Assistive exercise treatment, as with all exercises, assumes some functional power, as the practice consists of a systematic exercise of the functions. Thus in pareses we are able to exercise the injured motor neurons which still possess a certain amount of functional power, and by degrees increase this power, while such exercises are excluded in complete paralyses. With apparently entirely destroyed functions it is of primary importance to stimulate them to some, if only the slightest amount of, activity. The methods which have shown themselves effectual in this contribute in a high degree in throwing increased light upon the physiology of nerves.

A common method in hemiplegia is to allow the patient to perform at the same time the same movements on the affected as on the healthy side. Swedish gymnasts call these movements "double-sided,"* e.g., simultaneous extension in the knee joints of both legs. Alternate movements also aid "assistive" treatment; they also take place on both sides, but not simultaneously, e.g., walking or cycling.

The performance of movement "at word of command" is considered also assistive.

Many gymnasts first show the patient the movement, then perforin it passively upon him, and then let him try to perform it actively.

Some give the word of command just at the moment when they pass an electric current through the paretic group of muscles and its nerves. As improvement increases, the strength of the current is diminished.

* P. H. Ling recognised our tendency to perform the same movements simultaneously with both sides of the body. He divided involuntary movements into associated movements, reflex movements, imitative movements, purposeful movements, and rhythmic movements. As the reader of physiology understands, all these kinds of involuntary movements are reflex movements except the ryhthmic (muscles of the heart and respiration), which can no longer be considered as such.

Further we can make movement easier for the damaged nerve elements by letting the patient perform the movement in a warm bath (35° C, 15 - 30 minutes), by which means the weight of his extremities is lightened by the mass of water displaced, so that he is often able to perform movements in the bath before he can perform them out of it.

Persons who delight in learned expressions sometimes speak of the kineto-therapeutic mirror. With this one may practise both assistive and resistive treatment; e.g., after infantile paralysis, by letting the patient practise in front of a looking-glass and observe himself one is able to exercise a strengthening influence upon the motor impulses of his will. Similarly, a patient with cramp of the muscles supplied by the spinal accessory nerve is able to control the attacks for a longer time in front of a looking-glass than without one, and thus obtains complete recovery more easily.

Resistive treatment is of use chiefly in hypertonic and irregular movement (ataxy or tremors), and is partially under the power of will.

One may, however, control the movements in two quite different ways. In the one case, and in hypertonic diseases, one represses the (pathological hypertonic) innervation. In the other case, with irregular movements, one does not repress the innervation, but makes it stronger and more complicated, and what is impeded is only the speed of the movement.

I have already given above a good example of true inhibition of motor innervation in a patient with cramp of the muscles supplied by the spinal accessory nerve, and who by will power (with or without a mirror and other means) attempts to control the attacks of cramp in these muscles (trapezius and sterno-cleido-mastoid), lengthens the intervals between the attacks of cramp, and by degrees causes them to cease entirely. Only in a definitely specified sense can such inhibition be reckoned as gymnastics, in that it aims at the maintenance of a certain (normal) position.

But, as already said, one may also control movements by innervating the antagonists of those synergistic muscles which perform the movement and in this way make the movement at the same time both slower and stronger.

In modern gymnastics we have two gymnastic systems which represent this method of control.

The "self-resisted" movements introduced by the brothers Schott at Nauheim into the treatment of heart diseases are performed slowly during the keenest attention of the patient, and while he innervates both the synergists and antagonists so strongly that the whole of the external movement in comparison to the muscle action becomes a negligible quantity. Even the highest motor centres in the cortex of the brain are strongly exercised during these movements; they are supposed to have a specially strong influence upon the automatic centres, and in this way a strong collateral effect upon the motor centres of the heart. The Schott exercises are used in organic heart disease, but are contra-indicated in neuroses of the heart. I will not take it upon myself to estimate their value; personally I have used instead Stokes' "terrain cure."

The movements of Frenkel's gymnastics for the ataxia of tabes are, in my opinion, self-resisted movements of a similar kind. These movements also are performed slowly with the keen attention of the patient, and while the antagonists of the muscles are innervated; speaking physiologically, these perform eccentric work. These resisted exercises of Frenkel are of great value in restoring a better power of co-ordination, and in teaching the ataxic patient to manage his positions and movements with his diminished sensory resources, and they have very considerably helped to ameliorate his hard fate.

The treatment does not only aim at enabling the patient to perform normal movements, but also at correcting the faulty positions due to the widespread hypotonus. The inability of tabetic patients to feel fatigue must be taken into consideration in the treatment. This subject will be more fully dealt with in the special part of this work.

The self-resisted movements are the only ones which lend themselves to the treatment of occupation neuroses, and in my opinion only then after long rest from the muscle work which brought on the neurosis. Massage has here the preference.