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ACTIVE ASSISTIVE EXERCISES

ACTIVE ASSISTIVE EXERCISES. Definition:. Active assistive exercises are exercises performed by the patient or with the assistance of an external force as therapist, cord & pulley, weight & pulley circuit etc…. Active assisted exercises are used when:.

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ACTIVE ASSISTIVE EXERCISES

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  1. ACTIVE ASSISTIVE EXERCISES

  2. Definition: Active assistive exercisesare exercises performed by the patient or with the assistance of an external force as therapist, cord & pulley, weight & pulley circuit etc…

  3. Active assisted exercises are used when: • The muscles acting on one of the body levers are too weak to bring about movement, or • The muscles are too weak to control the movement adequately. • For the restoration of mobility.

  4. 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.

  5. 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…

  6. Rules & principles of application • Starting position: Complete stability & comfort must be provided to the body to ensure complete pt’s attention, concentration & maximum effort required for performance. • Fixation: The proximal part & joint of the exercised limb should be adequately fixed by the PT to improve the efficiency of the agonist muscles.

  7. Support: Full support must be given to the exercised part or limb by means of: • Pillows. • Boards. • Slings. • Manually. Support → eliminate any force or load on the weak ms by counterbalancing the effects of gravity (eliminate effect of gravity).

  8. Characteristics of active assistive ex: a. The assistance should be sufficient to give adequate help to the working ms, it must not be allowed to exceed this level or a passive mov. will result. b. As the m. power increases (↑), the given assistance must be decreased (↓) proportionally. • Direction: The assistance or external force employed is applied in the direction of m. action. • Repetition: Depends on the level of m. fatigue. So the cause & extent of weakness must be known & understood.

  9. Understanding the pattern of movement: Clear information must be given & understood by the pt about what is expected from him to perform. This may be taught to him by: • Applying passive mov. to the affected side or • Active mov. of the contra-lateral sound side.

  10. 8. Patient’s co-operation: * Full pt’s cooperation is essential during application of A.A. exs. * Encouragement, concentration & co-ordination are essential to achieve controlled active assisted movement. * i.e. use a mirror, palpate his/her ms as they contract will encourage him/her.

  11. 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. • Shoulder horizontal abd. & add. • Shoulder rotation. • Elbow flexion & extension. • Forearm supination & pronation. • Wrist flexion & extension. • Radial & ulnar deviation. • Finger flexion & extension. • Thumb flexion with opposition & extension with reposition. • Hip & knee flexion & extension. • Hip abd. & add. • Ankle & toes movs.

  12. 2. Therapist assistance: The same movements are donewiththe therapist assistance, butnot by the therapistcompletely.

  13. II. Mechanical Assistive Exercises • 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.

  14. Skate Board & Powder Board: a board is placed under the affected limb to assist : • Isolate the effect of gravity. • Help post surgery cases. • After removal of plaster cast. • Suspension: the involved segment is suspended in a sling attached to a rope fixed to a point above the body segment. • Reciprocal Exercise Unit: is a device used to provide some hip & knee flex. & ext. to an involved LL by using the strength of the normal side.

  15. Wand Exercises • Shoulder flex & return. • Shoulder hyper ext. • Shoulder horizontal abd. & add. • Shoulder int. rot. & ext. rot. • Elbow flex. & ext.

  16. Finger Ladder Exercises • Shoulder flex. • Shoulder abd. * Precaution: The pt must be taught the proper motions &not allowed to substitutewithtrunk side bending, toe raising,orscapular elevation.

  17. Overhead Pulleys Pulley set up: • Two pulleys are attached to an overhead bar or to the ceiling approximately shoulder-width apart. • A rope is passed over both pulleys, & a handle is attached to each end of the rope. • The pt may be supine, sitting, or standing with the shoulders aligned under the pulleys. Pulley Exercises: • Shoulder flex & abd. • Shoulder int. & ext. rot. • Elbow flex. & ext.

  18. Shoulder Wheel Set-up: • A shoulder wheel is permanently attached to a wall. • Usually it can be adjusted to various heights & arm lengths. Shoulder wheel Exercises: • Sh. bd. & add. • Sh. flex. & ext. • Sh. int. & ext. rot.

  19. Skate Board & Powder Board * These devices are usually used following surgical procedures of hip to encourage ROM. * Proper instructions make them useful. * The advantages of their use encourage the pt versus telling the pt to move his leg, which often results in faulty mov. or lack of interest. Exercises: • Hip abd. & add. • Hip flex. & ext. • Knee flex. & ext.

  20. Suspension * This technique is used to free a body part from the resistance of friction while it is moving. * The part is suspended in a sling attached to a rope that is fixed to an appropriate point above the body segment.

  21. Types of suspension: • Vertical suspension • The point of attachment of the rope is over the center of gravity of the moving segment. • The part can move like a pendulum. • The mov. in a small ROM. • Used for support. • Axial suspension • The point of attachment of all ropes supporting the part is above the axis of the joint to be moved. • The part will move on a flat plane parallel to the floor. • Used to allow maximum mov. of a joint.

  22. Benefits of suspension for ROM exs. • Active participation is required, thus the pt learns to use the appropriate ms. for the desired mov. • Relaxation is promoted through secure support & smooth rhythmic movs. • Little work is required for stabilizing ms because the part is supported. • Modifications can be made to the system to provide grades of ex resistance. • After instructions, the pt can often work independently.

  23. Exercises using axial suspension: • Sh. abd. & add. • Sh. flex. & ext. • Hip flex. & ext. • Hip abd. & add.

  24. Reciprocal Exercise Unit * It uses the strength of a normal lower limb. * It is mobile, can be attached to the bed, wheel-chair, or standard chair. * It improves reciprocal patterns of movs. * It improves endurance. * It initiates strengthening programs.

  25. THANK YOU

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