Chapter 9 ADL PROM Flashcards
Range of Motion (ROM)
the amount of movement available between any two bony levers and is commonly used as a measure of flexibility.
ROM vs Stretching
Stretching is a specific technique designed to increase a muscle’s available ROM.
ROM monitors and maintains the capacity for motion that already exists.
Changes in joint structure
may negatively affect the amount of available ROM
Osteokinematics
The movement of one bone in relation to another. The bone moving around a joint axis.
Arthrokinematics
describes the internal joint motion that makes the osteokinematic motion possible.
ROM exercises must be performed with attention to
both osteokinematics and arthrokinematics.
Planes of motion
ROM exercises are done in straight or diagonal planes of motion around a triplanar axis.
Straight Planes of joint motion
Sagittal plane - side to side
Coronal plane - front to back
Transverse plane - up to down.
Sagittal plane
Movements best observed from the sagittal plane
Flexion and extension: cervical, trunk, shoulder, elbow, wrist, fingers, hip, knee, toes
Thumb metacarpophalangeal (MCP) abduction and adduction
CMC abduction and adduction.
Frontal Coronal plane
Movements best observed from frontal plane
Abduction and adduction: shoulder, hip, fingers
Thumb carpometacarpal and MCP flexion and extension.
CMC flexion and extension
Transverse plane
Movements that rotate around a vertical axis.
Internal and external rotation: shoulder, hip, knee
Right and left rotation: cervical, trunk
Forearm supination and pronation
triplanar axis
joints such as ankle that cuts through all three planes
Diagonal planes or Vectored planes
Each diagonal motion combines the three straight planes into one movement that, in its full excursion, crosses the midline of the body. - some shoulder and hip movements (ball and socket)
proprioceptive neuromuscular facilitation (PNF) techniques
Types of stretching:
Hold-relax
Contract-relax
Hold-Relax-contract
Types of diagonal plane movement.
D1 Flexion: This pattern involves moving a limb from an extended position across the body to a flexed position. Imagine reaching up and across your body to grab something from a high shelf.
D1 Extension: The reverse of D1 Flexion, moving from a flexed position across the body to an extended position.
D2 Flexion: This pattern involves moving a limb from an extended position out to the side and up. Think of drawing a sword from a sheath on your opposite hip.
D2 Extension: The reverse of D2 Flexion, moving from a flexed position out to the side and down.
PNF pattern D1 UE
PNF pattern D2 UE
LE PNF patterns D1 and D2
Active Range of Motion (AROM)
When the force that moves a joint is generated internally.
Passive Range of Motion (PROM)
When the force moving the joint is generated externally.
(person, machine, gravity.)
Active Assisted Range of Motion (AAROM)
When portions of the movement are supplied acively and others are assisted external forces
Continuous Passive motion machine CPM
Used to be more common, but evidence suggests that while there may be benefits post-op there are no long-term benefits following total knee arthroplasty.
PROM benifits
Localized decrease in edema through changes in intra-articular joint pressure
Prevention of joint stiffness through decreased adhesion formation
Decreased articular cartilage erosion** why?
Decreased articular cartilage erosion from PROM why:
- Nutrient Distribution: Cartilage is avascular, meaning it doesn’t have its own blood supply. It relies on the movement of synovial fluid within the joint to receive nutrients and remove waste products. PROM exercises help circulate this fluid, ensuring that the cartilage gets the nutrients it needs to stay healthy12.
- Reduced Inflammation: Regular movement through PROM can help reduce inflammation in the joint. Inflammation is a key factor in cartilage erosion, as it can lead to the release of enzymes that break down cartilage3. By keeping the joint moving, PROM exercises can help minimize this inflammatory response.
- Maintaining Joint Mobility: PROM helps maintain the joint’s range of motion, preventing stiffness and ensuring that the cartilage surfaces move smoothly against each other. This can reduce the wear and tear on the cartilage, slowing down the erosion process1.
AROM additional benifits
- Come from muscle loading around the joint.
- Pressure loading on tendons
- Helps callogen in tendons.
- loading on tendons puts load on the bones.
- Load on the bones keeps them healthy.
- Loading on cartilage and synovium provides nureshment for joint structures.
- Promotes local circulation.
- Lymphatic and venous return.
- proprioception and kinesthesia
Lack of regular movement
Negative affects on joints and ultimatly decreased ROM through contractures.
PROM Indications
- As an assessment technique
- When the patient’s own muscle force is not sufficient to produce safe, effective motion at the joint.
- When active contraction of the muscles would be harmful to the patient
- As a means of educating the patient.
PROM contraindications
- If the patient declines consent
- During stages of tissue healing in which motion could inhibit, retard, or stop repair.
- When patients experience muscle guarding that is too strong for them to voluntarily overcome
- when strong muscle guarding is accompanied by increased pain.
PROM Precautions
Clinician must judge:
1. When PROM temporarily increases the patients pain
2. When PROM elicits undesired muscle tone
How to judge PROM Precautions
SINSS
S-severity
I-irritabilityy
N-nature
S-Stage
S-stability
AROM indications
if the patient is able to perform the movements safely, effectively and without pain.
