Movements (Introduction)

Question 1

Aim of exercise ?

Answer 1

To promote activity whenever of wherever possible

To correct inefficiency of specific muscle or muscle group

To encourage the patient to use the abilities he has regained to perform normal functional abilities

Question 2

Goals and uses of passive exercise
(6)

Answer 2

Maintain joint and connective tissue mobility

Maintain physiological properties of the muscle

Assist circulation and enhance synovial movement and diffusion of materials in the joint

Maintain ROM and prevent formation of adhesion

Maintain patient awareness of movement by stimulating the kinaesthetic receptors

Inhibit pain .

Question 3

Precaution and contraindications
Of passive movements (7)

Answer 3

Immediately after acute tears , fracture and surgery

Signs of too much effusion or swelling..

Severe sharp and acute joint pain

When movement is disruptive to the healing process

When bony block limits joint motion

Acute infection around or in the joint (arthritis )

Increased joint hypermobility or haematoma.

Question 4

Limitations of Passive ROM

Passive ROM will not :

Answer 4

• prevent muscle atrophy
• increase muscle strength and
  Endurance.
• assist in circulation like active

Question 5

Classification of passive movements ?
(3)

Answer 5

• Relaxed passive movements
• Continuous passive movements
• Forced passive movements
  • manipulation of joint
  • mobilization of joints
    - controlled sustained stretching of tightening structure

Question 6

What is relaxed passive movements?

Answer 6

These are movements performed accurately , rhythmically and smoothly by the physiotherapist through available ROM.

Question 7

Note on Relaxed passive ROM

Answer 7

-performed through existing free range and within the limit of pain.

• The movements are performed in the same range and direction as active movement

Question 8

What are Accessory movements ?

Answer 8

These are any normal joint movement that may be absent or limited in an abnormal joint condition .

Consist of gliding and rotational movement..
Cannot be performed in isolation as voluntary movement

But can be isolated by the therapists

Question 9

Principles of Relaxed Passive ROM
(6)

Answer 9

*Relaxation :
Selection of a suitable starting position for comfort and support for both the therapist and the person…

*Fixation : correct fixation of the proximal and distal joint by the therapist to ensure that movement is localized to the movable joint..

*Support full and comfortable:
Support is given to the part that is moved so that the patient has confidence and will remain relaxed..

*Range of motion : The range of motion is done in the painless range to avoid spasm in the surrounding muscles .

*Speed and duration : it is essential that relaxation is maintained throughout the movement..
The speed must be slow and rhythmical

*Traction: many joint allow the articular surfaces to be drawn apart by traction.

Traction is thought to facilitate the movement by reducing the articular friction…

Question 10

Effects and uses of relaxed passive movements (4)

Answer 10

• Prevent formation of adhesion
• maintaining muscle extensibility
  And prevention of adaptive shortening
• Mechanical pressure and stretching passed across the joint moved assist in the venous and lymphatic return

*The rhythm of passive movement can have a soothing effect with can induce relaxation and sleep.

Question 11

What is CPM(continuous passive movement) ?

Answer 11

CPM device is used to maintain movement of joint after a limb sparing surgery.

Question 12

Benefits of CPM
(6)

Answer 12

• decrease in the complication of immobilisation
• Decrease in the post operative complications and pain

*Improving the recovery rate and ROM

• Improving the circulation through pumping action

*Prevent adhesion and contraction

• Prevent joint effusion and wound edema.

Question 13

Procedures of CPM?
(4 steps)

Answer 13

• Therapist should adjust the device to fit before surgery
• CPM is used right after surgery.
• Therapists has to give instructions and monitor how to use the device.
• CPM is allowed to set at 15° of motion right after surgery and allowed to be increased 15° a day..

Question 14

What is Forced passive Range of motion ?

Answer 14

An exercise performed on a subject by a partner who exerts an external force not only to produce a passive movement of a joint.

Question 15

Note on Forced passive:
(5)

Answer 15

• Movement in the joint is limited so it has to be carried beyond the existing free range in an attempt to restore the normal range..
• A sudden but controlled application of force at the limit
• or a steady sustained passive stretch.
• Aims at tearing or stretching the limiting structure at a stiff joint to increase the existing range of movement.
• Danger of over extension and damage to the joint if the exercise is not carried out successfully

Question 16

Effects and uses of forced passive ROM?

Answer 16

Breakdown of recently formed adhesion

Accessory movement which cannot be localized actively

Sudden movement may relace or alter position of interarticular disc.

Stretch can overcome the resistance of shortened structure.

