DPT 682 THERAPEUTIC EXERCISE
TIME
LOCATION
Instructor:
Office:
Office hours:
Phone:
E-mail:
Course Prerequisites
DPT 625 Clinical Anatomy 1, DPT 650 Pathophysiology, DPT 680 Integumentary Therapeutics, DPT 610 Foundations of DPT
Examination, DPT 686 Clinical Communication, DPT 785 Principles of Evidence Based Practice
Course Description
In the “Guide to Physical Therapist Practice” (APTA) Therapeutic Exercise is considered a core element of physical therapy plans of
care. Therefore mastery of the skills necessary to implement these approaches is vital to the practice of physical therapy. This
course examines the foundations and principles of Therapeutic Exercise as they apply to the clinical practice of physical therapy. In
the initial portions of the course the theory and principles by which a variety of therapeutic exercises produce beneficial
physiological outcomes will be discussed. Subsequently, these ideas will be utilized to outline the process by which clinicians design
appropriate therapeutic exercise programs. In doing so, students will be expected to interpret findings of a physical therapy
examination and utilize these to identify the presence of patient impairments, functional limitations and/or disabilities. Based on
these skills, the use of therapeutic exercise to address such problems will be a primary emphasis of the course. Therefore, methods
used to efficiently prescribe therapeutic exercise will be introduced and practiced. Furthermore, the various approaches to
therapeutic exercise will be surveyed and discussed within the context in which they are most appropriately utilized. This course will
also attempt to apply relevant knowledge of several systems including the musculoskeletal (anatomy and biomechanics),
respiratory, cardiovascular, and central nervous (motor control) and comment on their relationship to therapeutic exercise
interventions.
Course objectives
At the completion of this course, the student will be able to:
1.
Analyze mechanisms by which therapeutic exercises produce therapeutic benefits.
2.
Describe foundational principles and rationale for therapeutic exercise prescription as a management intervention for
patients and/or clients.
3.
Identify patient and/or client impairments, functional limitations and disabilities from examination findings/results.
4.
Select and provide rationale for therapeutic exercise interventions designed to address specific impairments, functional
limitations and/or disabilities.
5.
Determine a patient/client’s need for unilateral and/or bilateral therapeutic exercise prescription to manage their
condition.
6.
Apply the general classifications of therapeutic exercise administered in physical therapy as well as the circumstances
under which they are appropriate.
7.
Demonstrate competence in utilizing therapeutic exercise as an intervention for patient/client management including
prescribing, designing, and instructing patients and/or clients in selected therapeutic exercises.
8.
Apply knowledge of variables relevant to therapeutic exercise progression throughout an episode of care for a patient
and/or client.
9.
Consistently prescribe therapeutic exercise including patient/client instruction in all relevant dosage variables:
repetitions, sets, hold time, frequency (how often per day or week), duration (how many days/weeks/months to
continue therapeutic exercise), and resistance amount.
10.
Describe and teach safe biomechanical principles of sitting and lifting, and other activities of daily living based on the
concept of “neutral.”
11.
Correctly demonstrate four lifts: the golfer’s, tripod, diagonal squat and power.
12.
Select appropriate lifts to teach your patients based on their individual needs.
13.
Describe the ergonomics of workstation design to include features of chairs, monitors, keyboards, a mouse and
accessories (screens, wrist rests and text holders).
14.
Be able to examine a patient or client’s workstation and make appropriate recommendations for them.
15.
Describe concepts and principles related to balance.
16.
Select and prescribe appropriate exercises and activities designed to address balance impairments for a given
patient/client.
17.
Given a mock patient, select and perform appropriate joint mobilization techniques for extremity joints.
Teaching Methods and Learning Experiences
Learning experiences during this course will consist of lectures, class discussion, small group activities, analysis of patient case
studies, home work assignments, examinations, practicals and laboratory experiences. Tuesday class sessions will most often
consist of lectures, discussion, and/or in-class activities while Thursday sessions will generally focus on developing skills (e.g.
psychomotor) in the laboratory setting relevant to the use of therapeutic exercise in managing patients/clients. This format
however, will fluctuate during the semester to best meet the needs of the course.
To facilitate an interactive environment, students are encouraged to participate often by asking questions and voicing their reactions
to course material. As often as possible, the instructor will attempt to relate course content to the clinical setting. Students in turn
will often be asked to “think like clinicians” and apply knowledge to case studies and situations. Most often this will consist of
identifying patient problems/impairments that may exist and/or potential impairments that may develop in the future and
subsequently identifying therapeutic exercise designed to address the impairments.
