle or broken a bone, then you know the value of rehabilitation in helping you regain lost functions. Although interventions can involve a variety of measures—for example, ice, heat, electricity, ultrasound, manual therapy, and psychological counseling—we focus in this chapter on interventions that rely heavily on physical activity.

Rehabilitation specialists need a thorough knowledge of the pathological aspects of injury and disease, of the functional limitations that they impose on human performance, and of the types of treatments required to meet the patient’s functional needs. Because people are more than just muscles and bones, rehabilitation specialists must also take into account the psychological and social effects of the injury, the patient’s personal goals and expectations, and the course of care leading to recovery. One example of rehabilitative therapeutic exercise can be found in the regimen used by an athletic trainer to restore a gymnast’s injured knee so that they can return to competition.

The rehabilitation process includes habilitation, the processes and treatments that lead to the acquisition of skills and functions that are normal and expected for someone based on their age and status (Olivares et al., 2011). The standards or expectations that signal a need for habilitation may differ vastly for persons of the same age. For example, we would expect physical performance standards for lawyers to differ from those of professional athletes. A lawyer who is physically fit according to the definition presented in chapter 2 is probably not in need of habilitation; their state of fitness is desirable for good health, and they do not need special physical abilities for any rigorous occupation. In contrast, an athlete who is strong but upon return from the offseason lacks the advanced cardiorespiratory endurance or strength to perform the tasks needed in their sport is a candidate for habilitation that involves intensive conditioning, training, and other skill-specific exercise.

In both rehabilitative and habilitative therapeutic exercise, the clinician must consider any permanent disability or impairment, such as blindness, amputation, or paralysis, that a person may have. For example, a paraplegic person’s functional loss of use of the lower extremities would not call for rehabilitation, but if that person lacked upper body strength relative to what is considered normal with a spinal cord injury, they would need habilitative care. A physical therapist who tries to correct congenital postural problems is also practicing habilitative therapeutic exercise because it involves bringing the client to a level of functioning not previously attained.

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