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ACTIVE MOVEMENTS

Group I :Shailender Shambhavi Click to edit Master subtitle style Priya sharma Satyam Aashish Avneet

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Defination:

Movement performed within the unrestricted ROM controlled by the voluntary contraction of the muscle.

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Classification of Active Movement


Free

exercises-

Which are performed by patients own muscular efforts, without the assistance or resistance by any external force other than gravity. uses: -relaxation -muscle tone maintained -power increased acc. to speed, leverage & duration of ex. -coordination -confidence
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Advantage : once the patient has mastered the technique, & aware of its purpose, he can perform it when and where he pleases, and can no longer rely on others. Disadvantage : it makes insufficient demands on patients neuromuscular system to elicit a max response required.

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Classification (free ex.)

- Designed to produce - Usually involves use some local and specific of many jts. & muscles, effects to mobilize & effecting the whole strengthen particular body. - e.g. running, climbing muscle gp. - Movt. Is localised to a stairs , etc. Subjective Objectiv Full range of motion is Achievement of particular joint. e performed. particular aim, e.g. throwing a ball. - e.g. normal elbow flx. , pronation supination 3/12/12 etc.

Technique of Free ex.


Starting

position max. postural efficiency Instruction to patient such that it gains interest and co-operation of patient. Speed slow & rhythmic initially. Duration depends on pt.s capacity, practice with short rest periods ensures sufficient practice without undue fatigue.

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Examples of Active Free Exercises

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Effects & Uses

Relaxation rhythmical swinging & pendular movements,


reduce tension in muscles that decrease ROM & reduces neuromuscular co-ordination.

Jt.

Mobility- ex. are performed in full range. Muscle power & tone- increased/ maintained in
response to increased tension. (Power : by working against resistance ; endurance: by repeated practicing)
Neuromuscular

coordination- increased by repetition

of exercises. E.g. playing piano. Confidence achievement of coordinated & efficient movt. assures pt. to control of his body, giving him confidence ,satisfaction. E.g. jumping a rope.
Circulatory

& Resp. cooperation- resp. increases &

H.R. increases.

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Assisted Exercises 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 ROM. 3- This external force must be applied in the direction of the muscle action. 4- The magnitude of this assisting force must be sufficient only to augment the muscular action but not allowed to act as a substitute for it. 5- As the muscular power is increasing, the assistance given must be decreased proportionally.

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Technique of Assisted Exercise

The assisting force is applied only to augment the maximum effort and not to act as a substitute force. 1- Starting position: stability of the body is
important to ensure that the patients attention is concentrated on the pattern of the movement and the effort required to perform it.

2-Pattern of movement: this can be explained to


the patient by performing it passively or actively on the sound limb.

3-Fixation: of the proximal part of the prime movers

improves their efficiency. Avoid trick movements to 3/12/12 occur by proper fixation.

6-The antagonistic muscle: a proper starting

position should be selected to reduce the tension in the antagonistic muscles, e.g. a position in which the knee flexed is suitable for assisted dorsiflexion of the foot.

7-The assistance force: applied in the direction of


the movement by the PT hands.

8-The character of the movement: smooth and


its efficiency depends on the speed of contraction.

9-Repetitions: depends on the condition of the patient. 10-The cooperation of patient: The patient should
be encouraged to exert maximum effort.

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Effects & uses of assisted exerciseweak musculature. Active assisted ex. provide 1-When the patient has
enough assistance to strengthen the weak muscle. 2-Maintain physiologic elasticity & contractility of the muscles which will gain strength & hypertrophy. 3-provide sensory feedback from the contracting muscle to be used in early stages of neuromuscular re-education. 4-provide stimulus for bone integrity, so the ROM of joint may be increased. 5-The repetitive assisted exercises on the correct pattern learn the patient to control the movt. by himself, so helping in training co-ordination. 6-Confidence of the patient in his ability to move and helping to cooperate. 3/12/12

Contra-indications of assisted exercise

1. Acute tears & fractures. 2. Greater swelling ,fever & redness. 3. Immediately followed MI. 4. If active assisted exercises induced pain during movt.