Evaluation Methods
Student evaluation will be based on the criteria outlined below. Exam questions will typically consist of multiple choice, true/false,
and matching. There may also be short answer and essay formats. Many test items will be placed in a clinical context. In other
words, students will need to draw on course knowledge to solve a clinical problem or to propose a certain course of action for a
prospective patient/client. Furthermore, because much of the information taught in this course examines the scientific principles
behind therapeutic exercise as well as effectively teaching patients/clients to correctly perform therapeutic exercise, students
should be able to explain such ideas to their future patients. Therefore, it is recommended that students attempt to understand the
content in a manner that allows them to achieve these goals.
Grade Distribution for the course will be as follows:
Assignment 1
Midterm Exam
Midterm Practical
Assignment 2
Final Practical
Ther Ex/Neuro Skills Practical
Final Exam
Percent
5%
30%
15%
5%
15%
Pass/Fail
30%
Date
Finals Week
Assignments: There are two required assignments to be posted on vista so that all students in the course will benefit from the
information.
Assignment #1: You will be required to submit one exercise to lengthen a muscle/s or capsule/ligament that is too short.
Assignment #2: You will be required to submit one exercise to recruit a muscle that is either too long (shorten the muscle), too weak
(strengthen the muscle) or that will inhibit (shut-off) a hyperactive muscle.
The exercises can be with or without equipment e.g. physioball, dumbbells or cuff weights etc.). Primary muscles to be used for
your exercises will be assigned. This is practice for prescribing exercises for patients/clients, so make it layman friendly.
1. You will need to include a title of the exercise. Include the primary muscle to be lengthened for A#1 and the prime mover
(agonist) to be activated for A#2. You MUST also include if it is for the right muscle, left muscle or both.
2. You will also need pictures and descriptions of the exercises (the picture MUST match the description, if the picture is for
the right side, your description should also be for the left side). Do not include two pictures (one for right, one for left) if
you were assigned just ONE side (otherwise a point will be deducted). The description must be clear and correct for the
specified tissue to be lengthened/activated etc. and should be written in LAYMANS terms…in other words describe how to
do the exercise for a patient. It should also be complete to cover the beginning, middle and end phases of the exercise. If
you discuss pulling a lat bar down and end there, that would not be complete because the patient will have to allow the bar
to raise up to the starting position.
3. Tell me what muscle/s is/are being shortened, lengthened (A#1), strengthened or inhibited (A#2) and what type of muscle
contraction/s if any are occurring. Consider all phases of the exercise when thinking about muscle contraction type (A#2). If
you choose a major muscle e.g. to be stretched/lengthened and your exercise method obviously lengthens other muscles
(even on the other side of the body) please include them as well.
4.
You will need to write on the paper an exercise dosage including number of repetitions, number of sets, frequency (e.g.
one time/day, twice/day, 3 times/week) and duration of exercise (e.g. for 8 weeks), amount of weight if applicable, and the
number of seconds to hold the exercise position if applicable. The number of repetitions and sets can’t just be implied, but
must be specifically stated. If you say to stretch 3 times and that is it….then you will miss points for the “sets”….you need
to say 3 reps and 1 set.
5. See assignment 2 for additional requirements to identify the synergists acting in your exercise.
Assignments and practicals will be graded with the forms below. Be sure to cross check your assignments to the grade forms.
Assignment 1 DPT 682
Name __________________________
Points earned_____/11 * .05% = ___________points toward course grade
Lengthen exercise: (for a muscle/s, capsule/s, and/or ligament/s that is/are too short)
(1) Picture
(2) Clearly written description of exercise
(2) Tissue lengthened – including correct side of body
Dosage:
(1) Repetitions
(1) Sets
(1) Frequency of the exercise
(1) Duration of exercise
(1) Hold time (if applicable)
(1) Amount of weight (if applicable)
Assignment 2 DPT 682
Name __________________________
Points earned_____/14 * .05% = ___________points toward course grade
Recruiting exercise (for a muscle or muscles that are too long, to strengthen muscle/s, and/or inhibit muscle/s:
(1) Picture
(2) Clearly written description of exercise
(2) Muscle/s recruited (not just the one chosen as the prime mover but all muscles working with the exercise)
(2) Muscle contraction type (may be more than one for different phases)
(2) State what muscles are fixators, and which are synergists. Fixator: a muscle than anchors, steadies or supports a bone or body
part in order to provide a stable base for another muscle to act. Synergist: when 2 or more muscles contract simultaneously to
perform an action.
