therapeutic ex

1. Active-Assisted
Exercise
BY
Dr. Doaa Tammam

2. • Definition of AAROM: Movement
performed within the unrestricted ROM
controlled by the voluntary contraction of
the muscle, In which assistance is provided
by an outside force, either manual or
mechanical when muscle strength is
inadequate to complete the motion.

3. -(muscle strength is less than grade 3 manual
muscle test). Once patients gain control of
their ROM, they are progressed to AROM

4. The principles of active assisted
exercises:
1-When the voluntary contraction of the muscle is
insufficient to produce movement,
2- An external force may be added to complete range.
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.

5. Types of assistance
• Manual assistance: as the therapist or
by the sound limb of the patient (self
assistance).

6. • Mechanical assistance: as wooden stick or
T-bar, finger ladder, shoulder wheel, pulleys.

7. Effects and uses of AAROM:
1- When the patient has weak musculature (poor to fair
minus muscle test grade).
2- Maintain physiologic elasticity and contractility of the
muscles which will gain strength and 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 range of
effective joint movement may be increased.(ROM)

8. 5-The repetitive assisted exercises on the correct
pattern learn the patient to control the movement by
himself, so helping in training co-ordination.
6-Confidence of the patient in his ability to move
and helping to co-operate.
7- Can increase metabolism to help lose weight and
decrease stress and pain.

9. • 8- Increase local circulation, Maintain and
improve cardiopulmonary function.
• 9- A decrease in the risk of heart disease and
heart attack is another benefit of regular exercise,
as it reduces blood pressure and cholesterol.

10. Indications:
• 1- Muscle weakness as result of disuse or after
plaster cast.
• 2- Muscle re-education. And Following tendon
or m. transplantation.
• 3- Inability to do Activities of Daily Living.(ADL)
• 4-To increase ROM.

11. • 1- Swelling ,fever and redness.
• 2-Immediatlly followed myocardial
infarction.
• 3-If active assisted exercises induced sever
pain during movement.
• 4- Cardiopulmonary dysfunction.
• 5- Unhealed or unprotected recent fracture
or recent surgical site.
• 6- In cases of DVT.
Contra-indications of AAROM:

12. • ROM exercises proximal and distal to the
injured and /or immobilized joint: to
minimize venous stasis and thrombus
formation
Precaution:

13. • 1-Starting position: stability of the body is important
to ensure that the patient’s 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: fixation of the proximal part of the prime
movers improves their efficiency. Avoid trick
movements to occur by proper fixation.

14. 4- Support: the moved part should be supported to
reduce the load on the muscle. Pillows, Boards, Slings,
Manually.
• Support → eliminate any force or load on the weak
ms. by counterbalancing the effects of gravity
(eliminate effect of gravity ).

15. • 5-Traction: preliminary stretching of the
weak muscle provides a powerful stimulus
to contraction because it stimulate the
muscle spindle( Myotatic reflex) which
helps in the initiation of movement.
• 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.

16. • 7- The assistance force: the force used in assisting
the action of the muscle must be applied in the
direction of the movement by the PT hands.
• 8- The character of the movement: movement is
performed smoothly
• 9- Repetitions: repetition of the movement
depends on the condition of the patient.
• 10-The cooperation of patient: this is essential
during this type of exercise. The patient should be
encouraged to exert maximum effort.