Manipulation can be performed by surgeons under general anaesthesia

Eliminates pain or spasm

Question 17

Passive manual Mobilization Technique

Answer 17

Manipulation of joint :
They are accurately localized single quick decisive movement of small amplitude and high Velocity
Completed before the patient can stop it .

Mobilization of joint : they are small repetitive, rhythmical oscillatory localized movement done in various amplitude may be done gently or strongly..

-Controlled sustained stretching:
Passive stretching can be done to increase range of motion ..

-Movement can be gained by stretching adhesions in the structures.

Question 18

Basic principles
Controlled sustained stretching,:

Question 19

Active movements

Answer 19

Performed by the patient either freely , assisted or resisted

Question 20

Note on Active movements:
(4)

Answer 20

• They are movement performed or controlled by the voluntary movement of the muscles working in opposition to an external force.
• AROM is used when a patient can actively contract his muscle and move a body segment with or without assistance.

-AROM can be used for aerobic conditioning program.

-During immobilisation

Question 21

Goals of AROM

Answer 21

• Maintain physiological elasticity and contractility of participating muscles.
• Provide sensory feedback from the contracting muscles

*Provide a stimulus for bone and joint tissue integrity

*Increase circulation and prevent thrombus formation..

*Develop coordination and motor skill for functional activities..

Question 22

Free active exercise

Answer 22

The patient carries out this movement without resistance or assistance of other external factors except gravity…

Success is achieved depending on
the degree of cooperation obtained from the patient and skill of the instructor…

Question 23

Advantages of free active exercises

Answer 23

Free exercises help to cure the patient

Patient can master the technique once performed

Free exercises has great role in rehabilitation..

Question 24

Disadvantages of free active

Answer 24

Insufficient demand on NMS to elicit the maximal response required for the rapid redevelopment of weak muscles…

Patient with brain damage or muscle paralysis can’t cooperate..

Question 25

Classification of free exercises According to extent of area involelved :

Answer 25

Localized free exercises: They are designed primarily to produce some specific or local effect.. Movement is localized to one or more joint by patient's own effort... General free exercises : It involves the use of many joints and muscles all over the body and the effect is widespread

Question 26

General free active exercise 2 types :

Answer 26

Subjective exercises : Attention of patient is deliberately focused on form and pattern Objective exercises : Patient attention conc on achievement of aim which result from his effort

Question 27

Techniques of free exercises (4)

Answer 27

Starting position Instruction to patient to gain interest and cooperation Speed of exercise , slow in period of learning , then later according to patient natural rhythm Depend on patients capacity .. usually 3 bouts rest @ interval to avoid fatigue

Question 28

Effect and uses of free exercises depends on (4) factors

Answer 28

Nature of exercise Extent of exercise Intensity of exercise Duration

Question 29

Assisted active Principles

Answer 29

Magnitude of assisting force must be sufficient to augment muscular action Must not be a substitute for it if it does passive movement occurs. As power of muscle increases assistance given must decrease proportionately...

Question 30

Assisted active exercise:

Answer 30

- The therapist adopts the grips for passive movements and assists the patient to perform the movement - disadvantage it is impossible for either of them to know the extend of work each of them is performing

Question 31

Types of assisted active

Answer 31

Active assistance : Assists with his opposite extremity to perform the assisted exercise Advantage patient know pain limit and availability of ROM Can perform exercise with his pain limit. Passive assistance : Classified into Mechanical Manual

Question 32

Principles of assisted exercise

Answer 32

Range Command concentration Speed Repetition

Question 33

Technique of assisted active

Answer 33

Starting position Fixation Support Direction Repetition Pattern of movement Patients cooperation

Question 34

Effects and uses of Active Assistive 4)

Answer 34

The muscles will gain strength and hypertrophy Type of exercise used in early stage of Neuromuscular conditions Helpful in training coordination Range of effective joint maybe increased by assisted exercise.

Question 35

Resistive active exercise

Answer 35

When mechanical or manual resistance is applied Mech resist may be in form of weight , springs , water

Question 36

Principles of resistance

Answer 36

An external force maybe applied to a body lever to oppose force of Muscular contraction. Tension is increased in the muscles by opposing force Muscles respond by increase in power and hypertrophy Muscular contraction , tension in the muscle may lead to movement or no movement

Question 37

Principle of Assistance

Answer 37

1. The magnitude of assisting force must be sufficient to augment the muscular action and must not be allowed to act as a substitute for it. If it does passive movement occurs. 2. As the power of the muscle increases , the assistance given must decrease proportionately. Disadvantage is that the level of work put in by the therapist and the patient cannot be detected.