Active movement - Assisted exercises

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1. ACTIVE MOVEMENT –
ASSISTED EXERCISE
Prof. Dr. M. Rajesh, PT, M.P.T(cardio), B.C.R.C
TRINITY MISSION AND MEDICAL FOUNDATION
MADURAI

2. INTRODUCTION
Activeexerciseoractivemovementisatermcommonlyusedby
physicaltherapy,rehabilitationandfitnesscentres.‘Active
movement’isthatwhichanindividualdoesvoluntary
movement,one’sownstrengthorenergy.Activeexercisehelp
keepjointsflexible,maintaingoodbloodflowtotheexercised
jointsandmayhelppreventbloodclots.Ahealthcare
practitionermayassignactiveexercisesafteraninjuryorin
connectionwithmedicationsandothertherapiestohelp
managechronicpain.

3. VOLUNTARY MOVEMENT
Definition
Movementperformedorcontrolledbythevoluntaryactionof
muscles,workinginoppositiontoandexternalforce.

4. CLASSIFICATION
Freeexercise–theworkingmusclesaresubjectonlytothe
forcesofgravityactinguponthepartmovedorstabilized.
Assisterexercise–whenmusclestrengthorco-ordinationis
inadequatetoperformamovementanexternalforceisapplied
tocompensateforthedeficiency.
Assisted-resistedexercise–musclesmaybestrongenoughto
workagainstresistanceinpartoftherangeandnotinothers.
Thistypeofexerciseensuresthattheexternalforcesapplied
areadaptedineverypartoftherangetotheabilitiesofthe
muscles.
Resistedexercise–theforcesofresistanceofferedtotheaction
oftheworkingmusclesareartificiallyandsystematically
increasedtodevelopthepowerenduranceofthemuscles.

5. ASSISTED EXERCISE

6. PRINCIPLES OF ASSISTED
EXERCISE
Whentheforceexertedononeofthebodyleversbymuscular
actionissufficientfortheproductionorcontrolofmovement,
anexternalforcemaybeaddedtoaugmentit.Thisexternal
forcemustbeappliedinthedirectionofthemuscleactionbut
notnecessarilyaatthesamepoint,asamechanicaladvantage
canbegainedbyincreasingtheleverage.Themagnitudeofthis
assistingforcemustbesufficientonlytoaugmentthemuscular
actionandmustnotbeallowedtoactasasubstitiueforit,forif
itdoesapassivemovementresults.Asthepowerofthemuscle
increases,theassistancegivenmustdecreaseproportionally.

7. TECHNIQUE
Thegeneralplanistoensurethattheinefficientmusclesexert
theirmaximumefforttoproducemovementunderconditions
designedtofacilitatetheiraction.Theassistingforceisapplied
onlytoaugmentthismaximumeffortandnottoactasa
substituteforit

8. START POSITION
Stabilityforthebodyasawholeensuresthatthepatient’s
wholeattentionisconcentratedonthepatternofmovement
andtheeffortrequiredtoperformit

9. PATTERN OF MOVMENT
Thismustbewellknownandunderstoodbythepatient.Itcan
betaughtbypassivemovementorinthecaseoflimb
movementsbyactivemovementofthecontralaterallimb.

10. FIXATION
Adequatefixationoftheboneoforiginoftheprimemovers
improvestheirefficiency.Wheneverpossiblethisfixationshould
beachievedbyactivemeansinorderthattheweakmuscles
mayreceivereinforcementfromofthosemuscleswithwhich
theynormallyassociatefortheproductionofvoluntary
movement.Whenthereisatendencyformovementtobe
transferredtoneighbouringjointstocompensateforthe
inefficiencyoftheweakmuscles,movementinthesejointmust
becontrolledor‘heldback’bymanualpressureorothermeans
offixation,sothatthemovementisprovidedattherequired
joint.

11. SUPPORT
Thepartofthebodymovedissupportedthroughouttoreduce
theloadontheweakenedmusclesbycounterbalancingthe
effectsoftheforceofgravity.Thissupportmaybeprovidedby
thephysiotherapist’shands,suspensionslings,polished
horizontalsurfacesuchasre-educationboard,thebuoyancyof
waterorball-bearingskates.Advantageofmanualsupportis
thatitcanbeeffectiveinwhicheverplaneismostsuitablefor
themovementandtheassistanceadjustedtowhatisrequired
ineachsuccessivepartoftherange.

12. SUSPENSION SLING

13. RE-EDUCATION BOARD USING FOR
ASSISTING MOVEMENT

14. BUOYANCY OF WATER

15. ANTAGONISTIC MUSCLES
Everyeffortmustbemadetoreducetensioninthemuscles
whichareantagonistictothemovement.Thestartingposition
forthemovementshouldbechosentoensurethattensionin
thesemusclesisminimal,e.g.apositioninwhichthekneeis
flexedissuitableforassisteddorsiflexionofthefoot.

