ACTIVE MOVEMENTS

D R : M ARYA M M EM O N
L E CT U R ER : J M I P RS
 ACTIVE MOVEMENTS

Movement performed or controlled by the voluntary

action of muscles, working in opposition to an
external force.
 Classification:

Free exercise
Assisted exercise
Assisted-resisted exercises
Resisted exercises
 ACTIVE FREE EXERCISE

Exercises performed by the patient’s own muscular

efforts without the assistance or resistance of any
external force, other that of gravity.
FREE EXERCISE CAN INDUCE:

• RELAXATION BECAUSE OF RHYTHMICAL OR

PENDULUM NATURE OF EXERCISE
•
• MUSCLE TONE MAINTENANCE
•
• CO-ORDINATION BY NATURAL PATTERN
•
• CONFIDENCE TO PERFORM AND CONTROL
MOVEMENT
Advantage: helps in maintaining range of motion by
the patient itself without relying on others for this
purpose.

Relaxation can be achieved in rhythmical or pendular

exercise

Maintain tone, power is increased, improves coordination,

restores confidence.
Disadvantage: they frequently make insufficient
demands on neuromuscular system to elicit the
maximal response required for redevelopment of
weak muscles.

Compensatory movements will occur due to

muscular imbalance, if not supervised

Patients unable to initiate movement

cannot perform active exercises
 FREE EXERCISE CLASSIFICATION

1. Localized: These exercises are designed primarily

to produce some local and specific effect, for example
to mobilize a particular joint or to strengthen
particular muscle groups e.g. Flexion of elbow joint.

2. General: These exercises usually involve the use

of many joints and muscles all over the body and the
effect is wide spread e.g. Walking or Running
 General exercises:

THEY ARE FURTHER CLASSIFIED IN TO TWO TYPES:

 SUBJECTIVE EXERCISES:

THESE ARE FORMAL OR GENERAL ANATOMICAL MOVEMENTS

PERFORMED IN FULL RANGE.

 OBJECTIVE EXERCISES:

PATIENT’S ATTENTION IS REQUIRED FOR PARTICULAR AIM

OR THERE IS PRESENCE OF GOAL I.E. STANDING, ARM
STRETCHING UPWARD
 Technique

1. The starting position is selected and taught to the

patient with care.
2. Instruction is given in a manner which will gain
the interest and co-operation of the patient.
3. The speed at which exercise is given depends on
the effect required.
4. The duration of the exercise depends very largely
on the patient’s capacity (do not fatigue)
 Indications of active free exercises:

In cases of muscle weakness.

After removal of plaster cast following surgical
procedures (tendon or m. transplantation).
Muscle re-education.
Limitation of ROM.
Cardiovascular or respiratory disorders.
Inability to do basic functional ADL independently.
 Contra-indications of active free exercises:

Immediately after cardiovascular disorders e.g. myocardial

infarction & angina pectoris.
Immediately after recent tear to ligament, muscle, or injured joints.
At the site of fracture (#).
Recent surgical procedures to tendons, ligaments, muscles, joint
capsules or skin.
Diseases of bone (e.g. TB) & pathological # (e.g. osteoporosis &
tuberculosis of bone).
Acute joint inflammation.
Acute muscle inflammation.
Muscle swelling.
Severe joint pain.
Acute muscle pain.
Examples of Active Free Exercises
 The effect and uses of free exercises
 1. Relaxation: rhythmical swinging movements assist in relaxation of
hypertonic muscles.

 2. Joint mobility: normal ROM is maintained by exercises performed in full

range.

 3. Muscle power and tone: it is increased by tension created by the muscles.

 4. Neuromuscular coordination: it is improved by repetition of exercises.

 5. Confidence: coordinated activity assures patient of his ability to maintain

control of his body

 6. Circulatory and Respiratory Co-operation: during vigorous activity,

heart beats faster and depth of respiration is increased.
ACTIVE FREE PENDULAR ACTIVE
EXERCISE FREE EXERCISE
JOINT MOBILITY
 CIRCULATORY AND
NEURO MUSCULAR RESPIRATORY
CO ORDINATION IMPROVEMENT
 ACTIVE ASSISTED EXERCISES

When the force exerted on one of the body by

muscular action is insufficient for the production or
control of movement, an external force may be added
to augment it. As the power of muscle increases, the
assistance given must decrease.
 Indications

To assist movement in case of m. weakness.

