Classification of movements

Classification of movements

1. CLASSIFICATION OF MOVEMENTS Dr. Ramandeep Kaur Saini, PT Assistant Professor- Community PT DPO’s Nett College Of Physiotherapy

2. Objectives: At the end of the session you should know: Definition of movement Classification of Passive and active movements Principles of passive and active movements Effect, uses and techniques of different movement type

3. Definition Movement is a fundamental characteristic of all animal life and the means by which the organism adapts itself to demands made upon it by the environment in which it lives.

4. Classification of movements Passive movement- Movement which are produced by an external force during muscular inactivity. Active movement- Movement performed or controlled by active contraction of muscle Can be voluntary or Involuntary Voluntary movement is directly under the control of the will. Involuntary is never under the control of will.

5. Active voluntary movements Free Assisted Resisted Active involuntary movements: Reflex Associated

6. PASSIVE MOVEMENTS CLASSIFICATION Relaxed passive movement Forced or manipulative passive movement Manipulation

7. I) RELAXED PASSIVE MOVEMENT A state of relaxation is presupposed, and the joint is movement through the existing free range and within the limits of pain.

8. PRINCIPLES OF GIVING RELAXED PASSIVE MOVEMENTS Relaxation Fixation Support Traction Range Speed and duration

9. EFFECTS AND USE OF RELAXED PASSIVE MOVEMENTS Prevent adhesion formation Maintain free range of movement When active movement not possible Extensibility of muscle maintained Assist circulation and vascular dynamics Induce relaxation

10. Movement in a joint is limited; these movements are carried beyond the existing free range, in an attempt to restore the normal range By sudden but controlled application of force at the limit OR A steady sustained passive stretch Aims at increasing the existing ROM in a stiff joint by tearing or stretching the limiting structure II) FORCED OR MANIPULATIVE PASSIVE MOVEMENT

11. Differs in speed and range Fixation Accuracy of movement to be maintained Sudden forceful over pressure at the limit of movement Steady and sustained traction TECHNIQUE

12. EFFECT AND USE OF FORCED PASSIVE MOVEMENTS Breakdown of recently formed adhesion Accessory movements which cannot be localised actively Sudden forceful movement may relace or alter position of interarticular structure Stretch can overcome resistance of shortened structures

13. III) Manipulations Performed by surgeons under general anaesthesia Eliminates pain or spasm Use of greater force Maximum effort after manipulation to maintain the ROM gained

14. Active movements

15. Active movements Active voluntary movements Free Assisted Resisted Active involuntary movements: Reflex Associated

16. Definition: Active voluntary movement Movements performed or controlled by the voluntary action of muscle Working in opposition to an external force Active voluntary movements Free exercise : subject only to the forces of gravity Assisted exercise : inadequate co-ordination or strength of muscle performed by an external force Resisted exercise : forces of resistance offered

17. Free exercise Performed by patients own muscular efforts without the assistance or resistance of any external force Uses only gravity

18. Classification There are two types of free exercises. 1. Localized: specific muscle or joint 2. Generalized : use of many joints and muscles all over body - example: running, walking

19. Characteristic of free exercises Subjective: -usually formal and consist of more or less anatomical movements performed in full range - Focus on form and pattern Objective: -patients attention is concentrated on particular aim -accuracy of movement -Example: Bending and touching the great toe with the middle finger. Here the goal is set to touch the toe.

20. Technique of free exercises: Starting position Instruction Speed of movement Duration

21. Effects and uses of free exercises: Relaxation by pendular and rhythmical swinging Joint mobility Muscle power and tone Neuromuscular co-ordination Confidence Increase Circulatory and respiratory function

22. Assisted exercises If the strength or the coordination of the muscle is insufficient to perform an activity, the external force is utilized to compensate the lack. The muscle has the strength or endurance but is not sufficient to perform an activity or control an action.

