Active and Assisted Exercise Techniques
Active Exercises
Active Movement: Performed by voluntary contraction of muscles, working in opposition to an external force.
Classification of Active Exercises
Higher education: Free exercises, which are performed by the patient.
Resistance: Inheritance of any external action other than gravity.
Effects of Active Exercises
- Muscle Degree: Depends on the patient’s skill.
- Relaxation: Muscle tone is maintained.
- Power: Increases according to the speed and duration of exercise.
- Coordination: Improves with practice.
- Confidence: Established to perform and control movement.
- Circulatory & Respiratory Cooperation: Enhanced through coordinated movement.
Disadvantages of Active Exercises
- Neuromuscular Demands: Can be demanding on the patient’s system.
- Compensatory Movements: Muscular imbalances may occur during voluntary movements.
- Brain Damage: Patients who have suffered brain damage may not be able to cooperate until voluntary control is established.
Classification of Exercises
Exercises can be designed to produce a localized and specific effect on a particular joint or to strengthen particular muscle groups. Localized exercises target one or more joints.
General Exercises: Involve many joints and muscles all over the body. The effect is widespread (e.g., pushing).
Character of Exercises
A. Subjective Exercise: Consists of anatomical movement performed by the patient. Attention is focused on the pattern of the exercise to ensure accuracy.
B. Objective Exercise: The patient’s attention is focused on achieving a result from their effort (e.g., stretching to touch a mark on the wall).
Assisted Exercises
Definition: When the force exerted on the body by muscular action is insufficient for the production or control of movement, an external force may be added to augment it. The external force must be applied in the direction of the muscle action.
Technique for Assisted Exercises
- Ensure maximal effort is exerted by the patient’s insufficient muscles.
- Starting Position: Provide stability for the patient’s whole body.
- Pattern of Movement: Can be taught through passive movement, using the contralateral limb or active movement.
- Fixation: Ensures efficiency because there is a tendency for movement to be transferred to other joints. This can be controlled manually.
- Support: The load on the weakened muscle is supported by counterbalancing the force of gravity. Support may be provided by the physiotherapist’s hand, suspension slings, a ball, learning skates, or the buoyancy of water.
- Education: Educate the patient on the part of the body.
- Antagonistic Muscles: Effort must be made to reduce tension in the muscles that are antagonistic to the movement.
- Traction: Stretching the muscle provides a powerful stimulus to reflex contraction.
- Assisting Force: Should be applied in the direction of movement by means of the physiotherapist’s hand.
Technique of Free Exercises
- The starting position should ensure maximum postural efficiency.
- The movement should be smooth. Very weak muscles cannot contract rapidly; hence, attention is given to repetitions.
- Instructions should be given in a manner that will gain the interest and cooperation of the patient and lead to an understanding of the exercise pattern.
- The exercise pattern is slow during the learning period, and later the patient is allowed to find their own rhythm.
- The duration of the exercise depends on the patient’s capacity.
- The number of repetitions depends on the condition of the patient.
- The aim for the patient is to achieve active movement without assistance.
Uses of Assisted Exercise
- Enable the patient to cooperate in the production of movement.
- Help the patient relearn to control movement independently.
- Establish confidence in the ability to move.
- Increase the range of effective joint movement through exercises.