Active Assisted Exercise in Physiotherapy

Active assisted exercise, In which assistance is provided by an outside force, either manual or mechanical when muscle strength is inadequate to complete the motion.

The principles of Active assisted Exercise:

1. When the voluntary contraction of the muscle is insufficient to produce movement,

2. An external force may be added to the 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.  

The technique of Active Assisted Exercise

The assisting force is applied only to augment the maximum effort and not to act as a substitute force. 

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. The pattern of movement: this can be explained to the patient by performing it passively or actively on the sound limb.

3. fixation of the proximal part of the prime movers improves their efficiency. Avoid trick movements to occur by proper fixation.

4. Support: the moving part should be supported to reduce the load on the muscle. Manual support is more effective since it can be provided in any place suitable for the movement and adjusted in each successive part of the range.

5. Traction: preliminary stretching of the weak muscle provides a powerful stimulus to contraction because it stimulates 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.

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 and its efficiency depends on the speed of contraction.

9. Repetitions: repetition of the movement depends on the condition of the 

10. The cooperation of the patient: this is essential during this type of exercise. The patient should be encouraged to exert maximum effort.

Contra-indications of Active assisted exercise

1. Acute tears and fractures.

2. Greater swelling, fever, and redness.

3. Immediately followed myocardial infarction.

4. If active assisted exercises induced pain during movement.

Effects and uses of assisted exercise

• The confidence of the patient in his ability to move and helping to co-operate. 
• When the patient has weak musculature( poor to fair minus muscle test grade). Active assisted exercises are used to provide enough assistance to strengthen the weak muscle.
• Maintain physiologic elasticity and contractility of the muscles which will gain strength and hypertrophy.
• provide a stimulus for bone integrity so the range of effective joint movement may be increased.
• it's corrective movement pattern learning, The repetitive assisted exercises on the correct pattern learn the patient to control the movement by himself, so helping in training coordination.
• provide sensory feedback from the contracting muscle to be used in early stages of neuromuscular re-education.