Clinical Assessment ROM

Question 1

range of motion

Answer 1

Definition: The end-to-end distance of a specific joint movement that is structurally possible

Question 2

principles to follow

Answer 2

Must do a bilateral assessment
First explain and demonstrate the movement to the guest and ensure they understand what is expected from them
Begin the assessment with the active range of motion (AROM) of the unaffected side – this gives the therapist a chance to develop a baseline observation/ measurement for normal range for the guest
Instruct the guest to perform the movement in the pain free range

Question 3

continued

Answer 3

After AROM of both sides, the therapist performs passive range of motion (PROM) of both sides – starting with the unaffected side
This is followed by resisted range of motion (RROM) – unaffected side first.
Note: Depending on the nature of the presentation the therapist can perform all range of motion (ROM) assessment on the unaffected side first – this gives a baseline of measurements – then performs the ROM assessment on the affected side

Question 4

active range of motion AROM

Answer 4

performed by guest

Question 5

active assisted range of motion AAROM

Answer 5

performed by guest with help of therapist

Question 6

passive range of motion PROM

Answer 6

performed on patient by therapist with no active involvement from patient

Question 7

begin with 
History
Observation
Palpation
M--ovement

Answer 7

(previous Class)

Introduction to PALPATION
Using Palpation as an assessment tool
Discuss Anatomical vs. Sensory Palpation
Review the 4 T’s of Palpation
Review Palpation for the purposes of postural assessment integration.
Demonstration and Practice – Class review and reading assignment.

Question 8

pair the movements when talking about them

Answer 8

flex-ext
abd-add
int-ext rotation

Question 9

Types of ROM assessment include:

Passive Over Pressure (POP)

Answer 9

Performed by the therapist after AROM.
The guest actively moves an extremity to their end active range - the therapist then passively takes the joint to its passive end range – stabilizing the joint or extremity is very important.

Question 10

Resisted Range of Motion (RROM)

Answer 10

Performed by the guest and Therapist
Joint is in a relaxed position
The therapist provides resistance to the movement.
Therapist uses the term “Don’t let me move you”

Question 11

establish firstly

Answer 11

functional range of motion — brushing hair, looking over shoulder
pain free range of motion

Question 12

secondly

Answer 12

anatomical range of motion

Question 13

Considerations of Range of Motion

Answer 13

Note:
When performing ROM the joint will eventually come to a stop. Each joint has a specific range based on the anatomy of the joint and the structures surrounding the joint.
Important Note:
The therapists must be familiar with the normal range of motion of a joint and what it feels like when the range is completed. If a joint presents with a range that is ‘not within normal limits’, that joint must be further assessed to determine what factors are affecting the normal ROM

Question 14

AROM – Active ROM

Answer 14

(AROM) Movement within the unrestricted ROM for a segment that is produced by an active contraction of the muscles crossing that joint. Will primarily assess contractile tissue
Limitations of AROM- for strong muscles, AROM does not maintain or increase strength. It also does not develop skill or coordination except in the movement patterns used.

Question 15

Therapist observation - AROM

Answer 15

Is the action/ movement the right action?
Can the guest complete the full range of motion?
Any compensation from other muscles – if so during what stage of the range?
Facial expression of the guest
Quality of the movement – smooth, jerky

Question 16

POP – Passive Over Pressure

Answer 16

Passive Over Pressure is a passive range of motion that will assess the end range of a joint taken actively to its full AROM.

Question 17

Therapist observation - POP

Answer 17

Quality of AROM
Can they complete the full range
Are there any compensatory muscles etc.
Does POP have more ROM?
Does the joint have a normal end feel?
Facial Expressions etc…

Question 18

PROM - Passive Range of Motion

Answer 18

AKA – Passive Relaxed Range of Motion
Movement within the unrestricted ROM for a segment that is produced entirely by an external force

There is no voluntary muscle contraction.

The external force may be from gravity, a machine, another individual, or another part of the individual’s own body.

Note: PROM is often slighter greater than AROM
PROM will primarily assess non-contractile tissues – including ligaments and joint capsule, thereby assessing a joint for hyper/hypo mobility
PROM will also put a ‘stretch’ on contractile tissue.
PROM is limited by pain

Question 19

Therapist Observation - PROM

Answer 19

Quality of movement – smoothness etc
Can the full range be completed?
If there is a block of movement – what does the ‘end feel’ feel like? - see page 125 -126 of Rattray
Facial expression of the guest as the movement is carried out

Question 20

Limitations of PROM

Answer 20

True passive, relaxed ROM may be difficult to obtain when a muscle is innervated and the guest is conscious.
Passive motion does not…
a. prevent muscle atrophy
b. increase strength or endurance
c. assist circulation to the extent that active, voluntary muscle contraction does

Question 21

Active Assisted Range of Motion

Answer 21

Active Assisted Range of Motion (AAROM)
A type of ROM in which assistance is provided by an outside force, either manually or mechanically, because the prime mover muscles need assistance to complete the motion

Question 22

Resisted Range of Motion

Answer 22

Resisted Range of Motion (RROM) Movement within the unrestricted ROM for a segment that is produced by active contraction of the muscles crossing that joint against external resistance offered by the therapist.

ARROM – can be performed in 2 ways-
A.) the muscles undergoes an isometric contraction - with the muscle placed in a specific position – a muscles typically displays it’s greatest strength at it mid-point.
B.) The muscle is tested throughout its range – Isotonic Contraction

Question 23

Active Resisted Range of Motion cont’d

Answer 23

during resisted ROM or testing;
if there is a painful contraction: 
this symptom typically indicates an injury to the muscle or tendon
if there is a weak contraction:
this may indicate one of the following
a weak muscle
a peripheral nerve injury
a partial rupture of the muscle or tendon

Question 24

Therapist observation -RROM

Answer 24

Quality Resisted Movement
Is it strong?
Is it weak?
Are there segments in the full range that are weak?
Can they complete the full range?
Are their compensatory muscles etc.
Facial Expressions etc…

Question 25

ROM Assessment - Procedure

Answer 25

Examination, Evaluation and Treatment Planning
(pp 45 – 46 Therapeutic Exercise - Kisner Colby)
1. examine and evaluate the guest’s impairments and level of function, determine any precautions.
2. Determine the ability of the guest to participate in the ROM activity and whether PROM, A-AROM , or AROM can meet the immediate goals.

Question 26

continued

Answer 26

3. Determine the amount of motion that can be safely applied for the condition of the tissues and health of the individual.
4. Determine what patterns can best meet the goals.
   ROM techniques can be performed in the…
   a. Anatomic Planes of motion: frontal, saggital, transverse
   (what we will focus on in this level)
   b. Muscle Range of Elongation: antagonistic to the line of pull of the muscle
   c. Combined Patterns: diagonal motions or movements that incorporate several planes of motion
   d. Functional Patterns: motions used in activities of daily living (ADL’s)

Question 27

All ROM Assessment Should Include

Answer 27

Active Range of Motion
AA’ssisted’ROM if needed
Passive Over Pressure (POP)
Passive Range of Motion (or POP)
Resisted Range of Motion (either Isotonic or Isometric)
Must be assessed BILATERALLY
Chart your findings…