ACTIVE ASSISTIVE EXERCISES

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• ACTIVE ASSISTIVE EXERCISES

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• 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

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• 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.

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• 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.

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• Types of assistance
• I. Manual assistance
• When the assistance is provided by
• a. The P.T.
• b. The pts sound limb (self assisted).
• II. Mechanical assistance
• When the assistance is applied by mechanical
  tools as
• slings.
• Pulleys.
• Slings.
• Wheels, etc

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• 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.

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• 3. 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).

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• 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.

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• 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.

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• 8. Patients co-operation
• Full pts 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.

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• 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.

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• 2. Therapist assistance
• The same movements are done with the
  therapist assistance,
• but not by the therapist completely.

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• 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.

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• 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.

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

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• Finger Ladder Exercises
• Shoulder flex.
• Shoulder abd.
• Precaution
• The pt must be taught the proper motions not
  allowed to substitute with trunk side bending,
  toe raising, or scapular elevation.

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• 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.

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• 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.

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• 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.

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• 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.

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• 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.

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• 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.

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

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• 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.

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