2. Definition: Free active exercises are those which are performed by the pt’s own muscular efforts without the assistance or resistance of any external force, other than that of the gravity.

3. Active free ex’s vary widely in character & effect because of: 1. The nature & extent of the movement. 2. The manner in which they are performed. Active free ex’s can be used to obtain any effects which are produced by ex’s as a whole, if it is performed & used judiciously.

4. Indications of active free exercises:  In cases of muscle weakness.  After removal of plaster cast following surgical procedures (tendon or m. transplantation).  Muscle re-education.  Limitation of ROM.  Cardiovascular or respiratory disorders.  Inability to do basic functional ADL independently.

5. Goals of active free exercises: 1) To improve circulation. 2) To ↑ rate & depth of respiration. 3) To mobilize stiff joints. 4) To improve ROM. 5) To strengthen weak muscle. 6) To improve co-ordination & balance. 7) To achieve ADL independently. 8) To correct deformities. 9) To improve posture. 10) To improve gait & ambulation.

6. Contra-indications of active free movements : 1) Immediately after cardiovascular disorders e.g. myocardial infarction & angina pectoris. 2) Immediately after recent tear to ligament, muscle, or injured joints. 3) At the site of fracture (#). 4) Recent surgical procedures to tendons, ligaments, muscles, joint capsules or skin. 5) Diseases of bone (e.g. TB) & pathological # (e.g. osteoporosis & tuberculosis of bone). 6) Acute joint inflammation. 7) Acute muscle inflammation. 8) Muscle swelling. 9) Severe joint pain. 10) Acute muscle pain.

7. Classification of active free exercises: It may be classified according to the extent of the part involved into 1. Localized. 2. General.

8. Localized: Are designed primarily to produce some local & specific effects. E.g.: a. Mobilization of particular joint or b. Strengthening of particular muscle group. E.g.: Pendulum exs. for the shoulder.

9. 2.General: Are free exercises that usually involve the use of many joints & muscles all over the body. Their effect is wide spread. E.g.: a. Coordination exs. b. Respiratory exs.

10. Rules & principles of active free exs. (procedures): 1. Instructions Instructions are given in a manner which will gain the interest & cooperation of the patient.

11. 2. Starting position Is selected & taught with care to insure the maximum postural efficiency as a basis for the movement. The P.T. must choose it according to: The pt’s condition Type of active exercises. The type of muscle contraction desired.

12. 3. Speed of movement  The speed at which the exercises are done depends on the effects required.  It is usually slow during the period of learning & later the patient is either allowed to find his own natural rhythm or the speed desired is dictated by the P.T.  It often helps the patient to maintain his natural rhythm at home.  During practice under the P.T. supervision the patient is encouraged to count loudly.

13. 4. Progression  An active free ex program must be progressive & as soon as the patient is capable of performing a more difficult task, he should be encouraged to do it.  Constant re-evaluation of the patient’s abilities is essential to allow the re-education to be progressive.

14. 5. Repetitions  The number of times the movement is repeated depends on: A- The aim (strengthening or endurance). B - The fatigue of the ms. * The condition which has caused the muscle weakness must be known & understood as in some conditions muscle fatigue can be injurious.

15. Group Therapy 1) Goals of group therapy. 2) Rules of choosing the members of the group. 3) Location of group therapy. 4) Tools used in group therapy.

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