Therapeutic Exercise Equipment & Techniques: Indications, Contraindications, and Theory

1. Therapeutic Exercise Equipment & Techniques RC- STD. 18

2. Standard 18 • Describe the indications, contraindications, theory, and principles for the incorporation and application of therapeutic exercise equipment and techniques, including but not limited to: continuous passive motion machine, aquatic therapy, manual therapy, adaptive therapeutic techniques, and/or assistive devices and mobilization.

3. Gate Control Theory • A principle of pain control • There is a “gate” within the spinal cord that organizes and interpret sensations • Larger fast nerve fibers carry sensations such as temperature and pressure • Smaller, slower nerve fibers carry the pain sensation • Stimulating the larger, faster nerves can “close the gate” on the smaller slow pain nerves • Translation: Cold, heat, acupuncture, rubbing an injury and chemical irritants can provide relief against pain

4. Principles of Exercise Equipment & Techniques • Progression • Regularity • Overload • Variety • Recovery • Realism • Balance • Specificity • Always start light and work your way up (heavier weights, more resistance, higher intensity, etc.) • There is no “cookie cutter” approach to therapy. It has to be individualized to be truly effective.

5. Therapeutic Equipment Choosing the right piece of exercise equipment for rehabilitation programs differs from choosing exercise equipment for fitness. Rehab programs often need to take into consideration factors such as: • low starting speed • accessibility and needs for disabled people • handles and grab bars strategically positioned to increase safety • larger/brighter screens for the visually impaired • range limiting devices to accommodate people with limited range of motion • wheelchair accessibility

6. Continuous Passive Motion Machine • Indications • Knee replacement • Fracture • Arthritis • Hip Surgery • Ligament Surgery • Contraindications • Unstable fracture • Muscle rigidity • Manic phase • Epileptic seizures • Unstable vital signs • Fever/Sweating

7. CPM Machine • Designed to overcome joint adhesions, joint stiffness, muscle atrophy, degenerative & traumatic arthritis after a patient has had joint surgery

8. Aquatic Therapy • Indications • Sensory disorders • Limited ROM • Weakness • Poor motor coordination • Pain • Spasticity • Balance Deficits • Contraindications • Open wound/rash • Seizures/Heart Disease • Urinary Infections • High/Low BP • Fever • Incontinence • Menstrual Cycle

9. Aquatic Therapy • Aquatic therapy is physical therapy that takes place in a pool or other aquatic environment under the supervision of a trained healthcare professional. It is different from aquatic exercise/fitness because it is a physical medicine and rehabilitation specialty that requires the involvement of a trained professional and is covered by many insurance providers.

10. Manual Therapy • Indications • Mild pain • Non-irritable condition • Intermittent musculoskeletal pain • Pain that is relieved by rest, or by particular motions/positions • Contraindications • Joint effusion/inflammation • Rheumatoid arthritis • Neurological issues • Osteoporosis • Hypermobility • Pregnancy • Dizziness • Sutures over the area

11. Manual Therapy • Defined as a clinical approach utilizing hands-on techniques, including but not limited to manipulation/mobilization, used by the therapist to treat soft tissue and joints to reduce pain, increase ROM, decrease myofascial restrictions, improve muscle length, decrease swelling/inflammation, assist the body in muscle/soft tissue repair, and facilitate movement to improve function.

12. Manual Therapy • Soft Tissue Techniques • Massage • Mobilization • Myofascial release • Strain counterstrain • Craniosacral therapy • Active Release Technique • Feldenkrais • Graston • Joint Techniques • Mobilization • Manipulation/Thrust • Muscle energy techniques • Mulligan techniques • Traction

13. Adaptive Therapy • Any of the services, techniques, and technologies used in rehab to help patients with functional disabilities overcome environmental barriers.

14. Assistive Devices • An Assistive Device is any device that helps someone do something that they might not otherwise be able to do well or at all. Generally the term is used for devices that help people overcome a handicap such as a mobility, vision, mental, dexterity or hearing loss.