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Shallow-water (shoulder to chest deep) exercises with the spine held in neutral position by cocontraction of ab dominals and gluteals: walking forward and backward, side-stepping while wearing aqua gloves, and hamstring stretching with back against the wall (. The program progressed the duration, repetitions, and speed of movement in the water, placing greater emphasis on abdominal and gluteal control in the neutral spine position and increasing the excursion of movement of the trunk and lower extremities. Shallow-water exercises: forward and backward jogging interval training, running progression, plyometric directional drills with and without a step bench and superimposing a variety of arm positions and movements (. Thus, instructions should be discussed with the for older individuals, the clinician should recommend patient before he or she removes the aid to enter the a medical checkup for blood pressure and other med water. Owing to the age-related in to place all frequently taken medications in a bag and crease in central processing time and response time, to bring them in). Medications of particular concern exercise instruction should be slow paced and clearly are the antihypertensives and cardiac drugs that may demonstrated. A comparison of entering and exiting the pool; the accidents are usu land and water exercise programs for older individuals. Effect of aquatic therapy on temporal spatial parameters of gait in the left at the side of the pool. A case study in adaptive aquatics for the geriatric railings, nonslip surfaces, and organization of the population. There are many treatment options and pa dysfunction of the spine and extremities. The clinician must con before introducing specific aquatic techniques in a sider the physical properties of water each time a clini plan of care. To increase success with chil cellent choice for children with juvenile rheumatoid dren, the clinician should focus on play with thera arthritis for treatment of both strength and flexibility peutic purposes. Water Aquatic exercise has been described as an appropri can be used for assistance or resistance, depending ate and safe intervention for children with osteogen on the exercise prescription. Extremes of plore movement more freely, strengthen muscles, temperature may be difficult for children to manage and practice functional activities. Most Aquatic therapy offers children opportunities for so aquatic therapy for children is one on one rather than cial interaction and may help promote development in groups. Poolside charts and pictures help children of independence and a positive body image.

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The process can be enhanced even more if a contraction of the agonist occurs at the end of the range of motion. This sets up an increase in the relaxation of the antagonist or the muscle being stretched. For example, passively move the foot into plantarflexion to stretch the dorsiflex ors. Contract the dorsiflexors isometrically against resis tance applied by a partner on the top of the foot. The antagonists generate a slow-reversal movement to elongate the target muscle, activating the muscle spindles and desensitiz ing the spindle during the follow-up passive elongation. Plyometric training has been effective in increasing power output in athletes in sports such as volleyball, basketball, high jumping, long jumping, throwing, and sprinting. Plyometrics builds on the idea of specificity of training, whereby a muscle trained at higher velocities will function better at those velocities. A plyometric exercise consists of rapidly stretching a muscle and immediately following with a contraction of the same muscle (5). Plyometric exercises improve power moves through a diagonal pattern, with manual resistance applied at output in the muscle through facilitation of the neurologic the foot and thigh. The neurologic basis for plyometrics is the input from the stretch reflex via the type Ia sensory neuron. Thus, if a muscle can exercise is the restitution of elastic energy in the muscle be rapidly stretched and immediately contracted with no (40). At the end of the stretch phase in a plyometric pause at the end of the stretch, this reflex loop produces exercise, the muscle initiates an eccentric muscle action maximum facilitation. If an individual pauses at the end that increases the force and stiffness in the musculoten of the stretch, this myoneural input is greatly dimin dinous unit, resulting in storage of elastic energy. The myoelectric enhancement of the muscle being a muscle is stretched, elastic potential energy is stored in chapter 4 Neurologic Considerations for Movement 119 the connective tissue and tendon and in the cross-bridges throwing motion with the right hand while holding the as they are rotated back with the stretch (2). The arm will generate a movement orous short-term stretch, maximal recovery of the elastic against the surgical tube resistance and then be drawn potential energy is returned to the succeeding contraction back into a quick stretch by the tension generated in the of that same muscle. These resistive tubes or straps can be purchased in prestretch with a small time period between the stretch varying resistances, offering compatibility with a variety of and the contraction is that larger forces can be produced different strength levels. Implementation of this technique suggests catching a medicine ball and immediately throwing it. Plyometric Examples A plyometric exercise program includes a series of exer cises imposing a rapid stretch followed by a vigorous contraction. Because the muscle is undergoing a vigorous eccentric contraction, attention should be given to the number of exercises and the load imposed through the eccentric contraction (16, 45). It is suggested that plyo metric exercises be done on yielding surfaces and not more than two days a week.