To increase ROM.

To assist functional activities of ADL.

After removal of plaster cast.

Following tendon or m. transplantation.

As a method of muscular reeducation.

 THE PRINCIPLES OF
ASSISTANCE
1.When the voluntary contraction of the muscle is
insufficient to produce movement.

2.An external force may be added to complete range

3.This external force must be applied in the direction of the

muscle action.
 THE PRINCIPLES OF
ASSISTANCE

4.The magnitude of this assisting force must be sufficient

only to augment the muscular action but not allowed
to act as a substitute force.

5.As the muscular power is increasing, the assistance given

must be decreased proportionally.
 Types of assistance

I. Manual assistance:

When the assistance is provided by
 a. The P.T.
 b. The pt’s sound limb (self assisted).

II. Mechanical assistance:

When the assistance is applied by mechanical tools as
 slings.
 Pulleys.
 Slings.
 Wheels, etc…
 Technique

 1. Starting position and pattern of movement: this must be

well known and understood by the patient.

 2. Pattern of movement: must be well known can be taught by

passive movement.

 3. Fixation: adequate fixation of the bone origin of prime movers

improves their efficiency.

 4. Support: the part of the body moved is supported throughout to

reduce the load on weakened muscles.

 5. Antagonistic muscles: every effort must be made to reduce

tension in the antagonistic muscles.
 6. Traction: preliminary stretching of the weak muscles to elicit the
stretch reflex.

 7. Assisting force: the force used to augment the action of the

muscles is applied in the direction of the movement.

 8. The character of the movement: the movement should be

smooth.

 9. Repetitions: the number of times the movement is repeated

depends on the condition of the patient.

 10. The cooperation of the patient is essential during this exercise.

 MANUAL ASSISTANCE
1. Self assistance
When a pt has unilateral weakness or paresis, he can be taught to use his
normal extremity to move the affected limb through ROM.
Examples of movements:
 Shoulder flexion & extension, horizontal abd. & add.
 Elbow flexion & extension.
 Forearm supination & pronation.
 Wrist flexion & extension.
2. Therapist assistance:
The same movements are done with the therapist
assistance, but not completely by the therapist.
 II. MECHANICAL ASSISTIVE EXERCISES

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

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

3. Cord & Pulley or Weight & Pulley

Circuit:
provide assistance for shoulder, elbow &
wrist ROM.

4. Shoulder Wheel:
provide assistance for the ULs.
 Effects and uses of assisted exercise

1. The working muscles will co operate in the

production of movement which they are incapable of
achieving unaided.

2. The memory of the pattern of co-coordinated

movement is stimulated by the correct performance
of movement.

3. Patient’s confidence in the ability to move is

established.
 Indications for Active and Active-Assistive

 Whenever a patient is able to contract the muscles actively and

move a segment with or without assistance, AROM is used.
 When a patient has weak musculature and is unable to move a
joint through the desired range (usually against gravity),
Active assisted Ex. is used to provide enough assistance to the
muscles in a carefully controlled manner so the muscle can
function at its maximum level and be progressively
strengthened.
 Once patients gain control of their ROM, they are progressed
to manual or mechanical resistance exercises to improve
muscle performance for a return to functional activities
When a segment of the body is immobilized for a
period of time, AROM is used on the regions above
and below the immobilized segment to maintain the
areas in as normal a condition as possible and to
prepare for new activities,
such as walking with crutches.
 Goals

There are physiological benefits that result from active

muscle contraction and motor learning from voluntary
muscle control. Specific goals are to:

Maintain physiological elasticity and contractility of the

participating muscles
Provide sensory feedback from the contracting muscles
Provide a stimulus for bone and joint tissue integrity
Increase circulation and prevent thrombus formation
Develop coordination and motor skills for functional
activities
Any Questions …

…thank you