0 ‫بــ ِم ِ ٰٱَلهَّّلـ ٱّـَّلْحَرـ َٰم ِن ٱّـَّلِحَرـي ِم‬

‫ِ ْس‬
in the name of god,the Most Gracious,
the Most Merciful.

LECTURE NO 3
SUBJECT
kinesiology ii

Dr Syeda Abida Hussain Sherazi(PT)

MSAPT(DUHS)DPT(BMU)
MPPTA
Snr.Lecturer physical therapy UAJ&K
 Assisted Exercise

When muscle power or co-ordination is

inadequate
to overcome the resistance of gravity or another
external force,
it can be augmented by the use of an external
force applied
 in the direction of the muscle pull to perform
movement or to stabilize a joint.
 THE Principles of Assistance
When the force exerted on one of the body
levers by muscular action is insufficient for the
production or control of movement
 an external force may be added to augment
it.
 CONT;
 This external force must be applied in the
direction of the muscle action
but not necessarily at the same point,
as a mechanical advantage can be gained by
increasing the leverage.
 CONT;
 The magnitude of this assisting force must be
sufficient only to augment the muscular action
and
 must not be allowed to act as a substitute for
it, for if it does a passive movement results.
 As the power of the muscle increases, the
assistance given must decrease proportionally.
 Technique
• The general plan is to ensure that the
inefficient muscles exert their maximum effort
to produce movement under conditions
designed to facilitate their action.
 The assisting force is applied only to augment
this maximum effort
and
 not to act as a substitute for it
 Cont;
1 . Starting Position:
Comfort and stability for the body as a whole ensure
that the patient’s whole attention is concentrated on
the pattern of movement and
the effort required to perform it.
2. Pattern of Movement:
This must be well known and understood by the patient.
It can be taught by passive movement
or in the case of limb movements by active movement of
the contralateral limb.
 Cont;
3. Fixation.
 Adequate fixation of the bone of origin of the prime movers
improves their efficiency.
 Whenever possible this fixation should be achieved by active
means in order that the weak muscles may receive
reinforcement from the action of those muscles with which they
normally associate for the production of voluntary movement.
 When there is a tendency for movement to be transferred to
neighboring joints to compensate for the inefficiency of the
weak muscles,
 movement in these joints must be controlled or held back by
manual pressure or other means of fixation,
 so that the movement is pivoted at the required joint.
 Cont;
4. Support:
 The part of the body moved is supported throughout
to reduce
 the load on the weakened muscles by counterbalancing the effects
of the force of gravity.
This support may be provided by the
physiotherapist’s hands, suspension slings, a polished horizontal sur
face such as a re-education board, the buoyancy of water or
ballbearing skates.
 The advantage of manual support is that
it can be effective in whichever plane is most suitable for the
movement.
 Cont;
5. The Antagonistic Muscles:
Every effort must be made to reduce tension in the muscles which are
antagonistic to the movement.
This may be achieved by a variety of methods, e.g. heat, massage, stretching
or relaxation techniques ;
the starting position for the movement should be chosen to ensure that
tension in these muscles is minimal,
e.g. a position in which the knee is flexed is suitable for assisted dorsiflexion of
the foot.
6. Traction:
Preliminary stretching of the weak muscles to elicit the myotatic (stretch)
reflex provides
 a powerful stimulus to contraction
 and traction maintained throughout the movement
helps to facilitate joint movement.
 Cont;
7. The Assisting Force.:
The force used to augment
the action of the muscles is applied in the direction of the movement,
preferably by means of the physiotherapist’s hands,
which should be placed in such a way that
 they rest on the surface of the patient’s skin which is in the
direction of the movement.
 In Some cases the patient’s own hands may be substituted for
those of the physiotherapist,
 provided he thoroughly understands the procedure.
The range of movement is as full as possible,
but as
 the power of muscles varies in different parts of their range
 more assistance will be necessary in some parts than in others.
 CONT;
In general, most assistance is required to overcome the initial inertia
 at the beginning of movement and
 at the end to complete the range.
In the treatment of stiff joints overpressure may be given at the conclusion of
the movement in an attempt
to assist the muscles to increase the free range against the tension of limiting
structures.
The assistance provided by
 mechanical means
 varies in different parts of the range
 according To definite physical laws
 and therefore it cannot be adjusted to meet the precise requirements of the
muscles,
with the result that their maximum effort is rarely elicited
And
all too frequently the movement becomes passive in character.
 Cont;
8. The Character of the Movement :
The movement is essentially smooth
as
 this is characteristic of efficient voluntary movement and
 it is performed in response to a forceful command
 which demands the patient’s full attention.
The speed of movement depends on
 the muscles involved
 as each has its own optimum rate of contraction
 which varies according to its structure
 and the load.
 Cont;
 Generally speaking fusiform muscles contract rapidly
 and multipennate ones take longer.
• Very weak muscles cannot be expected to produce a
sustained contraction
 and therefore assistance is given ‘in step’ with the
contraction
 which may only be evident as a flicker in the early stages
but
 as power increases the speed of the movement can be
decreased.
 CONT;
• When assisted exercise is used to increase the range of joint
movement
the natural rhythm which ensures
 the fullest possible range is most satisfactory together with an
effort to increase the range with timed
 overpressure in the rhythm of the movement.
 The rapid movement sometimes advocated
• either results in a reversal of the movement before the limit of
the range is reached
• or the momentum gained is so great that it eliminates the
necessity for muscle contraction
• and results in jarring of the joint from what is virtually a forced
passive movement.
 Cont;
9. Repetitions:
 The number of times the movement is repeated depends on
whether it is considered advisable or
injurious to fatigue the muscles in question;
therefore the condition which has caused the weakness must
be known and understood.
 In the case of stiff* joints
where there is no joint lesion and
the muscles are weak from disuse
 the movement can be continued as long as the patient can
be persuaded to make the effort to improve the range.
 Cont;
10. The co-operation of the patient:
It is essential during this type of exercise,
 the aim being for him to achieve controlled active movement
without assistance.
 Concentrated effort is needed to encourage the muscles to do all
they can to help the movement, so praise, well earned, should not
be stinted.
 The ability to see results and to feel what is happening is a great
help to the patient so
 he can be encouraged to palpate his muscles as they contract and
the use of a mirror to observe results
may be helpful especially when co-ordination is poor
 Effects and Uses of Assisted Exercise

