exercise therapy

1. EARLY RE-
EDUCATION
Soundararajan k
K. Soundararajan, SRIHER 1

2. OBJECTIVE
Initiation of muscle contraction
Measure used
1. Warmth
2. Stabilisation
3. Grip or manual contact
4. Stretch
5. Irradiation
K. Soundararajan, SRIHER 2

3. The initiation of muscular
contraction
 Lesion cause paralysis & inactivity
which follows both increase threshold
of excitability of AHC
 In acute phase of lesion motor unit
reactivation is possible except
permanent damage
 Example: death of cell or lack of
continuity of axon
K. Soundararajan, SRIHER 3

4. The initiation of muscular
contraction (continue…)
 AHC is more difficult to stimulate when its
threshold is increased fail to react to
normal stimulus which is patient maximal
voluntary effort of contraction
 This demand is supplied by stimulation of
sensory receptor i.e. proprioceptors
exteroceptors
 With lower threshold AHC is stimulated &
facilitate passage of impulse in nervous
pathway K. Soundararajan, SRIHER 4

5. The initiation of muscular
contraction (continue…)
 When stimulated AHC discharge
impulse to muscle fibres which
respond by contraction
 A single discharge of impulse results in
muscle twitch
 But discharge repeated sufficiently
frequently lead to summation and a
sustained contraction
K. Soundararajan, SRIHER 5

6. Measure used to obtain initiation
of contraction
1. Warmth
2. Stabilisation
3. Grip or manual contact
4. Stretch
5. Irradiation
K. Soundararajan, SRIHER 6

7. 1. Warmth
 Area affected must be warm, as
moderate warmth improve quality of
contraction
 Any method designed to improve
circulation in area is effectively
 Active exercise of affected muscle
against strong resistance is the
method of choice
K. Soundararajan, SRIHER 7

8. 2. Stabilisation
 Stabilize bone origin of affected
muscle, of joint distal, over which
muscle work, improve their efficiency
 Whenever possible isometric
contraction of synergist working
against maximal resistance as their
effort re-inforces
 Example: initiating elbow flexors
shoulder & wrist are stabilized by their
flexor working against resistance of
K. Soundararajan, SRIHER 8

9. 3. Grip or Manual Contact
 The Physiotherapist hand’s give
pressure only in the direction of
movement , to direct the patient’s
effort and give sensory stimulation
K. Soundararajan, SRIHER 9

10. 4. Stretch
 Stimulation of muscle spindle elicits
reflex of that muscle provided reflex
arc is intact
 Sharp but controlled stretch of
affected muscle at limit of extended
range
 Prolong stretch or failure to allow
muscle shortens inhibits contraction
 Command for voluntary effort must be
brief forceful timed to coincide withK. Soundararajan, SRIHER 10

11. 5. Irradiation
1. Use of resistance to functional movement
of opposite limb which normally produce
fixator action on other side assist initiation
of contraction in affected muscle
2. The use of resistance to strong group
which normally work with the affected
muscle also encourage contraction of that
muscle
K. Soundararajan, SRIHER 11

12. Reference
 The principles of exercise therapy, 4th
edition, Dena Gardiner, Page no:178-
179
K. Soundararajan, SRIHER 12

13. Discussion …
K. Soundararajan, SRIHER 13

14. K. Soundararajan, SRIHER 14

15. K. Soundararajan, SRIHER 15