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Active Assistive Exercises

Objectives
By the end of the lecture, the student will be able to:

Define active assistive exercises. Enumerate the uses of exercises. Explain indications of the exercises. Clarify points to be considered during application. Classify the types of assistance. Describe methods of mechanical assistance.

Definition
Active
are exercises performed by the patient or with the assistance of an external force as therapist, cord, weight or pulley system.. etc

assistive

exercises

Uses
1. When the muscles acting on one of the body levers are too weak to bring about movement. 2. When the muscles are too weak to control the movement adequately. 3. For restoration of mobility.

Indications
To assist movement in case of muscle weakness. To increase ROM. To assist functional ADL. After removal of plaster cast. Following tendon or muscle transplantation. As a method of muscular re-education.

Types of assistance
I. Manual a. P.T. b. The pts sound limb (self assisted). II. Mechanical a. Pulleys. b. Slings. c. Shoulder wheel, etc

Rules & principles of application Starting position:


Complete stability & comfort must be provided to the body to ensure complete pts 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.

Support:
Full support must be given to the exercised part or limb by: Pillows. Boards. Slings. Manual grasp.
Support eliminates any force or load on the weak ms by counter-balancing the effects of gravity (i.e. eliminate effect of gravity).

Characteristics:
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 movement will result. b. As ms power increases, the given assistance must be decreased proportionally.

Direction:
The assistance or external force employed is applied in the direction of ms. action.

Repetition:
It depends on the level of ms fatigue. So the cause & extent of weakness must be known & understood.

Understanding the movement pattern:


Clear information must be given & understood by the patient about what is expected from him/her to perform. This may be taught by: a. Applying passive movement to the affected side. b. Active movement of the contra-lateral sound side.

Patients co-operation:
* Full pts cooperation is essential during the application. * Encouragement, concentration & coordination are essential to achieve controlled movement. i.e. Use a mirror, palpate his/her ms. during contraction will encourage him/her.

Examples of Assistance
I- 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. 2. Therapist assistance: The same movements are done with the therapist assistance, but not by the therapist completely. II. Mechanical Assistance

Wand Exercises
A wooden stick, cane or similar objects may be used.

Finger Ladder

Finger Ladder

With wall climbing is tool used to assist shoulder & hand movements. 1. Shoulder flexion. 2. Shoulder abduction. * Precaution: The pt must be taught the proper motions & not allowed to substitute with trunk side bending, toe raising, or scapular elevation.

Overhead Pulleys

Overhead Pulleys
It provides assistance for shoulder, elbow & wrist ROM set up:
1. Two pulleys are attached to an overhead bar or to the ceiling approximately shoulder-width apart. 1. 2. 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:
1. 2. 3.

Shoulder flexion & extension. Shoulder int. & ext. rotation. Elbow flexion & extension.

Shoulder Wheel

Shoulder Wheel
It provides assistance for the upper limbs.

Set-up:

1. A shoulder wheel is permanently attached to a wall. 2. Usually it can be adjusted to various heights & arm lengths.

Shoulder wheel Exercises:


1. Sh. bd. & add. 2. Sh. flex. & ext. 3. Sh. int. & ext. rot.

Skate Board & Powder Board

Powder Board

A sliding board is placed under the affected limb to assist :


A. Isolate the effect of gravity. B. Help post surgery cases. C. After removal of plaster cast.

Skate Board & Powder Board


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

encourage ROM.

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

Exercises: 1. Hip abd. & add. 2. Hip flex. & ext. 3. Knee flex. & ext.

Suspension

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

Suspension

Reciprocal Exercise Unit

Reciprocal Exercise Unit


* It is a device used to provide some hip & knee flex. & ext. to an involved LL by using the strength of the normal side. * It is mobile, can be attached to the bed, wheel-chair, or standard chair. * It improves reciprocal patterns of movements. * It improves endurance. * It initiates strengthening programs.

References
http://physiotherapyguide.blogspot.com/2011/06/wand-exercise-for
shoulder-injuries.html. http://www.qualitymedicaltrading.com/overhead-shoulder-pulley-systemwall-mounted-shoulder-exerciser.html http://bwmed.net/catalog.php?cat_id=12 http://www.comparestoreprices.co.uk/skateboards/united-skatesskateboard.asp http://www.sci-step.com/pictures_of_jason.htm http://www.indiamart.com/ims-electrocare/exercise-therapy-products.html http://www.keepmovingforward.info/3.html http://www.rehazentrum.de/en/Programm/Therapie/Schlingentisch.html http://www.indiamart.com/milleniumbiomedicale/exercise-therapy.html