Introduction To Goniometry, MMT, And ROM

Question 1

Goniometry and manual muscle testing (MMT)

Answer 1

• 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

Question 2

Precautions

Answer 2

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

Question 3

Contraindications

Answer 3

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

Question 4

Positioning

Answer 4

• 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

Question 5

Considerations for ROM

Answer 5

• 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

Question 6

Hypermobility

Answer 6

Greater mobility than normal
- can be due to congenital, occupation based, laxity of ligaments

Question 7

Hypomobility

Answer 7

Less mobility than normal
- edema, scars, pain, shortening, muscle weakness, hypertrophy, tone, excess tissue

Question 8

Goniometry

Answer 8

Precise measure of the amount of active or passive movement at a joint

Question 9

Goniometer

Answer 9

A tool used to obtain joint measurements
- static arm
- moving arm
- axis

Question 10

Static arm

Answer 10

Aligned with the body structure proximal to the joint

Question 11

Moving arm

Answer 11

Aligned with the body structure distal to the joint

Question 12

Goniometer axis

Answer 12

Aligned with the joint being measured

Question 13

Functional range of motion (FROM)

Answer 13

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

Question 14

Active range of motion (AROM)

Answer 14

Motion that the patient is able to generate independently

Question 15

Passive range of motion (PROM)

Answer 15

Motion produced externally by an OT or the patient (with the use of the opposite arm)

Question 16

Active-assist range of motion (AAROM)

Answer 16

Combination of clinician and patient effort

Question 17

End-feel

Answer 17

The way the joint feels to the hands of the clinician at the end of the movement

Question 18

ROM sequence of events

Answer 18

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

Question 19

Special cases and documentation (slide 12)

Answer 19

• 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

Question 20

MMT

Answer 20

Established the need for adaptive equipment for durable medical equipment and helps us to form goals and treatments

Question 21

Considerations for Strength/MMT

Answer 21

• gender, age, occupation
• current activity level
• cognition
• psychosocial factors
  
  • fear of pain or re-injury
  • stress or anxiety
  • depression
• pain
• health/nutrition
• genetics

Question 22

MMT sequence of events

Answer 22

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