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The frequency with which the exercises are performed will depend upon the patient’s strength and reactive powers. Usually they are taken one to three times a day, in addition to whatever general exercise may be indicated. Comparatively light movements, such as foot exercise, can be taken more fre¬quently than heavy movements such as the exercises on the slanting board for hernia. The patient must always be guided by his feelings. If it is a great effort for him to take the exercises, he should go more slowly and. take them less fre¬quently, even though the movements are light.
The energy consumed by the exercise depends not only on the amount of physical resistance, but on the amount of mental effort re- quired. One should not be lazy, but neither should one overdo. Overexertion may be detected even before actual fatigue is felt, by the fact that the movement is not being performed so perfectly. In some conditions sensation is less acute so that fatigue is not noticed as it Mould be normally, while in other cases it may be well to stop, even though there is actually no fatigue as ordinarily experienced. This applies particularly to conditions of partial paralysis. When the nerves are not greatly affected, the exercise should be continued to the point of moderate fatigue in order to bring about the desired muscu¬lar development. It is well to follow each period of corrective exercise with a period of rest, the length depending on the patient’s reactive powers but always continuing until there is a desire to resume activity.
All movements should be performed rather slowly for the sake of both accuracy and concentration. If performed in a hurry when the control is imperfect, the effect may be quite different from that intended. Carelessness in regard to pos¬ture and exercise are often responsible for deformities, and a continuation of this carelessness will naturally prevent the achievement of the desired results. Of course, after the pa¬tient has become very familiar with the special exercises lie needs, he can perform them more rapidly, but lie should never do them so fast that he cannot give careful attention to each part of the movement. Mental concentration always improves the results from corrective exercise. This is not only because the exercise is performed more perfectly, but because think¬ing about the part improves the circulation in that part and the mental effort creates a demand for better nerve action. Cases are on record in which the use of paralyzed limbs was recovered by exercise when it was necessary to make a start by merely thinking about moving the part even though no actual movement resulted. This is concentration plus sug¬gestion and is of the utmost value when using corrective exercises.
The method of taking the exercises is the important point. All the general rules for exercising apply to corrective move¬ments as well as to general ones; but with the former it is particularly important that the exercise be performed exactly as prescribed and that it be carried to the fullest possible ex¬tent. A little twist of an arm or a leg, a change in the position of the feet, or a change from the standing to the reclining position, may make a lot of difference in the specific effect of an exercise upon a muscle or group of muscles. The follow¬ing rules also apply to the use of corrective exercises.
Corrective exercises, except in a few instances, are not unique or peculiar movements, but are merely ordinary move¬ments given in a special way. The construction of the joints limits the number of movements that can be made, and those which are possible must be modified and combined as neces¬sary in order to constitute corrective exercise. In many de¬formities certain muscles are paralyzed so that they exert no pull whatever. The opposing muscles may then exert such a pull as to produce marked deformity, such as the various kinds of clubfoot, twisted arms, or extreme spinal curvatures. Naturally, such contracted muscles need relaxation more than exercise, though a moderate amount of the latter is valuable for improving the circulation and preventing them from losing tone. In these cases the chief attention is given to the weak¬ened or paralyzed muscles, passive exercise being used if active is impossible, while anything else indicated to remove the causes of the trouble is also done. All cases may not be completely correctable, hut improvement is always possible.
There may be some cases, especially of compound spinal curvatures, in which it will be best to avoid certain movements entirely, but as a rule the corrective exercises are merely added to general exercise. The latter are required for their physiological benefits and for maintaining general symmetry, and the former for building up the weakened muscles which have permitted the deformity to develop.
