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ACTIVE MOVEMENT

Mazyad Alotaibi

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ACTIVE MOVEMENT ARE: Movements performed within the unrestricted ROMROM controlled by the voluntary contraction of the muscles

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Classification of Active Movement

1- Free exercise: in which the working muscles are subjected only to the forces of gravity acting upon the part moved or stabilized.

2- Assisted exercise: in which the muscle strength is inadequate to perform a movement, an external force ( manually or mechanically) is applied to compensate for the movement.

3- Resisted exercise: the forces of resistance offered to the action of the working muscle are manually or mechanically and systematically increased to develop the strength and endurance of the muscles.

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Active ASSISTED EXERCISE

The principles of assistance:The principles of assistance:• When the voluntary muscular action is

insufficient for the production or control of movement, an external force may be added to augment it.

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The 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, for if the muscle increases, the assistance given must decrease proportionally.

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Technique 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.

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 performing it.

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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. 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.

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Technique of Assisted Exercise

5- 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.

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Technique of Assisted Exercise

5- 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 dorsi-flexion of the foot.

6- 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.

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Technique 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.

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Technique of Assisted Exercise

8- 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.

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Technique of Assisted Exercise

9- Repetitions: repetition of the movement depends on the rate of fatigability. Therefore, the condition which caused the weakness must be known and understood.

10-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.

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Indications and uses of assisted exercise

1- In the early stages of neuromuscular re-education. When a patient has weak musculature ( poor to fair minus MTG), active assistive exercise is used to provide sensory feedback from the contracting muscles.

2- Maintain the physiological properties of the muscle to increase muscle strength and hypertrophy.

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Indications and uses of assisted exercise

3- Coordination training : 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.

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Indications and uses of assisted exercise

4- 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.

5- Increase and maintain ROM.6-Provide stimulus for bone integrity.

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Contraindications

1- acute tears and fractures.2- Gross swelling, fever and redness.3- Acute intolerable pain during movement

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Active Free ExerciseActive 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.

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Indications and 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 in character.

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Indications and Uses of Active Free Exercise

2- 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.

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Indications and Uses of Active Free Exercise

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 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.

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Indications and Uses of Active Free Exercise

4- 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.

5- 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.

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Uses Indications and Uses of Active Free ExerciseActive Free Exercise

6- Circulatory and respiratory improvement: during vigorous or prolonged exercise, the speed and depth of respiration is increased leading to the production of heat.

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Technique of free exerciseTechnique 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.

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Technique of free exercise

• Free exercise may be: • localized localized to produce a local or specific effect

i.e. to mobilize a particular joint or strengthen a particular muscle group.

• GeneralizedGeneralized involving use of more joints and muscle groups.

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Examples of Active Free Exercises

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Examples of Active Free Exercises

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Examples of Active Free Exercises

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Examples of Active Free Exercises

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Examples of Active Free Exercises

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Examples of Active Free Exercises

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Examples of Active Free Exercises