INTRODUCTION:
The physiotherapist must give her undivided attention to a patient when passive movement is given, but active exercise can often be taught or supervised either individually or with others.
INDIVIDUAL EXERCISE
As each patient’s problem differs in some respects from that of others individual treatment is essential to obtain and accelerate his rehabilitation by correcting specific imbalances of muscle strength, limitation of joint range and establishing co-ordination. The physiotherapist must know and check her patient’s abilities with regard to functional activities and work with him to gain independence by training self-care in the circumstances in which he lives whenever this is possible, e.g. in the ward, home or workshop.
As too much individual attention leads to the patient relying on the presence of the physiotherapist as a stimulus to activity, he must be encouraged and given the opportunity to practice on his own.
GROUP EXERCISE
Group exercise provides the opportunity for the patient to practice activities he ‘can do’ to build up his endurance and increase the speed of his performance. Working with other patients stimulates his efforts and helps to give him confidence in his own abilities while his performance is guided and controlled by the physiotherapist.
At the outset it is essential to distinguish Group exercise from Mass exercise. The latter is performed by a large number of people to a formal word of command, or a rhythm dictated by an instructor, and little or no assistance or correction can be given to the individual. In contrast, where a small number of people work together in group exercise there is concentration on the needs of the individual while the stimulation which results from working with others is utilized.
A small number of patients, preferably never exceeding six or eight are grouped together because they have some common disability which will benefit from exercises which are similar in character. While there is common ground with regard to the exercises there is also room for modification in range, effort and speed of movement, so that they can be adapted to suit the individual needs of each member of the group and produce the maximum effect. Because of the common ground, the pattern of each exercise can be taught to the whole group simultaneously; time is then allowed for free practice of the whole or part of the exercise, during which each patient performs the movement according to his own capacity and in his own rhythm, being helped, resisted, encouraged and corrected by the physiotherapist according to his individual need.
THE VALUE OF GROUP EXERCISE
The patient learns to take a measure of responsibility for his own exercise, and so is helped towards adequate home practice. Patients treated individually for too long come to rely on the presence and assistance of the physiotherapist and are conditioned to feel that these are essential. In a group, the amount of attention given to the individual patient decreases in proportion to the number in the group, and yet a measure of help, supervision and encouragement is available when required.
The patient learns to work with others and no longer considers himself set apart from his fellow-men because of his disability. Help is at hand if he needs it, meanwhile he learns to take his place with other members of the community.
The patient is given confidence in the treatment and is therefore stimulated to further effort, as progress on the part of other members of the group does not pass unnoticed.
The patient is given confidence in his ability to hold his own with others when the group performs some exercises in unison.
Effort is stimulated by some activities which call for a mild form of competition. True competition can only take place on equal ground, therefore activities of this kind must be carefully controlled by the physiotherapist.
Patient are helped to forget their disability temporarily by objective and Game-like acitivities, which are only possible in group treatment. This helps to promote natural movement, general activity and a cheerful outlook. In small groups careful supervision can be given and help is at hand if required.
The value of group exercise must always be assessed from the point of view of the benefit to the patient. Form the physiotherapist’s point of view much of her time is saved when several patients are treated simultaneously, but her effort must be very concentrated if maximum value from the treatment is to be obtained by all the patients in the group.
THE DISADVANTAGES OF GROUP TREATMENT
These arise from the abuse or misunderstanding of the system. Faulty selection of patients, inadequate explanation to the patient, lack of, or inefficient, grading of groups, overcrowding of groups, and poor technique of instruction on the part of the physiotherapist, are the most common causes of failure to benefit the patient.
THE ORGANISATION OF GROUP EXERCISE
As with any other form of exercise therapy the keynote of success is to give the patient the right exercises, at the right time, and in the right way. In other words, to match the exercises he is required to perform to his capacity to perform them.
Selection of patient - any patient who is capable of, and is expected to do, home exercise can be drafted into a suitable group once the basic instruction has been given and is understood. Group treatment cannot replace individual treatment; it is a progression from and an adjunct to it.
Grading of groups – the patient must only be drafted to a group in which the exercises performed are suitable to his capacity, and he must be progressed from that group to a another as his capacity increases.
Groups are formed according to the location and nature of the disability, the age group and sex of the patients, and are graded according to the nature and strength, of the exercises performed.
