4- Passive Movement
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Transcript of 4- Passive Movement
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PASSIVE
MOVEMENT
Dr. Amal Hassan Mohammed Ibrahim
Professor of Physical Therapy
Lecture IV
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PASSIVE MOVEMENT
These movements are produced by
an external force during muscular
inactivity or when muscular activity
is voluntary reduced as much as
possible to permit movement.
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CLASSIFICATIONOF PASSIVE
MOVEMENT
1- Relaxed Passive Movements, including
accessory movements.
2- Passive Manual Techniques:(i)- Mobilization of joints.
(ii)- Manipulation of joints.
(iii)- Controlled sustained stretching of
tightenedstructures.
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RELAXEDPASSIVEMOVEMENT
ACCESSORYFUNCTIONALMOVEMENTS
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A- RELAXED PASSIVE MOVEMENT
Definition:
These are movements performed
accurately, rhythmical and smoothly
by the physiotherapist through
available range of motion. A
knowledge of the anatomy of joints is
required. The movements are
performed in the same range and
direction as active movements. Thejoint is moved through the existing
free range and within the limits of
pain.
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B- ACCESSORY MOVEMENT
Definition:
These occur as part of any normal
joint movement but may be limited or
absent in abnormal joint conditions.
They consist of gliding or rotational
movements which cannot be
performed in isolation as a voluntary
movement but can be isolated by the
physiotherapist.
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B- ACCESSORY MOVEMENT
Accessory movements contribute
to the normal function of thejoint in which they take place or
that of adjacent joints.
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B- ACCESSORY MOVEMENT
In abnormal joint conditions there may belimitation of these movements due to loss offull active range caused by stiffness of jointsfrom contracture of soft tissue, adhesionformation or muscular inefficiency.
Accessory movements are performed by thephysiotherapist to increase lost range of
movement and to maintain joint mobility.Hence they form an important part of thetreatment of a patient who is unable toperform normal active movement.
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PRINCIPLES OF RELAXED PASSIVE
ANDACCESSORYMOVEMENTS
1-Relaxation:
A brief explanation of what is to happen is
given to the patient, who is then taught to
relax voluntarily, except in cases of flaccidparalysis when this is unnecessary. The
selection of a suitable starting position
ensures comfort and support, and the
bearing of the physiotherapist will domuch to inspire confidence and
cooperation in maintaining relaxation
through the movement.
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PRINCIPLES OF GIVING RELAXED
PASSIVE MOVEMENTS
2-Fixation:
Where movement is to belimited to a specific joint, thebone which lies proximal to it
is fixed by the physiotherapistas close to the joint line aspossible to ensure that themovement is localized to that
joint; otherwise any decrease
in the normal range is readilymasked by compensatorymovements occurring at other
joints in the vicinity.
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PRINCIPLES OF GIVING RELAXED
PASSIVE MOVEMENTS
3-Support:
Full and comfortable
support is given to the part
to be moved, so that the
patient has confidence and
will remain relaxed. The
physiotherapist grasps the
part firmly but comfortably
in his hand, or it may besupported by axial
suspension in slings.
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PRINCIPLES OF GIVING RELAXED
PASSIVE MOVEMENTS
The latter method is particularly useful for the
trunk or heavy limbs, as it frees the
physiotherapists hands to assist fixation and to
perform the movement. The physiotherapists
stance must be firm and comfortable. Whenstanding, his feet are apart and placed in the line
of the movement.
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PRINCIPLES OF GIVING RELAXED
PASSIVE MOVEMENTS
4-Traction:
Many joints allow thearticular surfaces to bedrawn apart by traction,
which is always given inthe long axis of a joint, thefixation of the boneproximal to the jointproviding an opposing
force to a sustained pull onthe distal bone. Traction isthought to facilitate themovement by reducinginter- articular friction.
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PASSIVE MANUAL MOBILIZATION
TECHNIQUES
5-Range:
The range of movement is as full as
the condition of the joints permits
without eliciting pain or spasm in
the surrounding muscles. In normal
joints slight over pressure can be
given to ensure full range, but in
flail joint care is needed to avoid
taking the movement beyond thenormal anatomical limit.
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RANGE
As one reason for giving full-range
movement is to maintain the
extensibility of muscles which pass
over the joint, special consideration
must be given to muscles which passover two or more joints, these
muscles must be progressively
extended over each joint until they
are finally extended to their normallength over all the joints
simultaneously e.g. the Quadriceps
are fully extended when the hip joint
is extended with the knee flexed.