Dosage:
(1) Repetitions
(1) Sets
(1) Frequency of the exercise
(1) Duration of exercise
(1) Hold time (if applicable)
(1) Amount of weight (if applicable) _________________________________________________________________
Grading Rubric for Therapeutic Exercise Practical Exam
Psychomotor
Performance
Good to Excellent
Performance
Adequate to Fair
Performance
Poor Performance
Performs most skills
properly with minor fine
tuning and cueing
Performs skills properly with
moderate amounts of cueing
and guidance
Needs significant cueing or
guidance to perform skills
properly
(5 points)
Most interactions are
(3-4 points)
Provides some appropriate
(0-2 points)
Needs significant cueing to
Score:
Patient
Interactions
Score:
Treatment
Rationale and
Score:
Ability to Progress
or Modify
Procedures
Score:
Final Score:
appropriate; Provides
effective instructions
interactions and instructions,
while others require
redirection
provide adequate
instructions and interact
appropriately
(5 points)
Provides mostly sound
rationale for performing
procedures;
(3-4 points)
Needs some cueing to arrive
at proper rationale for
procedures
(0-2 points)
Needs significant cueing to
provide rationale and / or
modify procedures based on
given circumstances
(0-2 points)
(5 points)
Is able to appropriately
modify procedures to
represent a progression or
revision based on given
circumstances with minor
cueing
(5 points)
(3-4 points)
Needs some cueing to
appropriately modify
procedures based on given
circumstances
Needs significant cueing to
modify procedures based on
given circumstances
(0-2 points)
(3-4 points)
_______ / 20 * .15 = _____%
Final Grades will be assigned using the standard scale of:
90-100
80-89
70-79
<70
A
B
C
F
Required Text and required Readings
Kisner, C., Colby, L.A.; Therapeutic Exercise Foundations and Techniques, 5 th Edition: F.A Davis, Philadelphia, 2002.
O’Sullivan P. et al. Altered Motor Control Strategies in Subjects with Sacroiliac Joint Pain During the Active Straight-Leg Raise Test.
Spine.2002;27(1):E1-E8
Witt P, Gress R. Criteria and Rationale for Selecting Ergonomic Equipment. FM Journal 1996; pgs. 11-15.
Additional or Recommended Text and Readings
Hall, C., & Brody, L.T., Therapeutic Exercise: Moving Towards Function, 2 nd Edition: Lipincott, Williams, & Wilkins, Philadelphia,
2005.
Nyland, J., Clinical Decisions in Therapeutic Exercise: Planning and Implementation: Prentice Hall, Upper Saddle River, New Jersey,
2006.
Houglum, P., Therapeutic Exercise for Musculoskeletal Injuries, 2 nd Edition: Human Kinetics, Champaign, Illinois, 2005.
Huber FE, Wells CL. Therapeutic Exercise Treatment Planning for Progression. Saunders Elsevier. St. Louis, MO, 2006.
Required Journal Readings
Alexander, L. D., Gilman, D. R., Brown, D. R., Brown, J. L., & Houghton, P. E. Exposure to low amounts of ultrasound energy does not
improve soft tissue shoulder pathology: a systematic review. Phys Ther, 90(1), 14-25.
Andersen, L. L., Andersen, C. H., Mortensen, O. S., Poulsen, O. M., Bjornlund, I. B., & Zebis, M. K. Muscle activation and perceived
loading during rehabilitation exercises: comparison of dumbbells and elastic resistance. Phys Ther, 90(4), 538-549.
Hayden, J. A., van Tulder, M. W., Malmivaara, A. V., & Koes, B. W. (2005). Meta-analysis: exercise therapy for nonspecific low back
pain. Ann Intern Med, 142(9), 765-775.
Hubbard, T. J., & Denegar, C. R. (2004). Does Cryotherapy Improve Outcomes With Soft Tissue Injury? J Athl Train, 39(3), 278-279.
Katalinic, O. M., Harvey, L. A., & Herbert, R. D. Effectiveness of stretch for the treatment and prevention of contractures in people
with neurological conditions: a systematic review. Phys Ther, 91(1), 11-24.
Mizner, R. L., Petterson, S. C., & Snyder-Mackler, L. (2005). Quadriceps strength and the time course of functional recovery after
total knee arthroplasty. J Orthop Sports Phys Ther, 35(7), 424-436.
Oriel, K. N., George, C. L., Peckus, R., & Semon, A. The effects of aerobic exercise on academic engagement in young children with
autism spectrum disorder. Pediatr Phys Ther, 23(2), 187-193.
