Management of ROM impairments Flashcards
1
Q
Results of reduced ROM
A
Interfere with ADL, function, physical performance, Interfere with self-care/hygiene, Pain, Pressure areas and/or Visual deformity
2
Q
Joint stiffness management
A
- Static and dynamic stretching exercise
- Manual therapy (targeting joint accessory motion)
- Some surgical options (i.e. surgical release of joint capsule)
3
Q
Non-neurally mediated cause management
A
- Static and dynamic stretching exercise
- Manual therapy (targeting muscle/tendon)
- Some surgical options (i.e. surgical release of tendon, fascia)
4
Q
Neurally mediated cause management
A
- Injectable and non-injectable pharmacological management (e.g. Botox)
- Some surgical options
- Stretching, splinting/casting (to prevent subsequent joint stiffness and non-neutrally mediated changes to muscle tendon structure)
5
Q
Pain, muscle guarding, fear management
A
- Education/reassurance
- Gentle, passive or active assisted ROM exercises
- Pain management modalities (e.g. heat/ice, TENS, etc)
- Manual therapy (targeting pain relief)
- Pharmacological management (analgesics)
6
Q
Weakness mangement
A
- Strengthening exercise
- Electrical stimulation
- Stretching, splinting/casting (to prevent subsequent joint stiffness and non-neutrally mediated changes to muscle-tendon structure)
7
Q
Swelling and scarring mangement
A
- Swelling management modalities (e.g. ice, compression)
- Manual therapy (targeting fluid movement or skin and subcutaneous tissue mobility)
- Dynamic ROM to facilitate fluid movement
- Static and dynamic stretching exercises to facilitate elongation of scar tissue
- Surgical release of scarring/ sustained positioning
8
Q
Principles of Stretching
A
- Patient generated/independent
- Frequent 5-6x/wk
- Total time /wk more important then hold time or session time
- Patient/muscle relaxed
- Use any new range actively- functional integration
- Stretch the right tissue
9
Q
Exercise Dosage
A
- ‘End range time’ is key to ROM exercise prescription
- 5min /day is common with up to 20min /day being attempted
- Higher end range time likely to be best with some better than none (based on theory)
10
Q
Exercise Types
A
- Passive or active assisted ROM reps within P1 limits
- Passive or active assisted ROM reps with overpressure
- Passive sustained holds with overpressure
Strength exercises are important but not optimal for ROM impairment
11
Q
- Passive or active assisted ROM reps within P1 limits
A
- Early post-injury/post-surgical setting i.e., high/irritable pain
- Patients accumulate end range time across a high volume of repetitions
- Passive if muscle injury. Active/active assisted otherwise preferred.
- Pain limits for patient i.e., stop at point of pain onset or increase
12
Q
Passive or active assisted ROM reps with overpressure
A
- pain is minimal, irritation risk is low
- Patients accumulate end range time across a high volume of repetitions
- Emphasis to patient on generating a strong stretch sensation (i.e., past R1) and holding reps for ~2sec
13
Q
Passive sustained holds with overpressure
A
- Pain is minimal, irritation risk is low
- Patients accumulate end range time by holding muscle/joint at the end range position
- Emphasis to patient on generating and maintaining a strong stretch sensation (i.e., past R1)
14
Q
Strength exercises
A
- Strength focussed exercises aim to stress functional limits of muscles and induce fatigue (optimal for building strength, endurance, etc)
15
Q
Planning physiotherapy treatment
A
- What is the patient’s goal of Rx?
- Identify relevant impairments, activity limitations, personal and/or environmental factors
- Prioritise problems
- Identify appropriate Rx modalities to address problems
- Negotiate Rx plan with patient - Mention session number/frequency