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PASSIVE MANUAL MOBILIZATION
TECHNIQUES
6-Speed and Duration:
As it is essential that relaxation is
maintained throughout the movement,
the speed must be uniform, fairly slowand rhythmical. The number of times
the movement is performed depends on
the purpose for which it is used.
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EFFECTS AND USES OF RELAXED
PASSIVE MOVEMENTS AND ACCESSORY
MOVEMENTS
1- Maintain range of motion and
prevent formation of adhesions.
2- Maintain the physiologicalproperties of the muscle
(extensibility, elasticity, etc.) and
prevent adaptive shortening.
3- Help in preserving and
maintain the memory of the
movement pattern by stimulating
the kinaesthetic receptors.
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EFFECTSAND USESOF RELAXED PASSIVE
MOVEMENTSANDACCESSORYMOVEMENTS
4- The mechanical pressure resulted
from the stretching of the thin
walled vessels which passing acrossthe moved joint will assist the
venous and lymphatic return. They
are used in conjunction with limbelevation to reduce oedema.
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EFFECTSAND USESOF RELAXED PASSIVE
MOVEMENTSANDACCESSORYMOVEMENTS
5- Can be used in training of
relaxation as the rhythmic
continuous passive movements canhave a soothing effect and induce
further relaxation and sleep.
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EXAMPLESOFRELAXEDPASSIVE
MOVEMENT
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EXAMPLESOFRELAXEDPASSIVE
MOVEMENT
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B- PASSIVEMANUALMOBILIZATION
TECHNIQUES
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1- MOBILIZATIONOFJOINTS
Definition:
Mobilization is manual therapy designed to
restore joint movement. These are usually smallrepetitive rhythmical oscillatory, localised
accessory, or functional movements performed by
the physiotherapist in various amplitudes within
the available range, and under the patients
control. These can be done very gently or quitestrongly, and are graded according to the part of
the available range in which they are performed.
M J M
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MAITLAND JOINT MOBILIZATION
GRADING SCALEGrading based on amplitude of movement &
where within available ROM the force is applied.
Grade I Small amplitude rhythmic oscillating movement at
the beginning of range of movement Manage pain and spasm
Grade II Large amplitude rhythmic oscillating movement
within midrange of movement Manage pain and spasm
Grades I & IIoften used before & aftertreatment with grades III & IV
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Grade III Large amplitude rhythmic oscillating movement up
to point of limitation (PL) in range of movement
Used to gain motion within the joint Stretches capsule & CT structures
Grade IV Small amplitude rhythmic oscillating movement at
very end range of movement
Used to gain motion within the jointUsed when resistance limits movement in absence of pain
Grade V(thrust technique) - Manipulation Small amplitude, quick thrust at end of range Accompanied by popping sound (manipulation)
Velocity vs. force
Requires training
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II- MANIPULATIONOFJOINTSBY
PHYSIOTHERAPIST
Definition
These are accurately localised, single, quick
decisive movements of small amplitude and high
velocity completed before the patient can stop it.
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MANIPULATIONOFJOINTBYSURGEON
/PHYSICIAN
Definition:
Manipulations performed by a surgeon or
physician are usually given under a general or
local anaesthetic which eliminates pain and
protective spasm, and allows the use of greater
force.
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MANIPULATIONOFJOINTBYSURGEON
/PHYSICIAN
Even well-established adhesions can be broken
down; but when these are numerous, it is usual
to regain full range progressively, by a series of
manipulations, to avoid excessive trauma and
marked exudation. Maximum effort on the part ofthe patient and the physiotherapist must be
exerted after manipulation to maintain the range
of movement gained at each session, otherwise
fibrous deposits from the invertible exudationwill form new adhesions.
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III- CONTROLLEDSUSTAINED
STRETCHING
Passive stretching of muscles and other soft
tissues can be given to increase range of
movement. Movement can be gained by
stretching adhesions in the tendon protective
reflex.
PRINCIPLES OF GIVING CONTROLLED
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PRINCIPLES OF GIVING CONTROLLED
SUSTAINED STRETCHING OF
TIGHTENED STRUCTURES
The patient is comfortably supported
and as relaxed as possible in an
appropriate position. With suitable
fixation the part is grasped by thephysiotherapist and moved in such a
way that a sustained stretch can be
applied to the contracted structures for a
period of time within a functionalpattern of movement.
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EFFECTS AND USES OF CONTROLLED
SUSTAINED STRETCHING
Steady and sustained stretching may be used to
overcome spasticity patterns of limbs, e.g. a
hemiplegic patient. The slow stretch produces a
relaxation and lengthening of the muscle.
A steady and prolonged passive stretch can
overcome the resistance of shortened ligaments,
fascia and fibrous sheaths of muscles.
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QUESTIONS????????????