AROM Contraindications
- Pain that occurs throughout the motion or persists after the activity
- Development of undesired muscle tone, promoting an already dysfunctional pattern.
- Presence of undesired cardiopulmonary responses, includingabnormal respiration, abnormal heart rate, abnormal blood pressure or pain associated with cardiac distress.
- Other adverse responses to exercises, such as excessive effusion or inflammation.
PROM durring early healing
Research is inssufficient. rest for first 48 hours at least. 48 to 72 hours can do some which may help with alignment and orientation of newly forming tissue fibers.
PROM dosage
Low intensity but high frequency is recomended for early tissue healing
For orthopedic problems, 5-12 reps at to 10 sec per cycle.
For neurologically increased muscle tone - may need to be performed slowly.
AROM dosage
by the patient’s response to movement.
pain, vitals, fatigue. quality or accuracy of movements.
Straight plane or diagonal plane movements
Straight plane movements are specific and isolate each joint’s full available range Definition: Movements that occur in a single plane (sagittal, frontal, or transverse) ie lateral raise - frontal plane
Diagonal plane movements may not move each joint through its complete range but are more similar to functional movemnt patterns of daily living. Definition: Movements that occur in multiple planes, often crossing the midline of the body. Example: Reaching across the body to grab an object, throwing a ball.
ROM exercise progression
PROM to AAROM to AROM to RROM.
Support in PROM and AROM
Support in PROM helps a client relax
Support in AROM helps with stability
Stabilizing proximal segment
Manually or through support surfaces. Chairs, matts, plinths. Durring wrist extension, the forearm is stabalized for instance. Active trunk stabilization may be necessary while performing shoulder flexion.
Gaurding the patient
Guarding amount depended amount client can maintain their own stability in static or dynamic conditions.
Stabilizing the joint proximal to motion
Is a form of CCDD
Mental rehersal of movement
can improve psychomotor performance. -useful when PROM is used as precurser to AROM
Order of ROM proceedurs considerations
Minimize the amount of patient repositioning.
Things to do when starting ROM proceedures
- Explain the procedure and obtain patient consent
- Position the patient
- Assess the patient’s Preactivity status
- Position yourself
Things to do when starting ROM activity
- Engage the patient as fully as possible in the activity.
- Move, or instruct the patient to move, the limb from one end of the joint or muscle range to the other with correct joint biomechanics.
- All motions should be performed slowly with a brief hold at the point of greatest joint range or muscle elongation.
- avoid stretching muscle in case of flacid or uninervated muscles.
- May use overpressure (which would stretch.)
Things to do after ROM activity
- Reassess symptoms and physiologic status
- Document activities and findings
- Leave the patient safely situated at the end of the exercise session
Overpressure
At the end of a pain free ROM, applying a small amount of force at the end of range can provide information about the joint condition
Self-ROM
Perform PROM or AROM on their own joints. -canes broom handles. “wands”
Pendulum exercises known as “cod man’s exercieses.”
codman’s exercise
axiel Skeleton ROM
PROM of head kneck and trunk are best left to a skilled clinician
TMJ movement
side to side - forward back. Closed and open to two or three knuckles.
Quality - clicking. Popping. Deviations laterally as opened and closed.
Pain.
ROM of the spine
33 vertebral bodies.
Quantitative Findings of ROM
The amount of available range is measured using a goniometer.
Hypomobile
Less than normal angles of range measured by goniometer.
Hypermobile
More than normal angles of range measured by goniometer.
Qualitative findings of ROM: Pain
What type of ROM was taking place?
Has this pain been felt before
What type of pain?
Where in the range did the pain occur?
How severe was the pain?
Qualitative findings ROM: Tone
Tone is the level of involuntary tension that exists within the muscle. Less than normal: hypotonicity
More than normal: hypertonicity
Spasticity
Rigidity
maintained hypertonicity that results in resistance to passive movement.
Cogwheel rigidity
muscle alternates between rigid and free movement in an on and off pattern.
flacid
Muscles in which the normal resting tone is absent
muscle spasms
involuntary active shortening of the muscle
Muscle guarding
muscle spasming that occurs in the surrounding tissues immediatly after acute or anticipated injury to the tissues.
Cramps
Temporary muscle spasms not associated with injury.
Joint end feels:
Soft end-feel
A soft, yielding compression with a gradual onset, typically created by the coming together of soft tissues such as muscle and fat (knee flexion.)
Joint end feels:
Firm end-feel
A firm springy movement: an feelilng of rising tension or tension with a slight “give” that comes on more gradually than a hard end-feel. typically created by a stretch of tendons and ligaments.
Joint end feels:
Hard end-feel
A painless, abrupt unyielding sensation typically created by the coming together of bony or joint capsule components. Knee extension for example.
empty end-feel
cessation of ROM because of pain.
Sounds of joint
Crepitus - grating or crackling
Cavitation - audible popping or cracking
Capsular patern
Joint capsule problems can limit movement following a pattern. Shoulder is example given
torn or ruptured ligament
can result in execcive movement in one direction.
painful arc
impingement or irritation of soft tissue or connective tissue structure occurs during range of motion.
dyskinesia
poorly coordinated muscle activity.
