F u n d a m e n t a l l s i i n P .
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First: General Terms
 Palpation is used to check for: edema, muscle spasm, muscle atrophy and temperature.
 The word "Stiffness" is used to describe the joints only
 The word "Spasm" is used to describe the muscles only
Second: Therapeutic Exercises
 Before I start, I would to note that it's important to know the: origin, insertion, innervations, function and location of your muscles!
 PTs (us!) have to know how to prescribe an exercise
 Passive movement = it is the movement caused by an external force
- These are movements produced by an external force during muscular inactivity or when the muscular activity is voluntarily reduced as much as possible to permit movement
Example: Paralyzed patients (quadriplegia, paraplegia)
 Why do we do relaxed passive movement?
- We need to move the joint to prevent/decrease: atrophy, edema, bed sours and muscle spasm
 Aim of exercise therapy:
1.
To promote healing + activity
2.
To correct the inefficiency of specific muscles or muscle groups and regain normal range of joint movement to achieve efficient functional movement
3.
To encourage the patient to use the ability he has regained – to accelerate his rehabilitation
 Techniques of exercise therapy:
A. Active movement
1) Voluntary
- Assisted (using board but patient does the movement not u)
- Free (w/o help)
- Assisted – Resisted (assisting movement while giving partial resistance)
- Resisted (patient moves through available ROM, PT applies resistance)
2) Involuntary Reflex (due to neurological damage)
Fundamentals in P.T. 203
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B. Passive movement
1) Relaxed passive movement
2) Passive manual mobilization techniques a.
Mobilization of joints b.
Manipulation of joints c.
Controlled sustained stretching of tightened structures
 Effects of relaxed passive movement:
1.
Prevent adhesion formation
2.
Preserve the memory of movement pattern by stimulating the receptors of kinesthetic
3.
To prevent adaptive shortening in muscles
4.
The venous and lymphatic return maybe assisted (limb will be cold if low there is low blood supply)
5.
The rhythm of continued passive movement can have a soothing effect and induce further relaxation and sleep
 Principles of giving relaxed passive movements:
1.
Relaxation
- Suitable starting position ensures comfort and support of patient
2.
Fixation
- Proximal joint fixed when movement is limited to specific joint
3.
Support
- Full and comfortable support given to the part to be moved
4.
Traction (separating two parts apart)
- Many joints allow the articular surfaces to be drown apart by traction
- Apart  traction / together  proximation
- Flail or flaccid  no muscle control / defective, or absent muscle tone
- aim of traction  to improve synovial membrane function to permit movement
- If doing proximation, you are limiting the movement
- You should know normal range of motion to prevent harm to joint
5.
Range
- The range of movements is as full as the condition of the joint permits without eliciting pain or spasm in the surrounding muscles
^ Normal joint  over pressure
^ Flail joint  not to go beyond the normal anatomical range of motion
6.
Speed and duration
- Speed must be uniform, fairly good, rhythmic and slow
 Sustained stretching:
- Sustained stretching can be applied to the contracted structures for a period of time within a functional pattern of movement
 Effects and uses of controlled sustained stretching
1.
Steady and sustained stretching may be used to overcome spasticity
2.
A steady and prolonged passive stretching can overcome the resistance of shortened ligaments, facia…etc
Fundamentals in P.T. 203
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- Stretch must be slow and relaxing
Third: P.N.F (Proprioceptive Neuromuscular Facilitation which means: to have coordination w/ eyes closed)(practical)
 Upper Limb
- Flexion, adduction, lateral rotation
- Extension, abduction, medial rotation
- Flexion, abduction, lateral rotation
- Extension, adduction, medial rotation
 Lower Limb
- Flexion, adduction, lateral rotation
- Extension, abduction, medial rotation
- Flexion, abduction, medial rotation (Karate kick)
- Extension, adduction, lateral rotation (Kick the ball)
Fourth: Passive movements (practical)
- Open the book, all written there!
B a t c h o f 2 0 0 4
B a 7 r a i i n i [ p t d o c t o r @ g m a i l l .
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c o m ] & S h a r i f f a
[These notes are not related to or funded by any student parties of Kuwait University as well as any outside parties in any way.
It is an independent entity of its own and is supported by the doctors of KU]
Fundamentals in P.T. 203
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