In connection with corrective exercises and general health-building measures, .special appliances are often used to keep the deformed part in the proper position until it is able to maintain that position of itself, or to provide an artificial pre¬ventive for the strain which the deformity may be putting on associated parts of the body. Braces are worn for bow-legs. In the case of clubfoot, the foot is taped or corrective shoes are worn. Arch-supports are sometimes prescribed for flat-foot. Various supports are used in the case of hernia. In connection with all artificial appliances of this sort, every ef¬fort must be made to build up the general vitality of the body and to provide such exercise and stimulation of the affected parts as will lead the body to do for itself what the braces or supports are accomplishing. If the stimulation cannot be given by exercise, massage or other mechanical manipulation is often employed.
The most difficult deformities to deal with are naturally those which have been the result of some disease like infantile paralysis or tuberculosis. Some of these could be corrected if taken in time, but, when the deformity has persisted, and the whole process of growth has been adjusted to it, the process of correcting the difficulty through exercise is slow, and in some cases only partial correction is possible. Paralysis may be corrected, in whole or in part, if the nerve centers in the affected part are not entirely dead. Exercise, carefully prescribed and scrupulously and patiently continued, will sometimes stimulate the dormant nerve centers, especially if these exercises are begun as soon as possible after the de¬formity appears.
Before prescribing special exercises for deformed parts it is necessary to know what the contributing causes are and to correct these. Naturally nothing can be done if the conditions which created the deformity are allowed to persist. Deform¬ities which have been caused by rickets or aggravated by over¬weight call for careful regulation of the diet. Deformities resulting from poor posture, and general low vitality, call for measures to stimulate and build up the body.
In case of flat-foot or broken arches, the improper shoes, which cause or per-petuatc the trouble must be thrown away. Sometimes a deformity in one part of the body will be a kind of compen¬sation for a less obvious defect in some other part. Spinal curvature, for example, shows itself in uneven shoulders, chicken-breast, etc. Some deformities—especially eye troubles, and deformities resulting from poor posture—are due to un¬due or long continued strain on some part of the body in cer¬tain occupations. The clerk may grow hollow-chested. The postman may have uneven shoulders. In such cases if the oc¬cupation cannot be given up, conditions and exercises which balance the particular strain must be worked out.
In the second place, where there is a special deformity of a part, there is a weakness or lack of control in the muscles of the part. Exercise acts directly on such muscles, and, in strengthening or correcting them, lessens or removes the de¬formity. By exercise weak muscles are strengthened, short ones are stretched, and stretched ones shortened, and the con¬trol of all is improved. All muscles have what is known as “tone.” There is a slight contraction of the muscle fibers which make them quick to respond to stimuli. If two oppos¬ing sets of muscles are not equally well developed, therefore, the general tone of the one set will exert a greater pull on the adjacent joints and bones, and will bring about some kind of deformity. This loss of tone in certain muscles is frequently the result of disease, or of neglect of diet, fresh air, exercise, and other health-preserving factors.
Among the more usual deformities are: bow-legs, which generally result from rickets, but which may occasionally be due to over-weight at the time when the child was learning to walk; chicken-breast, the result of spinal curvature, rickets, or interference with respir¬ation in babyhood; clubfoot, congenital or acquired, usually as the result of infantile paralysis; flatfoot, or weakened arches, generally due to improper shoes, combined with bad habits of walking; hernia, or rupture; hollow-chest, due to lack of vitality and poor posture; knock-knees, caused by weakness in the leg muscles, aggravated in many cases, by over¬weight; paralysis; prolapsus; uneven shoulders; spinal curva¬ture; and strabismus, popularly known as crossed eyes, and other eye troubles.
The effect of exercise in such cases is two-fold: In the first place, it improves the general tone of the body. When one who has not been in the habit of exercising begins to do so, he will soon note that his body is working better; he feels more energetic, and his strength and appearance improve. Appetite and elimination are both stimulated by exercise, and, in general, the patient sleeps more soundly and awakes more refreshed. As regards bodily weight and symmetry, exer¬cise of any kind is a normalizing procedure, as has already been explained. The fat person reduces, the thin person builds up, and deformities are gradually modified and corrected.
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