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Diagnosis Explore not only the history of complaints and former treatments, but any impairment, anxiety, and psychosocial issues. Use screeners and self-report questionnaires to enhance detection; use symptom diaries to assess course and factors inuencing symptoms. Provide the results of investigations to give clear reassurance that there is no serious physical disease. Explain that treatment is coping, not curing (when pathology cannot be found or does not explain degree of complaints). Referral Suggest coping strategies like regular physical activity, relaxation, distraction. Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity, and management. Table 5-2 Disorders of M ood Major Depressive Episode Manic Episode At least ve of the symptoms listed A distinct period of abnormally and below (including one of the rst persistently elevated, expansive, two) must be present during the or irritable mood must be present same 2-week period; they must for at least a week (any duration if represent a change from the hospitalization is necessary). It may attempt at suicide necessitate hospitalization for the the symptoms cause signicant protection of self or others. In distress or impair social, severe cases, hallucinations and occupational, or other important delusions may occur. Mixed Episode Hypomanic Episode A mixed episode, which must last at the mood and symptoms resemble least 1 week, meets the criteria for those in a manic episode but are both major and manic depressive less impairing, do not require episodes. Dysthymic Disorder Cyclothymic Episode A depressed mood and symptoms for Numerous periods of hypomanic most of the day, for more days than and depressive symptoms that not, over at least 2 years (1 year in last for at least 2 years (1 year children and adolescents). Tables 5-2 to 5-4 are based, with permission, on the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. For further details and criteria, the reader should consult this manual, its successor, or comprehensive textbooks of psychiatry. Recurrent, unexpected panic attacks, at least one of which has been followed by a month or more of persistent concern about further attacks, worry over their implications or consequences, or a signicant change in behavior in relation to the attacks. A panic attack is a discrete period of intense fear or discomfort that develops abruptly and peaks within 10 minutes.

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A progression of this activity would be an increase in the contextual demands: altering the sitting or standing the height of the step. Physical therapist gins at low carpet and proceeds over different size obstacles assistant is standing, without touching patient, behind and (A), high carpet, through pine bark (B), sit and rise from to the side of patient. In touch toes of outstretched limb); stepping in a circle using this example, the task is similar, but the context places more altering circumduction movements first in one direction demands on the cardiovascular system. The most common functional activity re Cardiovascular Endurance quiring sufficient cardiovascular endurance is walking in the home and community. Cardiovascular endurance involves the ability of the sys tem to perform work for a functionally sufficient amount of Contextual Training for Cardiovascular Endurance time. For example, cardiovascular endurance in walking should include the task walking across a four-lane street requires more cardiovas of walking. Therefore, a progressive walking program 432 Therapeutic Exercise for Physical Therapist Assistants Figure 17-9 Sitting hamstring stretch. Both of the hands are placed on the extended knee, and the knee is held in position while the toes are pointed toward the ceiling. For example, pushing and pulling a vacuum nation), whereas gross motor tasks like walking or running cleaner to complete housekeeping chores, taking stairs in require more integration and organization of the varied 12 stead of the elevator, or joining a mall walking group. Contextual Training of Coordination Coordination A program to train coordination should attempt to include Traditionally in therapeutic exercise, coordination has as many of the elements of contextual fitness as possible in been defined as the ability to perform smooth, accurate, repeated and random succession in varied environments. Patient extends trunk to reach and shelf at level that requires patient to reach up above shoulder flexes trunk to place objects in container (A and B). Stepping foot is on the outside and is free to upright, and patient is instructed to increase speed as can move. However, the patient/client should be free to move joint stability, cognition, coordination, etc.

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