Page, C. J., Hinman, R. S., & Bennell, K. L. Physiotherapy management of knee osteoarthritis. Int J Rheum Dis, 14(2), 145-151.
Piva, S. R., Teixeira, P. E., Almeida, G. J., Gil, A. B., DiGioia, A. M., 3rd, Levison, T. J., et al. Contribution of hip abductor strength to
physical function in patients with total knee arthroplasty. Phys Ther, 91(2), 225-233.
Rand, D., Miller, W. C., Yiu, J., & Eng, J. J. Interventions for addressing low balance confidence in older adults: a systematic review
and meta-analysis. Age Ageing, 40(3), 297-306.
Course Policies
1. Professionalism: As students are entering a professional field, it is expected that they will conduct themselves as
professionals both in and outside of the classroom. Professional behaviors, which include promptness, respect for
colleagues and faculty, and maintenance of an environment conducive to the learning process are expected at all times.
Unprofessional behaviors such as excessive talking, negative discussion related to colleagues/faculty, sleeping in class,
performing activities not related to course content, or otherwise disrupting class activities will not be tolerated and may
be considered when assigning final grades.
2. Preparation: Students are expected to complete all reading and other assignments prior to class time and be prepared to
discuss the relevant topics. Because some class activities will be based on students’ familiarity with assigned material, this
is expected for the benefit of the class as a whole.
3. Academic Dishonesty: Plagiarism or any other form of cheating will not be tolerated and will result in a grade of Failure (F).
Further action in accordance with departmental and university policy will also be taken. For further information on
plagiarism and cheating see SDSU policies.
4. Written and Practical Examinations and Assignments: All work must be completed on the day specified unless prior
arrangements have been made with the instructor. SUCH ARRANGEMENTS SHOULD BE MADE AS MUCH IN ADVANCE AS
POSSIBLE. Even with advance notice, there are no guarantees that the student will be given permission to take an exam or
practical at an alternate time, but exceptions may be made on a case by case basis. If a student is unable to attend an
exam/practical due to sickness or other unavoidable circumstances, they must contact the instructor by the start of class
time on the day of the exam. Failure to do so may result in a deduction of 10% of their grade per each 24 hour period. The
instructor may also require medical documentation to justify the student’s situation. All work must be turned in/completed
by the specified day or be subject to a 10% penalty per twenty-four hour period that the work is late unless prior
arrangements are made as listed above as pertaining to the criteria for rescheduling traditional exams.
5. Attendance: Consistent class attendance is required. If absence from a class session is unavoidable, it is recommended
that the student notify the instructor at the earliest possible time. University policies deem that the only conditions under
which absences may be considered excused are 1) illnesses for which documentation is provided by a medical professional,
and 2) death in the family or family emergencies. While class attendance is required per the[above stated policy, please be
cautious about attending class if you are feeling ill. Please inform me by phone or email if you are feeling unwell; if you are
experiencing flu-like symptoms, you should not attend class; please take precautions not to infect others, and seek medical
attention if your symptoms worsen.
6. Laboratory Sessions: Lab clothing will often be necessary during certain portions of the course (typically Thursdays).
Appropriate lab clothing for men includes shorts and T-shirts, for women shorts, halter-tops, swimsuits, and/or jogging
bras. Students with physical conditions or illnesses which may be complicated by physical activity should consult the
instructor prior to participating in lab experiences. If you are otherwise unable or unwilling to participate in lab activities,
please notify the instructor prior to the lab experience.
Physioballs will be required for at least one of the lab activities, and will also be used later in the SDSU DPT curriculum.
Students may come up with their own physioball for this purpose. Target usually has them for under $20. 55 cm balls
(recommended for individuals 5’ to 5’6”) will be approximately $15. 65 cm balls (5’7” to 6’2”) will be approximately $18.
You can also order online from companies such as Orthopedic Physical Therapy Products (OPTP) for high quality and
reasonable prices.
Statement on Cheating and Plagiarism
Cheating is the actual or attempted practice of fraudulent or deceptive acts for the purpose of improving one’s grade or obtaining
course credit; such acts also include assisting another student to do so. Typically, such acts occur in relation to examinations.
However, it is the intent of this definition that the term ‘cheating’ not be limited to examination situations only, but that it include
any and all actions by a student that are intended to gain an unearned academic advantage by fraudulent or deceptive means.
