The physical therapy has to go to the goal of improving the joint and muscle function, and thereby are the range of motion and the ability to maintain balance or to climb stairs to promote. For example, the physical therapy is most often used for exercising of leg amputees. Occupational therapy (occupational therapy (ET)) depends on the self-help skills, and improve fine motor coordination of muscles and joints especially the upper extremities. A range of movement only slight range of motion hinders the function and causes pain, as well as a predisposition for ulcers. The range of motion should be evaluated prior to therapy with a goniometer, and periodically thereafter (for normal values, normal values ??for the range of motion of joints *). A range of motion enhancing exercising of mobilizing stiff joints. This stretch is at a tissue temperature of about 43 ° C usually most effective and least painful (rehabilitative measures for the treatment of pain and inflammation: heat). There are several types: Active: The range of motion enhancing exercising of is used in patients who can practice without support and having to move their limbs independently. Active assistiv: Active Supported range of motion exercises are used when the muscles weak or the articulation is uncomfortable; However, with the assistance of a therapist – – these patients have their limbs move independently. Passive: Passive motion exercises are used in patients who can not take an active part in the exercises, the patient side, no effort is required. Normal values ??for the range of motion of joints * joint range of motion (°) hip flexion extension 0-125 115-0 hyperextension 0-15 0-45 abduction adduction 45-0 external rotation internal rotation 0-45 0-45 knee flexion extension 0-130 120-0 ankle plantar flexion 0-50 dorsiflexion 0-20 foot inversion eversion 0-35 0-25 0-30 metatarsophalangeal flexion extension 0-80 Terphalangealgelenke toe flexion 0-50 Extension 50-0 shoulder joint flexion to 90 ° extension 0-90 0-50 Abduction to 90 ° adduction 0-90 90-0 0-90 external rotation internal rotation 0-90 Elbow flexion extension 0-160 145-0 pronation supination 0-90 0-90 Wrist flexion 0-90 extension 0-70 Abduction adduction 0-25 0-65 0-25 metacarpophalangeal joints abduction adduction 20-0 flexion extension 0-90 0-30 Interphalange ale proximal joints of the fingers flexion extension 0-120 120-0 interphalangeal distal joints of the fingers flexion extension 0-80 80-0 metacarpophalangeal joint of the thumb abduction adduction 0-50 40-0 Flexion extension 0-70 60-0 interphalangeal thumb flexion extension 0-90 90-0 * scopes are for people of all ages. Alterssspezifische volumes have not yet been determined, but they are in healthy older people usually lower than in younger people. Extension on the midline. Many strength and conditioning exercises have a strengthening of muscle strength goal (graduation muscle strength grade muscle strength). Muscle strength can be increased by exercising of against slowly increasing resistance. With very weak muscles, gravity alone is a sufficient resistance. In itself enhancing muscle strength, the application of additional manual or mechanical resistance (weights, spring load) is required. General conditioning exercises combine different measures to deal with the consequences of weakness, prolonged bed rest or immobilization. Goals are to restore the balance hemodynamics, an increase of cardiorespiratory endurance capacity and, further comprising a maintaining range of motion and muscle strength. For older people, the purpose of these exercises is both muscles enough boost function normally and may recover the normal force for ages. Degree of muscle strength degrees Description 5 or N full range of motion against gravity and full resistance on the size of the patient, age and sex N- slight weakness G + Moderate weakness 4 or G movement against gravity and moderate resistance at least 10 times without fatigue but F + movement against gravity several times or slight resistance even 3 or F Fighting against gravity F- movement against gravity and complete range of motion Once P + Comprehensive range of motion without gravity eliminated with some applied resistor 2 or P full range of motion without gravity P- Incomplete range of motion without gravity 1 T or the detection of the contraction (visible or palpable), but no articulation normal 0 No visible or palpable contraction and no articulation N =; G = good; F = Fair; P = poor; Dog t =. Proprioceptive neuromuscular facilitation This technique helps to promote neuromuscular activity in patients who have a disorder of the upper motor neurons with spasticity. It makes it possible to feel muscle contractions the patient and helps maintain the range of motion of the affected joint. For example, the use of strong resistance against the flexor of the left elbow (biceps) in patients with right-sided hemiplegia contraction of biceps muscle paralysis and flexion of the right elbow effected. Coordination exercises improve this task-oriented exercises motor skills by repeating a movement that affects the same time more than one joint and muscle such. B. when picked up an object or touching a body part. Walking exercises before starting gait training, patients in standing must be able to maintain balance. Equilibrium exercises are carried out usually by means of bars, wherein the stands in front or just behind the patient. By adhering to the rods, patients shift their weight from side to side or front to back. If they can safely keep the balance, the patient can begin the walking exercises. Assisting a patient in walking. Rescuers should put one arm under the patient, gently grasp the patient’s forearm, and keep the arms tight below the armpit of the patient. So if the patient begins to fall, volunteers can support him by the shoulder of the patient. If a patient wears a belt, volunteers are free to use their hands to reach the belt. Walking exercises are often the main goal of rehabilitation. If individual muscles weak or spastic, orthotics can such. are as supporting bands used (Therapeutic and supportive aids). Walking exercises are usually started in a run ingots; with increasing progress, patients use a walker, crutches or a cane and finally walk without aids. Some patients wear a waist belt, where it keeps the therapist to prevent falls. Anyone who accompanied patients in their walking exercises should know how to be properly supported (support a patient during walking.). Once patients could see that the flat surfaces, they can begin to practice climbing stairs or crossing curbs when this ability is required. Patients who use walking aids must learn special techniques for climbing stairs and crossing curbs. Climbing stairs the climb begins with the healthy or better leg, and the descent with the affected leg (d. H the good leg leads out the bad leads down). Before patients are discharged, the social worker or physiotherapist should check whether secure handrails are installed along all levels in the patient’s home. Transfer training patients who do not reach independently from bed to chair, from the chair to the toilet seat or in a standing position, usually require care over 24 hours. Adjusting the heights of all dressers and chairs can help. Sometimes tools are useful for. B., people may have difficulty getting up from a seated position out profit from increased seat or standing up.

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