(1) The working muscles co-operate in the production

of movement which they are incapable of achieving
unaided.
Provided the maximum effort of which they are
capable is demanded from the weak muscles aid
the assisting force utilised is only complementary,
 these muscles will gain in strength and hypertrophy.
This type of exercise may be used in
 the early stages of neuromuscular re-education
during
 recovery from flaccid paralysis.
 Cont;
(ii) The memory of the pattern of co-ordinated movement is
stimulated by the correct performance of a movement
 which the patient is unable to achieve without assistance.
 By frequent repetition of the correct pattern with
decreasing assistance,
 the patient may relearn to control the movement himself
 as the conduction of impulses is facilitated in the
neuromuscular pathways
 Assisted exercise may therefore be helpful in training co-
ordination.
 Cont;
(iii) Confidence in the ability to move painful joints is
established
 when the patient observes the movement and
 the fact that his muscles co-operate in producing it.
 The contraction of the agonists also ensures reciprocal
relaxation of the antagonistic muscles
 which would otherwise tend to go into protective spasm
because of pain or the fear of it.
 The knowledge that the limb is supported throughout
 and that it can be rested at any point during the movement
encourages the patient to attempt a wider range.
 When movement must be maintained in spite of pain in
joints these exercises are very useful, e.g. in Rheumatoid
Arthritis.
 Cont;
(iv) The range of joint movement may be increased by
assisted exercise;
however, as both range and control are often dependent on
 the efficiency of the muscles working over that joint,
 a technique which utilises resisted exercise for these
muscles is usually preferable.
 Where overpressure is given in an attempt to increase the
range,
results are probably achieved
 by the repeated mechanical stretching of the soft
structures limiting the movement.
 Reference :
• The principles of exercise therapy by: M. Dena
Gardiner, 4th Edition
 Thanks

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