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Assisted resisted exercise Constitutes

a combination of assistance & resistance during a single movt. is preferable over assisted ex. As it meets the muscles need with greater accuracy.

It

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Resistive exercisesDefinitio A :technique based on applying n


resistance (an outside force which may be manual/ mechanical) to muscle during dynamic or static contraction to increase
(i) (ii)

the contractile force (strength) & muscle size (hypertrophy). In isometric & isotonic contraction, the resistance must be sufficient to increase the intra-muscular tension.
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can be provided by :- Free weights ( dumbells, pulleys, springs)

Resistance

- Weight machines - Water

- Body weight of patient - The physiotherapist.


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Factors Contribute Muscular Efficiency

Power: can be increased when you training muscle against progressive resistance (increase overload). Endurance: high repetition and low intensity resistive exercise can develop endurance. Volume: increasing the power and strength will lead to increase the muscle volume.
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Effect & uses of resisted exercise


1- Strengthening the muscles due to increase tension through gradual overload of resistance of a muscle or muscle group. 2- Endurance increase through low intensity repetitive exercise over a prolonged period of time without fatigue. 3- Increase coordination. 4- Increase muscle cross section (hypertrophy).

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Technique

When applying resistance, 4 basic rules should be observed:

1- The resistance must be given smoothly from the beginning to the end of range. 2- The direction of resistance force must be opposite to the direction of the movement. 3- It should be diminish gradually from the beginning to the end of movement. 4- dont forget to give enough period of relaxation to avoid fatigue.

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Starting position

ensuring comfort & stability to gain patients full attention. Movt. Pattern should be known by the patient. Has to be natural & purposeful movement. Stabilization improves efficiency. This is not static when performing natural movts. as it is being adapted to the circumstances of movements. Tendency of the movt. to transfer to other joint is always there so that movt pattern is altered. Traction prime stretch to the muscles to elicit stretch reflex, providing powerful stimulus to contraction.

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Resistance force

force resists muscle contraction. E.g. manual pressure, weights, springs, etc. Max resistance elicits max effort to develop power & hypertrophy, repeated contractions -> endurance.

Character of movement

smooth, non jerky, consistent speed with optimum contraction, ROM max possible.

Repetition repetition of exercises with gradually


increasing resistance gains power & hypertrophy of muscles. E.g. in O.A. , R.A. , traumatic injury etc.

Patients cooperation.
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Progressive Resistive Exercise (PRE)


Exercises that work through a full range of motion Isotonic or isodynamic contractions
Most popular & commonly used technique

Concentric vs. Eccentric


Greater force can be generated due to lower number of motor units recruited allowing other motor units to be recruited to generate increased force Oxygen use is much lower with eccentrics Efficiency of eccentric exercise is higher than concentric exercise Needs of the body acceleration and deceleration Must be able to control body movements deceleration and eccentrics allows for this control
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Free Weights vs. Exercise Machines


Advantages & disadvantages for both Machines

Safety & easy to use Constraints on motion & generally single plane of motion Do not restrict motion Incorporates certain level of neuromuscular control

Free weights

Surgical Tubing (Theraband) or Exercise Band


Allow for motion in multiple planes Ability to perform more functional movement Can be utilized with PNF & plyometrics

Variable Resistance

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Progressive Resistive Exercise Techniques (PRE)

Terminology
Repetitions Repetition maximum (RM) Set Intensity Recovery period Frequency

Recommended

Techniques of Resistance Training


Must consider 4 areas
Amount of weight to be used Number of repetitions Number of sets Frequency of training

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Resistance Training Techniques Used in Rehabilitation

DeLormes method
-Based on repetition maximum of 10 -Designed for early rehab -Designed for beginning rehab -Introduced PRE progressive loading -Builds in warm-up period

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Progression

Continued strength development depends on progressive resistance exercise that gradually places more stress on the target muscles. Weight load progressions should not exceed 5 percent between strength training sessions.

Uses :
-

Increase poundage -Increase on leverage of resisting force. -Alteration in speed of movt. -Increase in duration of the exercise.

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By group-I
Shailender Shambhavi Priya sharma Satyam Aashish Avneet

3/12/12

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