16. TRACTION
Preliminatystretchingoftheweakmusclestoelicitthemyotatic
(stretch)reflexprovidesapowerfulstimulustocontraction.
Othermeansoffacilitatingtheactivityofthemusclesmayalso
beused.

17. THE ASSISTING FORCE
Theforceusedtoaugmenttheactionofthemusclesisapplied
inthedirectionofthemovement,preferablybymeansofthe
physiotherapist’shands,whichshouldbeplacedinsuchinway
thattheyrestonthesurfaceofthepatient’skinwhichisinthe
directionofthemovement.Insomecasesthepatient’sown
handsmaybesubstitutedforthoseofthephysiotherapist,
providedthethoroughlyunderstandstheprocedure.

18. Therangeofmovementisasfullaspossible,butasthepower
ofmusclesvariesindifferentpartsoftheirrangemore
assistancewillbenecessaryinsomepartsthaninothers.In
general,mostassistanceisrequiredtoovercometheinitial
inertiaatthebeginningofmovementandattheendto
completetherange.Theassistanceprovidedbymechanical
meansvariesindifferentpartsoftherangeaccordingto
definitephysicallawsandthereforeitcannotbeadjustedto
meetthepreciserequirementsofthemuscles,withtheresult
thattheirmaximumeffortisrarelyelicitedandalltoofrequently
themovementbecomespassiveincharacter.

19. THE CHARACTER OF THE
MOVEMENT
Thecharacterofthemovement-themovementisessentially
smoothasthisischaracteristicofefficientvoluntarymovement
anditisperformedinresponsetoaforcefulcommandwhich
demandsthepatient’sfullattention.Thespeedofmovement
dependsonthemusclesinvolvedaseachhasitsownoptimum
rateofcontractionwhichvariesaccordingtoitsstructureand
theload.Generallyspeakingfusiformmusclescontractrapidly
andmultipennateonestakelonger.Veryweakmusclescannot
beexpectedtoproducedasustainedcontractionandtherefore
assistanceisgiver‘instep’withthecontractionwhichmayonly
beevidentasaflickerintheearlystagesbutaspower
increasesthespeedofthemovementcanbedecreased.

20. REPETITION
Thenumberoftimesthemovementisrepeateddependson
whetheritisconsideredadvisableorinjurioustofatiguethe
musclesinquestion;thereforetheconditionwhichhascaused
theweaknessmustbeknownandunderstood.

21. CO-OPERATION OF THE
PATIENT
Theco-operationofthepatientisessentialduringthistypeof
exercise,theaimbeingforhimtoachievecontrolledactive
movementwithoutassistance.Concentratedeffortisneededto
encouragethemusclestodoalltheycantohelpthemovement,
sopraise,wellearned,shouldnotbestinted.Theabilitytosee
resultsandtofeelwhatishappeningisagreathelptothe
patientsohecanbeencouragedtopalpatehismusclesasthey
contract.

22. EFFECTS AND USED OF
ASSISTED EXERCISE
(A)
Theworkingmusclesco-operateintheproductionofmovement
whichtheyareincapableofachievingunaided.Providedthe
maximumeffortofwhichtheyarecapableisdemandedfrom
theweakmusclesandtheassistingforceutilisedisonly
complementary,thesemuscleswillgaininstrengthand
hypertrophy.
Thetypeofexercisemaybeusedintheearlystagesof
neuromuscularre-education.

23. (B)
The memory of the pattern of co-ordinated movement is
stimulated by the correct performance of a movement which the
patient is unable to achieve without assistance. By frequent
repetition of the correct pattern with decreasing assistance, the
patient may re-learn to control the movement himself as the
conduction of impulses is facilitated in the neuromuscular
pathways.
Assisted exercise may therefore be helpful in training co-
ordination.

24. (C)
Confidenceintheabilitytomoveisestablishedwhenthe
Patientobservesthemovementandthefactthathismuscles
co-operateinproducingit.Theknowledgethatthelimbis
supportedthroughoutandthatthemovementattemptedwillbe
achievedencouragesthepatienttomakeamaximumefforts.
Whenmovementmustbemaintainedinspiteofpaininjoints
theseexercisesareveryuseful,e.g.inRheumatoidarthritis.

25. (D)
Therangofeffectivejointmovementmaybeincreasedby
assistedexercise;however,asbothrangeandcontrolareoften
dependentontheefficiencyofthemusclesworkingoverthat
joint,atechniquewhichutilizeresistedexerciseforthese
musclesforthesemusclesisusuallypreferable.

26. THANK YOU
Prof. Dr. M. RAJESH, PT,M.P.T(cardio),B.C.R.C
TRINITY MISSIOIN AND MEDICAL FOUNDATION
MADURAI.
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