Rhythmic initiation Rhythmic motion through desired range starting with passive motion progressing to active resisted motion

Combination of isotonics Combo of concentric, eccentric & stabilizing contractions of one group of muscles w/out relaxion Active control of motion Coordination Increase AROM Strengthen Func. Training in eccentric control Decr. Ecc. control Lack coordination Decr. AROM Lack of AROM

Dynamic reversals active motion changing from one direction (agonists) to opposite direction (antagonist) w/out pause or relaxation. Similar to throwing a ball, bicycling, walking increase AROM Strength develop coordination prevent or reduce fatigue increase endurance, decrease tone Decreased AROM weakness of agonists decr ability change directn exercised muscles fatigue relaxation hypertonic mm

Stabilizing reversals alternating isotonic contractions opposed by enough resistance to prevent motion push against by hangs or don t let me push you PT only allows small mvmt increase stability and balance increase muscle strength increase coordination between agonist and antagonist decreased stability weakness pt is unable to contract isometrically ands till needs resistance in a one way direction

Rhythmic stabilization alternating isometric contractions against resistance no motion intended

Goals

Indications

aid in initiation improve coord. & sense of motion normalize rate of motion(incr or decr) teach motion help pt relax difficulties initiating motion dysrhythmic motion (ataxia or rigidity) regulate or nomalize muscle tone general tension

Increase AROM and PROM Increase strength Increase stability and balance Decrease pain Limited ROM Pain, with motion Joint instability antagonistic weakness Decrease balance

Contra

Rhythmic stabilization may be too difficult with pt with cerebellar involvement If pt unable to follow instructions

Rhythmic initiation Description

Combination of isotonics passive motion using PT resists pt s speed of verbal moving actively command set rhythm through ROM (conc. pt asked to assist contraction) desired direction & At end, PT tells pt to return done by PT stay in position PT resists active (stabilizing mvemnt maintain contrctn) rhythm/verbal When stability pt finishes by making attained, PT tells pt motion allow part to be independently moved slowly back to the start position (ecc contraction) no relaxation btwn ecc or stabilizing muscle contraction may come before conc contraction

Dynamic reversals PT resists pt moving in 1 direction, usually stronger direction As end of desired range approaches PT reverses grip on distal portion of moving segment & gives command to prepare for change of direction At end of desired movement PT gives action command to reverse direction,w/out relaxation, gives resistance to new motion starting w/distal part When pt begins moving in opp direction, PT reverses proximal grip so all resistance opposes new direction done often as necessary start w stronger pattern finish w weaker

Stabilizing reversals PT gives resistance starting in strongest direction, very little motion allow Approx/traction should be used to incr stability When pt is fully resisting the force, PT moves one hand and begins to give resistance in another direction After pt responds to new resistance, PT moves other hand to resist new direction

Rhythmic stabilization PT resists isometric agonist contraction, pt maintains position w/out trying to move Resistance incr slowly as pt matches force When pt responding fully, PT moves 1 hand to begin resisting antagonistic motion at distal part- neither PT nor pt relaxes as resistance changes New resistance is built up slowly, as pt responds PT moves other hand to resist antagonistic motion Use traction/ approx as indicated Reversals repeated as often as needed command stay there don t try to move

Rhythmic initiation Modfication can be finished by combination of isotonics can be finished reversal of antagonists

Combination of isotonics May combine w/ reversal of antagonists Can start at end of ROM & begin w/ eccentric One type of muscle contraction can be changed to another before finishing ROM Change can be made from concentric to eccentric w/out stopping or stabilizing

Dynamic reversals Instead of moving thru full range, chng direction used emphasize particular ROM. Can begin w/ small motion in each direction incr ROM as strngth incr. Pt can be instructed to hold position & stabilize any point in range or at end can be done b4 or after reversing dirctn Can begin w/ stronger dirctn to gain irradiation weaker mm aftr reversng reversal should be done whnvr agonist fatigues If increasing strength is goal incr resistance w/each change Only use initial stretch reflex do not restretch when changng the direcn bc antagonist mm not under tension don t assist changing dirctns -Change direction emphasize particulr ROM

Stabilizing reversals Technique can begin w/slow reversals and progress to smaller ranges until pt is stabilizing Stabilization can start w/stronger muscles groups to facilitate weaker muscles Resistance may be moved around pt so that all muscle groups work Speed of reversal my be increased or decreased

remember

speed of verbal sets rhythm at the end patient should make motion independently technique may be combined

Start where pt has most strength/ best coord.Stabiliz or ecc contrctn may be 1st Emphasize end of range, start there w ecc contraction

Start working in the strongest direction Can begin with slow reversals and decrease range until pt is stabilizing

Rhythmic stabilization Can begin w/ stronger mm 4 facilitation weaker mm group (successive induction) Stabilizing activity can be followed by strengthening tech for weak mm To increase ROM, stabilization may be followed by asking pt to move farther into restricted range For relaxation, the pt may be asked to relax all muscles at the end for relaxation w/out pain technique may be done mm distant from painful area Use static commands bc no motion intended Stabilization may be done w mm distant from a painful area Stabilization can be followed by strengthnng technique