Definition:Definition:

Active assistive exercisesActive assistive exercises are are exercises performed by the exercises performed by the patient or with the patient or with the

assistance of an external force assistance of an external force as therapist, cord & pulley, as therapist, cord & pulley, weight & pulley circuit etc…weight & pulley circuit etc…

Active assisted exercises Active assisted exercises are used when:are used when:1.1. The muscles acting on one of the The muscles acting on one of the

body levers are too weak to bring body levers are too weak to bring about movement, orabout movement, or

2.2. The muscles are too weak to control The muscles are too weak to control the movement adequately.the movement adequately.

3.3. For the restoration of mobility.For the restoration of mobility.

Indications:Indications:

– To assist movement in case of m. weakness.To assist movement in case of m. weakness.

– To increase ROM.To increase ROM.

– To assist functional activities of ADL.To assist functional activities of ADL.

– After removal of plaster cast.After removal of plaster cast.

– Following tendon or m. transplantation.Following tendon or m. transplantation.

– As a method of muscular reeducation.As a method of muscular reeducation.

Types of assistanceTypes of assistance

I. I. Manual assistance:Manual assistance:When the assistance is provided by When the assistance is provided by a. a. The P.T.The P.T.b. The pt’s sound limbb. The pt’s sound limb (self assisted). (self assisted).

II. II. Mechanical assistance:Mechanical assistance:When the assistance is applied by mechanical When the assistance is applied by mechanical

tools astools asa.a. slings.slings.b.b. Pulleys.Pulleys.c.c. Slings.Slings.d.d. Wheels, etcWheels, etc……

Rules & principles of Rules & principles of applicationapplication

1.1. Starting position:Starting position: Complete stability & comfort must be provided to the Complete stability & comfort must be provided to the

body to ensure complete pt’s attention, concentration body to ensure complete pt’s attention, concentration & maximum effort required for performance.& maximum effort required for performance.

2.2. Fixation: Fixation: The proximal part & joint of the exercised limb should The proximal part & joint of the exercised limb should

be adequately fixed by the PT to improve the be adequately fixed by the PT to improve the efficiency of the agonist muscles.efficiency of the agonist muscles.

3.3. Support:Support:Full support must be given to the Full support must be given to the

exercised part or limb by means of:exercised part or limb by means of:• Pillows.Pillows.• Boards.Boards.• Slings.Slings.• Manually.Manually.

Support Support →→ eliminate any force or load on eliminate any force or load on the weak ms by counterbalancing the the weak ms by counterbalancing the effects of gravity (eliminate effecteffects of gravity (eliminate effect

of gravity).of gravity).

4.4. Characteristics of active Characteristics of active assistive ex:assistive ex:

a. The assistance should be sufficient to give a. The assistance should be sufficient to give adequate help to the working ms, it must not adequate help to the working ms, it must not be allowed to exceed this level or a passive be allowed to exceed this level or a passive mov. will result.mov. will result.

b. As the m. power increases (↑), the given b. As the m. power increases (↑), the given assistance must be decreased (↓) assistance must be decreased (↓) proportionally.proportionally.

5.5. Direction:Direction: The assistance or external force employed The assistance or external force employed

is applied in the direction of m. action.is applied in the direction of m. action.

6.6. Repetition:Repetition:Depends on the level of m. fatigue. So the Depends on the level of m. fatigue. So the

cause & extent of weakness must be cause & extent of weakness must be known & understood.known & understood.

Understanding the pattern of Understanding the pattern of movement:movement:

Clear information must be given & Clear information must be given & understood by the pt about what is understood by the pt about what is expected from him to perform.expected from him to perform.

This may be taught to him by:This may be taught to him by:

a.a. Applying passive mov. to the affected side orApplying passive mov. to the affected side or

b.b. Active mov. of the contra-lateral sound side.Active mov. of the contra-lateral sound side.

8. Patient’s co-operation:8. Patient’s co-operation:* Full pt’s cooperation is essential * Full pt’s cooperation is essential

during application of A.A. exs.during application of A.A. exs.

* * Encouragement, concentration & co-Encouragement, concentration & co-ordination are essential to achieve ordination are essential to achieve controlled active assisted movement.controlled active assisted movement.

