ACTIVE MOVEMENTS
VOLUNTORY MOVEMENT
Definition
Movement performed or controlled by the
voluntary action of muscles, working in opposition to and external force.
Classification
Free exercise – the working muscles are
subject only to the forces of gravity acting upon the part moved or stabilized.
Assister exercise – when muscle strength
or co-ordination is inadequate to perform a movement an external force is
applied to compensate for the deficiency.
Assisted-resisted exercise – muscles may
be strong enough to work against resistance in part of the range and not in
others. This type of exercise ensures that the external forces applied are
adapted in every part of the range to the abilities of the muscles.
Resisted exercise – the forces of resistance
offered to the action of the working muscles are artificially and
systematically increased to develop the power endurance of the muscles.
FREE EXERCISE
Free exercises are those which are
performed by the patient’s own muscular efforts without the assistance or
resistance of any external force, other than that of gravity.
They vary widely in character and effect,
not only because of the nature and extent of the movement, but according to the
manner in which they are performed.
This type of exercise can be used to
obtain any of the effects which are produced by exercise as a whole, if and
when it is used judiciously.
A degree of relaxation is induced by
exercises which are rhythmical ore pendular in character; muscle tone is
maintained and power increased according to the speed, leverage and duration of
the exercise, and the relationship of the part moved to gravity; co-ordination
is trained or improved as the natural pattern of group action is employed, and
confidence in the ability to perform and control movement is established.
Success in achieving the required effect
depends not only on the selection of a suitable exercise and on the manner in
which it is performed, but also on the degree of co-operation obtained from the
patient and the skill of the instructor.
The great advantage of free exercises
lies in the fact that once the patient has mastered the techniques of their
performance and is aware of their purposed, they are his own, to practice when
and where he pleases. He has, in fact, been given the means to cure or to help
to cure himself and need no longer rely on others for this purpose.
Whether or not he uses the exercise for
home practice to help himself largely depends on his desire for rehabilitation
and his confidence in the efficacy of the exercises.
The disadvantage of free exercises is
that they frequently make insufficient demands on the patient’s neuromuscular
system to elicit the maximal response required for the rapid re-development or
reinforcement of weak muscles. When there is muscular imbalance, compensatory
rather than normal patterns of movement may be used unless movements are
carefully taught and supervised. Patients who have suffered brain damage or who
are unable to initiate movement cannot co-operate in doing these exercises
until their performance has been facilitated and voluntary control has been
established.
CLASSIFICATIONS OF FREE EXERCISE
Free exercises may be classified
according to the extent of the area involved; they may be
Localized
General
(subjective, objective)
Localized – localized exercises are
designed primarily to produce some local and specific effect, for example, to
mobilize a particular joint or to strengthen particular muscle groups. Movement
is localized to one or more joints, either by the use of a suitable starting
position, or by voluntary fixation of other areas by the patient’s own muscular
effort.
General- General Exercises usually
involve the use of many joints and muscles all over the body and the effect is
widespread, for example, as in running.
The character of a particular exercise
may be
Subjective
Objective
Subjective – exercises which are
subjective are usually formal and consist of more or less anatomical movements
performed in full range. This attention of the patient is deliberately focused
on the form and pattern of the exercise to ensure accuracy of performance.
Objective – objective exercises are those
during the performance of which the patient’s attention is concentrated on the
achievement of a particular aim which will result from his efforts e.g.
standing; arm stretching upwards, to touch a mark on the wall, or to throw a ball. The presence of
a goal to be reached is stimulating to effort, like the proverbial carrot held
in front of the donkey’s nose, but care must be taken to see that the accuracy
of the movement is not sacrificed to the achievement of the aim. E.g. in
walking across a room to get a cup of tea, the quality of the walking must not
be allowed to deteriorate.
THE TECHNIQUES OF FREE EXCERCISES
The starting position is selected and
taught with care to ensure the maximum postural efficiency as a basis for
movement
Instruction is given in a manner which
will gain the interest and co-operation of the patient and lead him to
understand both the pattern and the purposed of the exercise.
The speed at which the exercise is done
depends on the effect required. It is usually slow during the period of
learning and later the patient is either allowed to find his own natural
rhythm, or the speed required is dictated by the physiotherapist. It often
helps the patient to maintain his natural rhythm at home if, during practice
under supervision, he is encouraged to count aloud.
The duration of the exercise depends very
largely on the patient’s capacity. Usually three bouts of practice for each
exercise, with short rest periods, or a change of activity, between, ensure
sufficient practice without undue fatigue.
THE EFFECTS AND USES OF FREE EXERCISE
The effect and consequent uses of any
particular free exercise depend on the nature of the exercise, its extent and
the intensity and duration of its performance.