Plagiarism is a specific form of cheating which consists of the misuse of the published and/or unpublished works of others by
misrepresenting the material (i.e., their intellectual property) so used as one’s own work. Penalties for cheating and plagiarism range
from a 0 or F on a particular assignment, through an F for the course, to expulsion from the University. For more information on the
University’s policy regarding cheating and plagiarism, refer to the Schedule of Courses (‘Legal Notices on Cheating and Plagiarism’) or
the University Catalog (‘Policies and Regulations’).
Students with Disabilities
The University is committed to providing reasonable academic accommodation to students with disabilities. The Student Disability
Services Office provides university academic support services and specialized assistance to students with disabilities. Individuals
with physical, perceptual, or learning disabilities as addressed by the Americans with Disabilities Act should contact Student
Disability Services office for information regarding accommodations at (619) 594-6473
(http://www.sa.sdsu.edu/dss/dss_home.html). Moreover, you should notify me so that reasonable efforts can be made to
accommodate you.
This syllabus and schedule are subject to change in the event of extenuating circumstances.
Tentative Course Schedule*
This schedule will be changed to meet the needs of the course as the semester progresses.
Tuesday
Class
Sessions
Day
Lecture Topic & Reading Assignment
Thursday
Lab
Sessions
Day
Course Intro-Ther Ex overview
Range of Motion/ Isometric
Exercise Lab
K & C Chaps 3 pgs 43-63 (ROM)
__________________________
Proprioceptive Neuromuscular
Facilitation (PNF)
K & C Chap 6 pgs 195-203
K & C Chaps 1-2 pgs 1-42 (Intro)
Day
Lab Activity
Day
Resistance Exercise 1
K & C Chap 6: pgs 147-194, 203-223)
Day
Resistance Exercise 2
Day
Assignme
nt
Day
The Disablement Model and Using
Exam Findings as the Basis for
Exercise Prescription
Day
Resistance Exercise Lab 1
__________________________
Proprioceptive Neuromuscular
Facilitation
Resistance Exercise Lab 2
__________________________
Proprioceptive Neuromuscular
Facilitation
Day
Joint & Nerve
Mobilization Lab
K & C Chap 13 pgs 349-370 (nerve
disorders/glides
__________________________
Proprioceptive Neuromuscular
Facilitation
K & C Chap 5 pgs 109-121, 127-129
(Joint mobilization)
Day
Day
Interventions to Address
Impairments in Flexibility
Soft tissue lengthening Lab
K & C Chap 4 pgs 94-105
(Manual stretching techniques)
K & C Chap 4 pgs 65-93
(Stretching)
Day
Day
Physiologic Adaptations to Exercise
K & C Chap. 7 pgs 231-248 (Aerobic
exercise)
Online Reading: Physiologic
Responses and Adaptations to
Lecture
Basic Considerations for Aerobic
Exercise and Strengthening and
Basic Exercise
Prescription Lab
Day
Day
Day
Day
Day
Assignme
nt
Day
Day
Day
Day
Day
Day
Exercise
Midterm Exam
Core Stabilization Principles
German Stabilization Exercise video
followed by lab
K & C Ch. 14 pgs 383-393 (Postural
stability)
O’Sullivan article
NO CLASS –SPRING BREAK
Exercise Concepts
to Induce
Neuroplastic Changes
in the CNS
Readings to be Announced
Foundation and rationale for
Therapeutic Exercise in water
“Aquatic Exercise”
K & C Chap 9 pgs. 273-292
Postural Control / Positioning
Approach to Ther Ex
Online Reading:
Activities: Postures and Movement
Patterns
Progression concepts
Women’s Health
Obstetrics & Pelvic Floor (if time)
K & C Ch. 23 pgs. 797-821
Yoga lecture/lab
Final Wrap Up
Final Exam review
Practice items for Skills Practical
Day
Midterm Practical
Day
Body Mechanics Lab
Healthy Back For Life Video and
lab/lecture
Ch.16 pgs. 476-478
Witt article for Ergonomic office
design
NO CLASS –SPRING BREAK
Exercise Concepts
to Induce
Neuroplastic Changes
in the CNS
Readings to be Announced
Day
Day
Day
Aquatics Lab (Summit Center)
(3 groups beginning at 730am)
Day
Postural Control,
Balance & Proprioception
K & C Chap 8 pgs 251-268
______________________
Balance Exercise Throughout
the Lifespan
Readings to be announced
Day
Physioball Exercises
Meet in Rolle Athletic Center
Case scenario questions
Day
Final Practical Exam
Using Cases
Day
Therapeutic Exercise/Neurosciences
Skills Practical
FINAL EXAM WEEK