23. Technique for assisted exercises: Starting position Pattern of movement Fixation Support The antagonist muscles Traction Assisting force Repetition Co-operation of patient Character of movement: smooth and uniform speed

24. Effect and use of assisted exercise Co-operation of working muscle in which they are capable Strength and hypertrophy Neuromuscular re-education Co-ordination training Confidence and encouragement for patient to make maximum effort Increasing range of motion

25. Resisted exercises The principles of resistance: An external force is applied to the body levers to oppose the force of muscular contraction. Tension increased by opposing force to increase power. 5 factors that contribute the development of muscular efficiency Power: progressive resistance-low rep. Endurance : low resistance-high rep. Volume Speed Co-ordination

26. Technique of resisted exercises Starting position Pattern of movement Stabilization Traction Resisting force Repetition Co-operation of patient

27. Resistances Types of Resisted Exercises 1. Manual The physiotherapist The patient 2. Mechanical Weight Pully circuits Springs Water

28. Progressive resistance exercises

29. PRE Restoration of muscle power and volume Dr Lorme Promote muscular development

30. Repetition Maximum Repetition Maximum : The maximum amount of the weight a person can lift throughout the range of motion only once is 1RM The maximum amount of the weight a person can lift throughout the range of motion exactly 10 times(10RM).

31. 3 types of progressive resisted exercise regimens are available. 1. DeLorme and Watkins 2. MacQueen 3. Zinovieff (Oxford technique)

32. De Lorme and Watkins 10 times with 1/2 10 RM. 10 times with 3/4 10 RM. 10 times with 10 RM. Progression i. 30 times weekly 4 sessions ii. Every week 10 RM progression.

33. a. For example: Consider 10RM—1 kg First week. 1/2 of 10 RM—1/2 kg. 3/4 of 10 RM—3/4 kg Full of 10 RM—1 kg Exercise regimen is 10 times with 1/2 kg, 10 times with 3/4 kg, 10 times with 1 kg

34. Second week Progression 10 RM = 10 RM + 10 RM = 1 kg +1 kg = 2 kg Exercise Regimen is 10 times with 1 kg 10 times with 1.5kg 10 times with 2 kg

35. In this exercise regimen, the weight is increased, i.e. first with 1/2 kg followed by 3/4 kg and 1 kg. Each and every session the patient has to lift the above said three types of weights 10 times each. So, that daily 30 times lifting been done.

36. In each and every session 30 times the exercise should be done with 2 breaks by the patient. i.e. 10 times 1/2 10 RM (1/2 kg) → Break → 10 times with 3/4 10 RM (3/4 kg) → Break→ 10 times 10 RM (1 kg) Weekly 4 sessions the exercise has to be practiced. For example: Monday, Wednesday, Friday, Sunday (i.e. every alternative day’s) exercise has to be practiced and remaining days, i.e. Tuesday, Thursday, Saturday given rest.

37. MacQueen and Oxford technique

38. Resistance by weight and pully circuits

39. Springs

40. Malleable substances

41. Water

42. Progression Increase pondage or wgt. of resisting force Increase leverage of resisting force Alteration in speed of movement Increase duration of the exercise

43. Effects and uses of resisted exercises Muscle power Endurance Stability and co-ordination Blood flow increased Vaso-dilation

44. Involuntary movement Reflex movement

45. Reflex arc Stretch reflex

46. Effects and uses of reflex movement Promote activity Normal joint movement Circulation improved Temporary relaxation of spastic muscles

47. Associated movements Occurs involuntarily and accompanies another movement which is usually voluntary May arise as a result of spreading of impluses discharged to promote the initial movement Example: Stimulation of involuntary musculature of alimentary tract asso. With voluntary muscle of abdominal wall Corresponding muscles on the opp. Side of the body tend to contract in unison or reciprocally when those of one side are stimulated Tremors frequently accompany specific voluntary movements

48. Active voluntary movements Free Assisted Resisted Active involuntary movements Reflex Associated Passive movements Relaxed passive movement Forced or manipulative passive movement Manipulation

49. Thank you!