2Classification of Active Movement Free exercise: the working muscles are subjected only to the forces of gravity acting upon the part moved or stabilized.Assisted exercise: muscle strength or co-ordination is inadequate to perform a movement, an external force is applied to compensate for the deficiency.Resisted exercise: the forces of resistance offered to the action of the working muscle are manually or artificially and systematically increased to develop the power and endurance of the muscles.
3Active Free ExerciseFree exercises are performed by the patient’s own muscular efforts without assistance or resistance of any external force rather than gravity.
4Uses of Active Free Exercise This type of exercise can be used to obtain the following:Relaxation: can be induced by exercises which are rhythmical or pendulum in character.
5Uses of Active Free Exercise Joint mobility: the normal range of joint motion is maintained by exercises performed in full range. Limited range is increased by rhythmical swinging exercises incorporated and performed with pressure at the limit of free range.
6Uses of Active Free Exercise Muscle power and tone: the power and endurance of the working muscles are maintained or increased in response to the tension developed in them. Tension is greater when the exercise is performed at a speed slower or faster than the natural speed of movement and also greater with the duration of exercise. A high degree of tension and low sequent increase in power is developed by free exercises when muscles work against the resistance of the body weight and increased leverage arm.During fixation of a joint the power can only be maintained or improved by repeated static contraction.
7Uses of Active Free Exercise Neuromuscular co-ordination: co-ordination is improved by the repetition of an exercise. As the pattern of movement is established the conduction of the necessary impulses along the neuromuscular pathways is facilitated.Confidence: the achievements of coordinated and efficient movement assure the patient of his ability to maintain subjective control of his movements, giving him confidence to attempt other and new activities.
8Uses of Active Free Exercise Circulatory and respiratory cooperation: during vigorous or prolonged exercise, the speed and depth of respiration is increased leading to the production of heat.
9Technique of free exercise The starting position is selected and taught with care to ensure the maximum postural efficiency as a basis for movement.Instruction is given to gain interest and cooperation of the patient.The speed at which the exercise is done depends on the effect required.The duration of the exercise depends very largely on the patient’s capacity.
10Technique of free exercise Free exercise may be localized to produce a local or specific effect i.e. to mobilize a particular joint or strengthen a particular muscle group, or it may be generalized involving use of more joints and muscle groups.
18Active ASSISTED EXERCISE The principles of assistance:When the force exerted on one of the body levers by muscular action is insufficient for the production or control of movement, an external force may be added to augment it.
19The principles of assistance This external force must be applied in the direction of the muscle action but not necessarily at the same point, as a mechanical advantage of this assisting force must be sufficient only to augment the muscular action and must not be allowed to act as a substitute for it. if the muscle strength increases, the assistance given must be decreased proportionally.
20Technique of Assisted Exercise The purpose is to ensure that insufficient muscles exert their maximum effort to produce movement under conditions designed to facilitate their action.Starting position: stability of the body is important to ensure that the patient’s attention is concentrated on the pattern of the movement and the effort required performing it.
21Technique of Assisted Exercise Pattern of movement: this can be explained to the patient by performing it passively or actively on the sound limb.Fixation: fixation of the proximal part of the prime movers improves their efficiency. However possible, this fixation should be achieved by the active means in order that the weak muscles may receive reinforcement from the action of the muscle helping or associating in the production of the movement.Avoid trick movements to occur by proper fixation.
22Technique of Assisted Exercise Support: the moved part should be supported to reduce the load on the muscle. Support may be provided by PT hand, suspension slings, body buoyancy of water or a smooth surface. However, manual support is more effective since it can be provided in any plane suitable for the movement and the assistance can be adjusted in each successive part of the range.
23Technique of Assisted Exercise The antagonistic muscle: a proper starting position should be selected to reduce the tension in the antagonistic muscles, e.g. a position in which the knee flexed is suitable for assisted dorsiflexion of the foot.Traction: preliminary stretching of the weak muscle provides a powerful stimulus to contraction because it elicits the myotatic reflex which helps in the initiation of movement.
24Technique of Assisted Exercise 7- The assistance force: the force used in assisting the action of the muscle must be applied in the direction of the movement by the PT hands. Patient may assist the movement himself so he can thoroughly understand the procedure. The movement should be possible in full range. The assisting force may vary in different parts of the range, since more assistance will be necessary in some parts than in others. Assistance is mostly required at the beginning of the movement to overcome initial inertia and at the end to complete the range.
25Technique of Assisted Exercise The character of the movement: movement is performed smoothly and its efficiency depends on the patient’s full attention. The speed of contraction depends on the type of muscle whether fusiform or pennated, etc.
26Technique of Assisted Exercise Repetitions: repetition of the movement depends on the rate of fatigability. Therefore, the condition which caused the weakness must be known and understood.The cooperation of patient: this is essential during this type of exercise with the aim to achieve controlled active movement without assistance. The patient should be encouraged to exert maximum effort.
27Effects and uses of assisted exercise The working muscles cooperate in the production of movement which are unable to execute unaided and hence, their strength increases and they become hypertrophied. This type of exercise may be used in the early stages of neuromuscular re-education.
28Effects and uses of assisted exercise The memory of the pattern of coordinated movement is stimulated. By frequent repetition of the pattern with decreasing assistance the patient may relearn to control the movement himself as the conduction of impulses is facilitated in the neuromuscular pathways. These types of exercises are helpful in training coordination.
29Effects and uses of assisted exercise Confidence in the ability to move is established with the performance of the movement. The feeling of the patient that the limb is supported encourages him to produce a maximum effort. These exercises are helpful in case with painful joints such as rheumatoid arthritis.
30Effects and uses of assisted exercise The range of movement is maintained or increased by this type of exercises.