Edmund M. Kosmahl, PT, EdD

COURSE TITLE

INSTRUCTORS

In keeping with the professional behavior that all members of a health care team should uphold, each student in this course is expected to conduct her/himself in a respectful and professional manner. This includes, but is not limited to:

• being punctual and prepared for every class session
• respecting his/her classmates and the instructor during class discussions
• working independently when asked to do so
• working in a positive and productive manner with classmates on group projects
• respecting oneself by presenting his/her own ideas and opinions in a positive and thoughtful manner that demands the attention and respect of classmates
• being committed to a positive learning experience

This course introduces the concepts of fitness and exercise and prepares the student to design and implement basic therapeutic exercise regimens for clinical use. Normal responses to exercise and training, and patient responses to traditional therapeutic exercise regimens are presented. The course investigates physical fitness as a function of the following determinants: strength, endurance, flexibility, power, and skill. Physiology of the neuromuscular system as it relates to exercise is reviewed. Energy metabolism and nutritional support for energy metabolism are discussed. The effects of aging, disuse, immobilization, denervation, and selected drugs on exercise performance are discussed. Laboratory activities include exposure to techniques for the clinical assessment and improvement of strength, flexibility, endurance, power, and skill (including manual muscle testing and goniometry).

REQUIRED TEXTS - (see the course schedule for reading assignments)

At the completion of this course, the student should be able to:

1. Define therapeutic exercise.

2. Define fitness.

3. Define each of the following determinants of physical fitness: strength, endurance, flexibility, power, and skill.

4. Outline the basic approach to patient evaluation and therapeutic exercise program development.

5. Define goniometry, and identify the steps required to perform a goniometric measurement.

6. Identify the following parts of the standard goniometer: body, stationary arm, moving arm.

7. Explain the following concepts as they relate to goniometry: validity, reliability (intratester and intertester), positioning, stabilization.

8. Define end-feel. Define and identify the following types of end-feels: capsular, bony, muscle stretch, soft tissue approximation, springy, empty.

9. Measure and document flexibility as a function of gross, osteokinematic movement (goniometry), and as a function of muscle length.

10. Explain the concept of flexibility in terms of osteokinematic and arthrokinematic movement.

11. Define the following types of exercise: active, active-assistive, passive, resistive, stretching.

12. Identify indications for, and contraindications and precautions for active, active-assistive, passive, resistive and stretching exercises.

13. Develop and competently perform exercise training programs designed to improve flexibility via active, active-assistive, passive, resistive and stretching exercises.

14. Define manual muscle testing, and identify the steps required to perform a manual muscle test.

15. Explain the following concepts as they relate to manual muscle testing: validity, reliability (intratester and intertester), positioning, stabilization, substitution, test position, test movement, break test.

16. Define the following manual muscle testing grade scale items: normal, good, fair, poor, trace, zero.

 17. Define, measure and document isotonic, isometric and isokinetic strength (including manual muscle testing and hand held dynamometry).

 18. Define concentric and eccentric muscle contraction.

 19. Identify contraindications and precautions for strength training.

20. Develop and competently perform exercise training programs designed to improve strength using all of the following exercise systems:

• isotonic isokinetic
• isometric manual resistance
• concentric eccentric

 22. Define muscular power.

 23. Design and competently perform exercise training programs to increase muscular power.

 24. Define: endurance, MAX VO₂, A-V O₂ difference, oxygen deficit, oxygen debt, cardiac output, age predicted maximum heart rate, MET.

25. Identify contraindications and precautions for endurance testing and training.

 26. Develop and competently perform exercise training programs designed to improve endurance and cardiovascular fitness.

 27. Define perceptual-motor skill and coordination.

28. Measure and document gross and fine motor coordination and balance.

 29. Develop and competently perform exercise training programs designed to improve gross and fine motor coordination and balance.

 30. Describe the structure and function of skeletal, cardiac and smooth muscle.

 31. Describe the structure and function of the various skeletal muscle fiber types.

 32. Describe the structure and function of the motor unit.

 33. Explain how the basic dietary nutritional components (carbohydrates, fats, proteins, vitamins, minerals, and water) influence the determinants of physical fitness.

 34. Explain how energy is metabolized from the basic nutritional components.

 35. State which energy metabolism systems are utilized to supply energy for each of the determinants of physical fitness.

 36. Monitor clinical responses to measurement and exercise training procedures to insure patient safety.

37. Explain the effect of exercise training programs designed to improve strength, endurance, flexibility, power, and skill on skeletal muscle, the motor unit, the cardio-vascular system, the peripheral vascular system, and connective tissue.

 38. Explain the effect of aging, disuse, immobilization denervation and selected drugs on skeletal muscle, the motor unit, the cardiovascular system, and connective tissue.

 39. Define acute and chronic vascular disorders that affect the arterial, vascular and lymphatic systems.

 40. Design and competently perform exercise programs for vascular disorders.

 41. Identify contraindications and precautions for childbirth preparation exercises.

 42. Design and competently perform exercise programs for childbirth preparation.

 COURSE CONTENT OUTLINE (see course schedule)

 EVALUATION OF STUDENT PERFORMANCE

 A. Attendance and Classroom/Laboratory Participation - Attendance, punctuality, preparedness, and participation in all activities are the required norms. Failure to do so can result in a grade reduction of as much as 10% at the discretion of the instructor.

1. Classroom

1. Lecture:
1. Attendance and Participation - (see "A" above) 10%
2. 2 Homework Cases - 20%
3. Exams (2 one hour exams, final exam -comprehensive) - 70%
• (All exams are weighed equally. Exams may include objective and essay-type problem solving items.)
2. Laboratory:
1. Attendance and Participation - (see "A" above) 10%
2. 1 Case presentation – 22.5% (see Lab Case Grading Guidelines)
3. 3 Performance exams – 67.5%
• (see Performance Exam 1 information)
• (see Performance Exam 2 information)
• (see Performance Exam 3 information)

lecture, discussion, question and answer, demonstration, student case presentations, video tape, computer-assisted instruction

Note: Course, unit, and individual performance exam grades below 77% are unacceptable for progression through the curriculum and will initiate the probation policy - See Student Handbook. Assigned grades reflect performance on tests and are rounded to two decimal places. Please don’t ask for adjustments to grades.

HOMEWORK CASE GUIDELINES

Homework cases give students the opportunity to independently investigate a clinical problem. Students work alone and present their findings in written form. Be sure that your writing clearly expresses your thoughts.

Prepare a SHORT, typewritten double-spaced report, two pages or less, that includes the following:

• Your name, date
• Problem type (isometric, isotonic, etc.)
• Problem number, re-type the problem
• Summary of important facts and findings - explain pertinent details of diagnoses, injury, situation, etc., that may affect progress
• Treatment goals with estimate of time for attainment of each goal
• Treatment plan (give enough detail so that I can understand exactly what you propose to do)

Lab case presentations give students the opportunity to investigate a clinical problem. Students work in small groups and present their findings to the class. The presentation, followed by questions and discussion, helps all students to learn about the clinical case.

1. Names of students in your presentation group, date
2. Problem type (isometric, isotonic, etc.)
3. Problem number, re-type the problem
4. Summary of important facts and findings - explain pertinent details of diagnoses, injury, situation, etc., that may affect progress
5. Treatment goals with estimate of time for attainment of each goal (if your case is evaluation only, list the tests you will be using, and the normal values for these tests)
6. Treatment plan (if your case is evaluation only, list test results that you would expect for this patient at this point in his/her case, and explain why you believe these test results are appropriate)