Introduction To Goniometry, MMT, And ROM Flashcards
Goniometry and manual muscle testing (MMT)
- goniometry is used more often in outpatient settings
- provide standardized methods of measuring respective movement and strength available at that individual joints of the body
Precautions
Something you want to take into consideration
- hyper mobility
- recent soft tissue injury or fracture
- active inflammation/pain at or near the joint
- some pain medications/muscle relaxers
- post-op restrictions
- osteoporosis or conditions that cause weakness of the bone
Contraindications
Things you should not be doing range of motion and testing on patients who have these things going on
- acute soft tissues injury or fracture
- joint instability/subluxation (partial dislocation)
- post-op restrictions limiting all ROM
- myositis ossificans or ecotopic ossification
- bones grow where the muscle tissue was; the bone forms in the tissues where it does not belong
Positioning
- stabilize the proximal joints to promote stability of the joint being assessed
- proximal joint should be in a neutral position
- goniometry is completed prior to MMT = provides the indication of strength
- moving against gravity and in gravity eliminated planes = specific to the movements
- MMT is performed in midrange (halfway) point of the movement
- consider compensatory movements = using other joints or body parts to move the specific joint being measured
Considerations for ROM
- hypermobility
- hypomobility
- joint structures may be unable to hold the joint in stable position
- lengthening, injury, subluxation
- environmental factors
- time of the day, noise, temp, preparatory activities
- you want to make sure you’re performing the MMT and ROM in the environment that will promote the most participation
- age (decreased flexibility with age)
- current activity level
- cognition (ability to understand directions)
- psychosocial factors
- fear of pain or re-injury
- stress or anxiety
- depression
Hypermobility
Greater mobility than normal
- can be due to congenital, occupation based, laxity of ligaments
Hypomobility
Less mobility than normal
- edema, scars, pain, shortening, muscle weakness, hypertrophy, tone, excess tissue
Goniometry
Precise measure of the amount of active or passive movement at a joint
Goniometer
A tool used to obtain joint measurements
- static arm
- moving arm
- axis
Static arm
Aligned with the body structure proximal to the joint
Moving arm
Aligned with the body structure distal to the joint
Goniometer axis
Aligned with the joint being measured
Functional range of motion (FROM)
Amount of active motion necessary to complete a specific functional task
- ex = driving = you don’t need 180 degrees of shoulder flexion to drive, just 90 degrees
Active range of motion (AROM)
Motion that the patient is able to generate independently
Passive range of motion (PROM)
Motion produced externally by an OT or the patient (with the use of the opposite arm)
Active-assist range of motion (AAROM)
Combination of clinician and patient effort
End-feel
The way the joint feels to the hands of the clinician at the end of the movement
ROM sequence of events
Chart Review and Observations
- identify precautions and contraindications
- note the patient’s posture, visible edema, bandages, and scaring
- explain the purpose of ROM assessment
Functional Range of Motion
- completed FROM assessment to determine the baseline AROM
- use clear language with the patient
Goniometry Assessment
- depending on the results of FROM, may need to measure degrees of movements passively and/or actively with your goniometer
Special cases and documentation (slide 12)
- documenting in range or full numbers
- hyper extension/hypermobility with negative or positive numbers
- flexion = positive number
- extension = negative number
- adduction and abduction = moving away or towards the midline
- consistency in documentation is key
- considerations:
- when PROM is higher than AROM
- when PROM = AROM
- elbow flexion in normal ROM example:
- 0-150 degrees = not limited
- 15-150 degrees = limited in extension
- 0-120 degrees = limited in flexion
- 15-120 degrees = limited in flexion and extension
MMT
Established the need for adaptive equipment for durable medical equipment and helps us to form goals and treatments
Considerations for Strength/MMT
- gender, age, occupation
- current activity level
- cognition
- psychosocial factors
- fear of pain or re-injury
- stress or anxiety
- depression
- pain
- health/nutrition
- genetics
MMT sequence of events
Chart Review and Observations
- identify precautions and contraindications
- note the patient’s posture, visible edema, bandages, and scaring
- complete the ROM asssessment
- explain the purpose of MMT assessment
Functional Manual Muscle Testing
- place one hand proximal to the joint to stabilize
- place resistive hand distal to the joint (do not cross additional joints)
- communicate (“meet my resistance” or “don’t let me move you”)
- gently apply increasing force
Joints of Functional Manual Muscle Testing
- shoulder flexion/extension
- shoulder internal/external rotation
- elbow flexion/extension
- composite finger flexion
