Kisner Ch 3- ROM Flashcards
What is functional excursion
the distance a muscle is capable of shortening after it has been elongated to its maximum
Types of ROM?
Passive ROM
Active ROM
Active Assisted
Indications for PROM?
Acute, inflamed tissue, passive motion is beneficial
When are pt. is not able to or not supposed to move actively
Goals of PROM
Maintain joint and connective tissue mobility
Minimize the effects of the formation of contractures
Maintain mechanical elasticity of muscle
Assist circulation & vascular dynamics
Enhance synovial movement for cartilage nutrition & diffusion of materials in the joint
Decrease or inhibit pain
Assist w/ the healing process after injury
Help maintain the patient’s awareness
What are limitations of PROM?
Passive motion does not:
Prevent muscle atrophy
Increase strength or endurance
Assist in circulation to the extent that active, voluntary muscle contraction does
Indications for AROM & AAROM
When the pt. is able to contract the muscles actively
Use AAROM when the patient’s musculature is too weak or unable to move joint through the desired range
Goals of AROM & AAROM
Maintain physiological elasticity & contractility of muscles in use
Provide sensory feedback from the contracting muscles
Provide a stimulus for bone & joint tissue integrity
Increase circulation & prevent thrombus formation
Develop coordination and motor skills for functional activities
Precautions & Contraindications to ROM exercises
ROM should not be done when motion is disruptive to the healing process
Use carefully controlled motions with in pain free range
Too much wrong motion will increase pain & inflammation
ROM should not be done when pt. response or the condition is life threatening
PROM may be carefully initiated to major joints
AROM to ankles & feet to minimize venous stasis & thrombus formation
What types of activities can be done after myocardial infarction, coronary artery bypass surgery or percutaneous transluminal coronary angioplasty?
AROM of the UE & limited walking
Principles & Procedures for applying ROM techniques
Evaluate pt. impairments & level of function
Determine ability of pt. to participate in ROM activity and amount of motion that can be safely
Decide what patterns best meet the goals; ADLs, muscle range elongation, anatomical planes, diagonal motions
Monitor pt. response during and after intervention
Document
Re-evaluate and modify intervention, if necessary
How do you prepare the patient for ROM activities?
Describe the plan and goals w/ patient
Free the region from restrictive clothing, linen, splints, & dressings
Position pt. in comfortable position w/ proper body alignment & stabilization
PT position to use proper body mechanics
Application of PROM
PT moves through ROM
No active resistance or assistance is given by the pt’s muscles
Motion carried out in the free ROM- the range available w/o forced motion or pain
Application of AROM
Demonstrate to pt desired motion using PROM, then ask pt to perform motion
PT provides assistance only as needed for smooth motion
Motion performed within available ROM
What are forms of self-assisted ROM?
Wand, finger ladder, wall climbing, ball rolling, pulleys, skateboard/ powder board, reciprocal exercise devices
What is continuous passive motion (CPM)?
passive motion performed by a mechanical device that moves a joint slowly and continuously through a controlled ROM
Benefits of CPM
Prevents development of adhesions & contractures thus joint stiffness
Provides a stimulating effect on the healing of tendons and ligaments
Enhances healing of incisions over the moving joint
Increases synovial fluid lubrication of the joint and thus increase the rate of intra-articular cartilage healing & regeneration
Prevents degrading effects of immobilization
Provides a quicker return of ROM
Decreases postoperative pain
Static stretching
Place muscle in elongated position
Pt. should feel mild tension (NOT DISCOMFORT)
Hold for 30 sec/ 3-5 times
Ballistic stretching
Get into elongated position of muscle & bounce into a more elongated position
repeat 10 to 15 times
Why is ballistic stretching dangerous?
Ballistic stretching may activate the muscle spindle that would in turn cause the muscle to actually resist the stretch
May increase risk of injury or cause microscopic trauma to muscle
In what situations would you NEVER use ballistic stretching?
Injured muscle or tendon
Sedentary, unconditioned, elderly persons, or persons w/ altered cognitive or sensory systems
What is an alternate technique for ballistic stretching?
Static stretching that gradually works up to faster oscillations at end range
Who is ballistic stretching best used for?
In athletes that require rapid end range responses that are ballistic in nature
What was PNF designed to influence? How?
Muscle performance
By providing input to the kinesthetic and proprioceptive sensors
What can PNF be used for?
ROM, strengthening, or stretching
Describe the PNF technique?
Brief contraction (isometric or concentric) before a brief static stretch Called contract- relax
What is PNF autogenic inhibition?
By fatiguing the AGONIST you will get relaxation in the agonist muscle, making it easier to stretch
What is the autogenic inhibition technique?
Passively move joint to elongated position
ISOMETRIC contraction of AGONIST in elongated position for 10 sec
Followed by instruction to relax
Passively move into a MORE elongated position & hold for 10 to 15 sec
Repeat 3-5 times
What is PNF reciprocal inhibition?
Fatiguing the ANTAGONIST will cause it to relax so that the agonist can contract and produce motion
What is the reciprocal inhibition technique?
Passively move joint to elongated position
CONCENTRIC contraction of ANTAGONIST in elongated position for 10 sec
Followed by instruction to relax
Passively move into a static stretch & hold for 10 to 15 sec
Repeat 3-5 times
What is Combination PNF?
Combines both Autogenic & Reciprocal techniques
Combination PNF technique
Alternates using Autogenic for 1 repetition then Reciprocal
Repeated for 3 to 5 times
Age related considerations
Geriatrics decreased soft tissue flexibility
Stretching weakness phenomena- aging and disuse of muscle alters performance
Recommendations: functional flexibility training or dynamic flexibility + AROM to end ROM and static stretching
Pediatrics developing muscles are maximally flexible
Use static and PNF stretching techniques over ballistics