* i.e. use a mirror, palpate his/her ms as * i.e. use a mirror, palpate his/her ms as they contract will encourage him/her.they contract will encourage him/her.

I.I. Manual assistanceManual assistance 1. Self assistance1. Self assistance

When a pt has unilateral weakness or paresis, he can When a pt has unilateral weakness or paresis, he can be taught to use his normal extremity to move the be taught to use his normal extremity to move the affected limb through ROM.affected limb through ROM.

Examples of movements:Examples of movements:I.I. Shoulder flexion & extension.Shoulder flexion & extension.II.II. Shoulder horizontal abd. & add.Shoulder horizontal abd. & add.III.III. Shoulder rotation.Shoulder rotation.IV.IV. Elbow flexion & extension.Elbow flexion & extension.V.V. Forearm supination & pronation.Forearm supination & pronation.VI.VI. Wrist flexion & extension.Wrist flexion & extension.VII.VII. Radial & ulnar deviation.Radial & ulnar deviation.VIII.VIII. Finger flexion & extension.Finger flexion & extension.IX.IX. Thumb flexion with opposition & extension with Thumb flexion with opposition & extension with

reposition.reposition.X.X. Hip & knee flexion & extension.Hip & knee flexion & extension.XI.XI. Hip abd. & add.Hip abd. & add.XII.XII. Ankle & toes movs.Ankle & toes movs.

2. Therapist assistance:2. Therapist assistance:

The same movements are The same movements are donedone withwith the the therapist therapist assistanceassistance,,

butbut notnot by by the therapistthe therapist completely.completely.

II. Mechanical Assistive II. Mechanical Assistive ExercisesExercises

1.1. Wand Exs.:Wand Exs.: a wooden stick, cane or similar objects may be used.a wooden stick, cane or similar objects may be used.

2. Finger Ladder2. Finger Ladder: : with wall climbing are tools used to assist shoulder & with wall climbing are tools used to assist shoulder &

hand movs.hand movs.

3. Cord & Pulley or Weight & Pulley Circuit3. Cord & Pulley or Weight & Pulley Circuit: : provide assistance for shoulder, elbow & wrist ROM.provide assistance for shoulder, elbow & wrist ROM.

4. Shoulder Wheel4. Shoulder Wheel: : provide assistance for the ULs.provide assistance for the ULs.

5.5. Skate Board & Powder BoardSkate Board & Powder Board: : a board is placed under the affected limb to a board is placed under the affected limb to

assist :assist :a.a. Isolate the effect of gravity.Isolate the effect of gravity.b.b. Help post surgery cases.Help post surgery cases.c.c. After removal of plaster cast.After removal of plaster cast.

6.6. SuspensionSuspension:: the involved segment is suspended in a sling the involved segment is suspended in a sling

attached to a rope fixed to a point above the attached to a rope fixed to a point above the body segmentbody segment..

6.6. Reciprocal Exercise UnitReciprocal Exercise Unit:: is a device used to provide some hip & knee flex. is a device used to provide some hip & knee flex.

& ext. to an involved LL by using the strength of & ext. to an involved LL by using the strength of the normal side.the normal side.

Wand ExercisesWand Exercises

1.1.Shoulder flex & return.Shoulder flex & return.

2.2.Shoulder hyper ext.Shoulder hyper ext.

3.3.Shoulder horizontal abd. & Shoulder horizontal abd. & add.add.

4.4.Shoulder int. rot. & ext. rot.Shoulder int. rot. & ext. rot.

5.5.Elbow flex. & ext.Elbow flex. & ext.

Finger Ladder Finger Ladder ExercisesExercises

1.1.Shoulder flex.Shoulder flex.2.2.Shoulder abd.Shoulder abd.

* * Precaution:Precaution: The pt must be taught the The pt must be taught the proper proper

motions motions && not allowed to substitutenot allowed to substitute withwith trunk side bendingtrunk side bending, , toe raising,toe raising, oror scapular elevation.scapular elevation.

Overhead PulleysOverhead Pulleys

Pulley set up:Pulley set up:1.1. Two pulleys are attached to an overhead bar or Two pulleys are attached to an overhead bar or to the ceiling approximately shoulder-width apart.to the ceiling approximately shoulder-width apart.

1.1. A rope is passed over both pulleys, & a handle is A rope is passed over both pulleys, & a handle is attached to each end of the rope.attached to each end of the rope.

