1. ACTIVE MOVEMENT

2. Definition:
Movement performed within the unrestricted ROM controlled by the voluntary contraction of the muscle.

3. Classification of Active Movement
1- Active assisted exercise: In which assistance is provided by an outside force, either manual or mechanical when muscle strength is inadequate to complete the motion. 2- Active free exercise: In which the voluntary contraction of the muscle can perform full ROM against gravity. 3- Active resisted exercise: In which the voluntary contraction of the muscle is resisted by an outside force.

4. ACTIVE ASSISTED EXERCISE
The principles of assistance:
1-When the voluntary contraction of the muscle is insufficient to produce movement,
2- An external force may be added to complete range.
3- This external force must be applied in the direction of the muscle action.
4-The magnitude of this assisting force must be sufficient only to augment the muscular action but not allowed to act as a substitute for it.
5-As the muscular power is increasing,
the assistance given must be decreased
proportionally.

6. Technique of Assisted Exercise
The assisting force is applied only to augment the maximum effort and not to act as a substitute force.
1- 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 to perform it.

7. Technique of Assisted Exercise
2-Pattern of movement: this can be explained to the patient by performing it passively or actively on the sound limb.
3-Fixation: fixation of the proximal part of the prime movers improves their efficiency. Avoid trick movements to occur by proper fixation.

8. Technique of Assisted Exercise
4- Support: the moved part should be supported to reduce the load on the muscle. Manual support is more effective since it can be provided in any plane suitable for the movement and adjusted in each successive part of the range.
5-Traction: preliminary stretching of the weak muscle provides a powerful stimulus to contraction because it stimulate the muscle spindle( Myotatic reflex) which helps in the initiation of movement.

9. Technique of Assisted Exercise
6- 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.
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.

10. Technique of Assisted Exercise
8- The character of the movement: movement is performed smoothly and its efficiency depends on the speed of contraction. 9- Repetitions: repetition of the movement depends on the condition of the 10-The cooperation of patient: this is essential during this type of exercise. The patient should be encouraged to exert maximum effort.

11. Effects and uses of assisted exercise
1-When the patient has weak musculature( poor to fair minus muscle test grade). Active assisted exercises is used to provide enough assistance to strength the weak muscle. 2-Maintain physiologic elasticity and contractility of the muscles which will gain strength and hypertrophy. 3-provide sensory feedback from the contracting muscle to be used in early stages of neuromuscular re-education. ) 9

12. 4-provide stimulus for bone integrity, so the range of effective joint movement may be increased. 5-The repetitive assisted exercises on the correct pattern learn the patient to control the movement by himself, so helping in training co-ordination. 6-Confidence of the patient in his ability to move and helping to co-operate.

13. Contra-indications of assisted exercise
1-Acute tears and fracture. 2-Greater swelling ,fever and redness. 3-Immediatlly followed myocardial infarction. 4-If active assisted exercises induced pain during movement.

14. Active Free Exercise
Free exercises are those which are performed by the patient’s own muscular efforts without the assistance or resistance of any external force other than gravity. And classified into:
1-Localized: to strengthen muscle group.
2-General: to use many muscles all over the body.

15. Uses of Active Free Exercise
This type of exercise can be used to obtain the following:
1-Relaxation: can be induced by exercises which are rhythmical or pendulum( swinging) in character.

16. Uses of Active Free Exercise
2- Joint mobility: the normal range of joint motion is maintained by exercises performed in full range.
3- 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 and long duration of exercise

17. Uses of Active Free Exercise
4- co-ordination: is improved by the repetition of exercise. As the pattern of movement is established the conduction of impulses along the neuromuscular pathways.
5- Confidence: the achievements of coordinated and efficient movement assure the patient of his ability to maintain and control of his movements, and new activities.
6-Circulatory and respiratory cooperation: during prolonged exercise, the depth of respiration is increased leading to the production of heat and increasing circulation.

18. Technique of active 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 without reaching fatigue.

19. Examples of Active Free Exercises

20. Examples of Active Free Exercises

21. Examples of Active Free Exercises

22. Examples of Active Free Exercises

23. Examples of Active Free Exercises

24. Examples of Active Free Exercises

25. Active Resisted Exercise

26. Definition:
Resisted exercise is a technique based on applying resistance (an outside force which may be manual or mechanical) to muscle during dynamic or static contraction to increase the contractile force (strength) and muscle size (hypertrophy). In isometric and isotonic contraction the resistance must be sufficient to increase the intra-muscular tension.

27. Several options are available for resistance training, including:
free weights (like dumbbells, pulleys, springs).
weight machines.
Water
Body weight of patient.
The physical therapist.

28. Factors Contribute Muscular Efficiency
There are five factors which contribute to the development of muscular efficiency:
1- Speed of contraction
2- coordination
3- Power
4- Endurance
5- volume.
The last three factors can be built up by use of resistive exercises.

29. Factors Contribute Muscular Efficiency
Power: can be increased when you training muscle against progressive resistance (increase overload).
Endurance: high repetition and low intensity resistive exercise can develop endurance.
Volume: increasing the power and strength will lead to increase the muscle volume. 29

30.   Physiological and mechanical principles of muscle strength and range of motion
During muscle contraction through wide range of movement the tension or strength are not equally powerful in all parts of their range. Physiologically; muscle exert their greatest strength in their outer range and as they shorten their force diminishes.

31. Effect and uses of resisted exercise
1- Strengthening the muscles due to increase tension through gradual overload of resistance of a muscle or muscle group. 2- Increase muscle endurance through low intensity repetitive exercise over a prolonged period of time without fatigue. 3- Increase coordination. 4- Increase muscle cross section (hypertrophy). 5- Increase blood flow of the working muscle. 6-Increase the power.

32. Technique When applying resistance, 4 basic rules should be observed:
1- The resistance must be given smoothly from the beginning to the end of range.
2- The direction of resistance force must be opposite to the direction of the movement.
3- It should be diminish gradually from the beginning to the end of movement.
4- don’t forget to give enough period of relaxation to avoid fatigue.