PT in Mental Health PERTEMUAN 13 Abdul Chalik

PT in Mental Health PERTEMUAN 13 Abdul Chalik Meidian & Jerry Maratis PRODI S 1 Fisioterapi

KEMAMPUAN AKHIR YANG DIHARAPKAN • Mahasiswa mampu memahami konsep dan peran fisioterapi pada gangguan psikiatri dan kesehatan mental

Goals of physiotherapy in mental health • Exercise is beneficial for mental health: – Reduced : • Anxiety • Depression • Negative mood – Improved : • Self esteem • Cognitive function • Quality of life

Psychological goals 1. To raise self esteem and confidence 2. To improve mood and promote wellbeing through a structured exercise program 3. To motivate the patient and promote self management in mental and physical health issues 4. To promote a more positive body image 5. To reduced social isolation 6. To address impaired body awareness and reduce dissociation associated with poor mental health 7. To improve quality of life

Physical goals 1. To provide non pharmacological management of pain 2. To improve muscle strength and flexibility 3. To improve cardiovascular endurance 4. Prevention and management of falls and other mobility issues in older subjects 5. Advice on weigth management

Physiological Basis • Exercise improves mental health ü By reducing: • • • Anxiety Depression Negative mood ü By improving: • • Self esteem Cognitive function • Exercise can be also found to alleviate symptoms such as low self esteem and social withdrawal

Physiological Basis Aerobic exercises, including: – Jogging – Swimming – Cycling – Walking – Gardening – Dancing Have been proved to reduce anxiety and depression

Physiological Basis These improvement in mood are proposed to be caused – by exercise-induced increase in blood circulation to the brain and – by influence on the hypothalamicpituitary-adrenal (HPA) axis and thus on the physiologic reactivity to stress

Physiological Basis This physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including: – The limbic system which controls motivation and mood – The amygdala which generates fear in response to stress – The hippocampus which plays an important part in memory formation as well as in mood and motivation

Physical Activity Programmes Recommended level of Physical Activity: The American College of Sports Medicine (ACSM) has published a position statement that recommends appropriate amounts of exercise needed to attain minimal levels of physical fitness ACSM guidelines: a minimal exercise program should consist of at least three 20 to 60 minute exercise sessions each week

Exercise prescribed for patients with mental health disorders 1. Relaxed deep breathing 2. Muscle flexibility exercises 3. Relaxation techniques 4. Endurace training 5. Hydrotherapy 6. Biofeedback 7. Ergonomics 8. Cycle ergometry 9. Muscle sthrengthening 10. General mobility exercises 11. Multi sensorial stimulation 12. Balance and equilibrium training 13. Re-education of posture and motion associated with intense and chronic pain 14. Gait re-education

Exercise prescribed for patients with mental health disorders In addition, physiotherapist’s working field in mental health also involves possible problems of : – – Incontinence Skeletal muscle Orthopaedic Neurological defisit

Clinical Evidence Clinical evidence has demonstrated that exercise has a positive relationship with the outcome of different mental disease, such as: • Depression • Alzheimer desease • Parkinsons desease Improving not only patients quality of live but also desease itself Exercise is related to enhanced cognitive function and brain plasticity

Designing physical activity programme The major concerns while designing a physical activity protocol for the patient are: 1. Structured versus lifestyle activities 2. Individually tailored interventions 3. Self monitoring 4. Group versus individual sessions 5. Self efficacy and patient’s safety

Participants safety § Concern about safety, particulary with respect to adverse cardiovascular events, can be a barrier to the implementation of physical activity programs in high-risk populations § Moderate intensity activities, including walking, are relatively safe, but some preexisting conditions may be exacerbated by moderate exercise, even walking.

PAR-Q • The Physical Activity Readiness Qustionnaire is a simple tool which can be used in pre participation screening for moderate intensity physical activity programs. • Individuals who have risk factors identified by PAR-Q should get medical clearance before they participate in a physical activity program

Risk of musculoskeletal injury • Another risk involved during exercises is musculoskeletal injury. • Risk of musculoskeletal injury can be minimized by: 1. Gradually increasing the intensity and duration of activity 2. Adding warm-up and cool down periods to a session 3. Wearing proper footwear

Conclusions 1. Physical Therapy can be used as a measure of upgrading the quality of life of patients with mental disorders through: – – – Enhanced self esteem Improved mood states Reduced state and trait anxiety Resilience to stress Improved sleep

Conclusions 2. Thus, physiotherapist acts as a faclitator for the improvement of the mental health in conjunction with the physical health of their patients 3. Further studies should be done to understand the impact of combining physiotherapy interventions with traditional mental health treatment including: – Psychopharmacology – Psychotherapy

Referensi: 1. Australian Physiotherapy Association, 2011. Mental Health and Physiotherapy. www. physiotherapy. asn. au 2. Kaur, J. Masaun, M. Bhatia, MS. 2013. Role of physiotherapy in mental health disosders. New Delhi: Delhi Psychiatry Journal 3. Probst, M. Skjaerven, L. H. 2017. Physiotherapy in Mental Health and Psychiatry: a scientific and clinical based approach. Poland: Elsevier