Relaxation
Rhythmical swinging movements and those
which are pendular in character assist the relaxation of hypertonic muscles in
the region of the joint moved. The alternating and reciprocal contraction and
relaxation of the opposing muscle groups, which is required to sustain the
movement, helps to restore the normal state of relaxation which follows
contraction. This type of exercise is used in conjunction with other methods
which induce relaxation to reduce a state of wasteful tension in muscles, which
limits the range of joint movement and reduces the efficiency of neuromuscular
co-ordination.
Exercise which work particular muscle
groups strongly achieve reciprocal relaxation of the opposing groups, e.g. work
for the scapular retractors and shoulder extensors assists relaxation of the
pectoral muscles.
Joint mobility
The normal range of joint movement is
maintained by exercises performed in full range. If and when the range of
movement is limited, rhythmical swinging exercises incorporating over pressure
at the limit of the free range may serve to increase it.
Muscle power and tone
The power and endurance of the working
muscles are maintained or increased in response to the tension created in them.
This tension is greater when the exercise is performed at any speed which is
slower, or more rapid, than when the natural speed of movement is employed, and
it increases with the duration of the exercise. A high degree of tension and
consequent increase in power can be developed by free exercises when the
muscles work for any mechanical disadvantage of an adverse leverage provided by
a long and heavy limb.
Normally, muscle power is maintained
adequately by a minimum of everyday activities, most of which are performed in
the middle range. Under abnormal conditions, however, for example during
fixation of joint, the power can only be maintained or improved by repeated
static contractions, which the patient must practice throughout the day.
Neuromuscular co-ordination
Co-ordination is improved by the
repetition of an exercise. As the pattern of movement is established, it is
simplified and becomes more efficient, and the conduction of the necessary
impulses along the neuromuscular pathways is facilitated. Exercises or
activities, which at one time required concentration and much effort, become
with practice more or less automatic in character, and skill is developed, as
for example in walking or playing the piano.
Confidence
The achievement of co-ordinate and
efficient movement assures the patient of his ability to maintain subjective
control of his body, giving him confidence to attempt other and new activities,
together with a feeling of exhilaration and satisfaction when they are
accomplished, for example, jumping a rope, or shooting a goal. Objective
exercises and activities are usually used for this purpose.
Circulatory and respiratory co-operation
During vigorous or prolonged exercise it
is apparent that the speed and depth of respiration is increased, that the
heart beat is faster and more forceful, and that heat is produced, whereas in
light exercise these changes are so slight that they are not noticed.
The needs
of the active tissues – the active tissues involved during muscular exercise
require a free supply of oxygenated blood and the removal of metabolic products
to enable them to continue their activity. To meet these demands and to keep
pace with them, the co-operation of the circulatory and respiratory systems is
enlisted
Preparation
for activity – it is probable that the cerebral cortex, which initiates the
muscular contraction, also prepares the body to supply the needs of the tissues
concerned, by communicating with the respiratory, cardiac, and vaso-motor
centre which form part of the autonomic nervous system. Sympathetic fibre from
these centers convey impulses to the appropriate organs which, with the help of
adrenalin, which is released into the blood stream, produce widespread results.
These results include increased respiration, increased frequency of the heart
beat, a rise in arterial blood pressure, and a re-distribution of blood, so
that the volume of blood in the muscles in increased at the expense of that in
the splanchnic area and the skin.
All these
change occur merely as the result of the anticipation of exercise as those who
have taken part in competitive sports may have been aware.
Local
circulatory changes in the muscles – during active exercise the capillaries in
the working muscles dilate and their permeability is increased. Many
capillaries that were closed when the muscle was at rest become open and blood
flows through them. In this way the capacity of the muscles to contain blood is
markedly increased and the interchange of fuel and waste products between the
blood and the tissue fluids is facilitated.
Regulation
of circulatory and respiratory function during exercise – the venous return to
the heart is increased during exercise and results in an increase in cardiac
output. The increased venous return is caused partly by the pressure variations
in the abdominal and thoracic cavities resulting from increased respiratory
movements which exert a pumping action upon the large veins in the direction of
the heart, and partly by the pressure of the contracting muscles of the thin
walls of the peripheral veins. Valves in these veins prevent regurgitation
increased during relaxation of the pressure.
Muscular
contraction increases both the carbon dioxide content and the temperature of
the blood, and both these factors stimulate the circulatory and respiratory
systems to further acitivity. The rise in temperature of the body is kept
within normal limits by dilation of the skin capillaries and stimulation of the
sweat glands, thus enabling heat to be lost from the surface.
Active
exercise can therefore be used to increase respiration, to increase both the
local and the general circulation, and to proved work for the heart muscles.
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