For example, a convenient method of grading leg exercises for men is as follows:-
i. Leg c. (Traumatic injuries; for non-weight bearing exercise)
ii. Leg B. (Traumatic injuries; for partial weight-bearing exercise)
iii. Leg A. (traumatic injuries; for full weight-bearing exercises)
The members of these groups are most likely to be fairly young men who could expect to achieve full rehabilitation, e.g. before and after menisectomy.
iv. Leg X. (non-traumatic conditions, for non-weight bearing exercise)
The majority of members of this group would in all probability be elderly and would therefore requires exercise at a slower rhythm.
v. Weight lifting and pulleys – patient needing repetitive resisted exercise for various parts of the body can work simultaneously under the direction of one physiotherapist who checks the magnitude of the weight and its application for each in turn. She can stimulated the patient’s effort verbally and supervise their performance.
This list of groups is by no means exhaustive and is only intended as an example of a satisfactory arrangement for a large department in which a wide variety of conditions are treated. It is an advantage for progressive groups to exercise simultaneously, as this facilitates the movement of patients from one group to another without the necessity of altering the time of the appointment for the treatment. Re-grading must be made at frequent intervals. This requires skilled assessment by the physiotherapist and determines the success of this method of giving treatment.
Explanation to the patient – before joining a group the patient must be given preliminary instruction in some of the exercise and an explanation of their purpose with regard to his disability. His confidence must be gained so that he feels he can report progress or any further symptoms which may arise. It is sometimes advisable to let a patient watch a group at work, or to allow him to take part in some of the exercises with the help of the physiotherapist with whom he has had individual treatment, before he is finally expected to work as a member of the group.
The number of patients in a group – the number of patients who can be successfully treated in a group depends to some extent on the nature of their disability and how much help or resistance each will require, and also on the ability of the physiotherapist to see and give this attention when it is needed. Overcrowding results in a form of mass exercise as the number of patients in the group makes it impossible for the physiotherapist to give adequate individual attention. The ability to look after several patients at one and the same time only comes with experience.
The technique of instruction – the techniques of conducting Group exercise is basically the same as that required to teach and supervise individual exercise. The ability to see where help and encouragement are required in the case of several people is merely an extension of the ability required to give it to one, and it comes with practice and experience.
Some have a natural flair for this type of work and their personality gets across without much attention to technique; still, every skill has its technique, a knowledge of which will improve performance, and even without much natural ability, a very adequate standard can be reached by studying this technique and by experience in applying it.
MASS EXERCISE
This method is only suitable for giving general exercise. Because of the large number who take part, it is impossible for the instructor to give much more than general encouragement and correction during the presentation of the exercises. Frequently, but not necessarily, the exercises are done in unison to a formal command or a rhythm dictated by the instructor, in which case the identity of the individual is submerged to produce a uniform pattern of movement, as for example in army drill or exercises arranged for demonstration purposes.
Introduced at the right time and used in conjunction with individual or group treatment this method of giving exercise often plays a part in the whole scheme of rehabilitation, as the circulation and general exercise tolerance are improved, and the discipline of working with others is stimulating. For many cases, however, it is unsuitable as it does not cater for the specialized needs of the individual.
RECREATIONAL ACTIVITIES AND SPORTS
These often provide a challenge to the patient which he cannot easily resist as can be seen when a football is left on the floor of a department where men are coming for treatment. Basic patterns of functional movement are used in many of these activities and, as skill and effort are needed to succeed or excel, they make a valuable contribution to rehabilitation.
The physiotherapist should have a working knowledge of as many suitable activities as possible so that she can direct the patient’s interest to those within his capabilities. Swimming and ball games are particularly useful but adequate supervision in the early stages is required to prevent accidents an unnecessary frustration. Supervision must be as informal as possible and, whenever it is practical, the physiotherapist should join in the activity.
Some patients with considerable residual disability find much satisfaction in continuing to practice competitive sporting activities after their rehabilitation is virtually completed, e.g. archery for paraplegics. Activities of this hind can be social asset and should be encouraged.
THOSE ABOVE ARE COLLECTED FROM SOME BOOK..
(The Principles of Exercise therapy - M. Dena Gardiner)
THANK YOU,
SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER
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