2.2. The pt may be supine, sitting, or standing with the The pt may be supine, sitting, or standing with the shoulders aligned under the pulleys.shoulders aligned under the pulleys.

Pulley Exercises:Pulley Exercises:1.1. Shoulder flex & abd.Shoulder flex & abd.2.2. Shoulder int. & ext. rot.Shoulder int. & ext. rot.3.3. Elbow flex. & ext.Elbow flex. & ext.

Shoulder WheelShoulder Wheel

Set-up:Set-up:1.1. A shoulder wheel is permanently A shoulder wheel is permanently

attached to a wall.attached to a wall.

2.2. Usually it can be adjusted to various Usually it can be adjusted to various heights & arm lengths.heights & arm lengths.

Shoulder wheel Exercises:Shoulder wheel Exercises:1.1. Sh. bd. & add.Sh. bd. & add.2.2. Sh. flex. & ext.Sh. flex. & ext.3.3. Sh. int. & ext. rot.Sh. int. & ext. rot.

Skate Board & Powder Skate Board & Powder BoardBoard

* * These devices are usually used following surgical These devices are usually used following surgical procedures of hip to encourage ROM.procedures of hip to encourage ROM.

* * Proper instructions make them useful. Proper instructions make them useful.

* * The advantages of their use encourage the pt versus telling The advantages of their use encourage the pt versus telling the pt to move his leg, which often results in faulty mov. the pt to move his leg, which often results in faulty mov. or lack of interest.or lack of interest.

Exercises:Exercises:1.1. Hip abd. & add.Hip abd. & add.2.2. Hip flex. & ext.Hip flex. & ext.3.3. Knee flex. & ext.Knee flex. & ext.

SuspensionSuspension

* * This technique is used to free a This technique is used to free a body part from the resistance of body part from the resistance of friction while it is moving.friction while it is moving.

* * The part is suspended in a sling The part is suspended in a sling attached to a rope that is fixed attached to a rope that is fixed to an appropriate point above to an appropriate point above the body segment.the body segment.

Types of suspension:Types of suspension:

1.1. Vertical suspensionVertical suspension The point of attachment of the rope is over the The point of attachment of the rope is over the

center of gravity of the moving segment.center of gravity of the moving segment. The part can move like a pendulum.The part can move like a pendulum. The mov. in a small ROM.The mov. in a small ROM. Used for support.Used for support.

1.1. Axial suspensionAxial suspension The point of attachment of all ropes supporting the The point of attachment of all ropes supporting the

part is above the axis of the joint to be moved.part is above the axis of the joint to be moved. The part will move on a flat plane parallel to the The part will move on a flat plane parallel to the

floor.floor. Used to allow maximum mov. of a joint.Used to allow maximum mov. of a joint.

Benefits of suspension for Benefits of suspension for ROM exs.ROM exs.

1.1. Active participationActive participation is required, thus the pt learns is required, thus the pt learns to use the appropriate ms. for the desired mov.to use the appropriate ms. for the desired mov.

2.2. RelaxationRelaxation is promoted through secure support & is promoted through secure support & smooth rhythmic movs.smooth rhythmic movs.

3.3. Little workLittle work is required for stabilizing ms because the is required for stabilizing ms because the part is supported.part is supported.

4.4. ModificationsModifications can be made to the system to provide can be made to the system to provide grades of ex resistance.grades of ex resistance.

5.5. After instructions, the pt can often work After instructions, the pt can often work independently.independently.

Exercises using axial Exercises using axial suspension:suspension:

1.1. Sh. abd. & add.Sh. abd. & add.

2.2. Sh. flex. & ext.Sh. flex. & ext.

3.3. Hip flex. & ext.Hip flex. & ext.

4.4. Hip abd. & add.Hip abd. & add.

Reciprocal Exercise UnitReciprocal Exercise Unit

* * It uses the strength of a normal lower limb.It uses the strength of a normal lower limb.

* It is mobile, can be attached to the bed, * It is mobile, can be attached to the bed, wheel-chair, or standard chair.wheel-chair, or standard chair.

* * It improves reciprocal patterns of movs.It improves reciprocal patterns of movs.

* It improves endurance.* It improves endurance.

* It initiates strengthening programs.* It initiates strengthening programs.