passive ROM Flashcards
why use passive ROM in assessment
diagnoses ROM
ROM
Presence of symptoms e.g. differentiates contractile vs non contractile dysfunction
Provides information re: end feel
Allows therapist to feel resistance to movement e.g. neurological muscle stiffness
(spasticity or rigidity), patient apprehension to movement, etc.
why use PROM as a treatment
maintain ROM where a patient is unable to do this themselves e.g. ITU
reduce spasticity in patients with neurological dysfunction
re-educate movement patterns
what are contraindications for PROM
where AROM or PROm could disrupt healing
e.g.
interrupting healing process after injury or surgery
suspected fracture/dislocation/subluxation
suspected myositis ossifications or ectopic ossifications
What are cautions for PROM
pain
inflammation
medication for pain/muscle relaxants
osteoporosis
hypermobility
haemophilia
in the region of a haematoma
suspected bony ankylosis
soft tissue disruption e.g. sprain
recently healed fracture
after prolonged immobilisation
key checks concepts for PROM
- Check patient is in a comfortable position before you begin
- Check you are in an appropriate position before you begin
- Ask about any pain at rest
- Go from inner to outer range of movement
- Isolate movement if possible
- Speed should be slow
- Observe patient, checking for signs of discomfort/pain.
- Ask patient for feedback
- Watch for compensatory movements
- Note ROM and end feel
- Return limb to start position
what are possible end feels and what does this mean
hard - bony e.g. passive elbow ext
soft - soft tissue apposition e.g. passive knee flexion
firm / elastic - soft tissue stretch e.g. passive ankle DF
how is hip flexion assessed
Start position: Supine. Hip/knee in neutral. Opposite leg can be
flexed/extended (be consistent with this).
* Stabilisation: Therapist stabilises ipsilateral pelvis at ASIS and iliac crest to
maintain pelvis at neutral.
* Therapist distal hand placement: Under posterior femur.
* End feel: soft or firm
what is an alternate handling for hip flexion
Proximal hand under distal femur, distal hand under heel of foot.
* Once past 90, proximal hand on proximal tibia to increase hip flexion
how is hip abduction/ adduction measured
Start position: Supine, pelvis level.
* Stabilisation: Therapist stabilises ipsilateral pelvis (alternative
positioning with opp. leg on a stool)
* Therapist distal hand placement: Medial aspect of distal femur
* End feel: firm
what is an alternate handling for hip abduction / adduction
proximal hand under distal femur, distal hand supporting patient’s heel
how is hip medial / lateral rotation assessed?
Start position: Supine, hip & knee at 90°
* Stabilisation: Pelvis is stabilised through body position. Therapist
maintains position of femur with proximal hand/forearm.
* Therapist distal hand placement: Distal tibia/fibula
* End feels: Firm for both MR/LR
what is an alternative handling for knee flexion /extension
as per hip flexion, with emphasis on distal hand on
tibia/fibula producing maximal knee flexion
what is an alternative handling for hip medial / lateral rotation
Proximal hand stabilises femur
position while distal hand supports foot. Distal hand moves creating
MR/LR at hip.
how is knee flexion / extension assessed?
Start position: Supine. Towel under distal femur for extension
* Stabilisation: Therapist stabilises femur for extension
* Distal hand placement: Distal tibia/fibula
* End feels: flexion: firm/soft Extension: firm
how is ankle DF assessed
Start position: Supine. Roll under knee producing knee flexion of 20-
30°
* Stabilisation: therapist stabilises tibia/fibula
* Therapist distal hand placement: Posterior aspect of calcaneus and
places forearm against the plantar aspect of the forefoot.
* End feel: DF: firm/hard
How is ankle plantar flexion assessed?
Start position: Supine. Roll under knee producing 20-30° knee flexion.
* Stabilisation: Therapist stabilises tibia/fibula
* Therapist distal hand placement: Dorsum of foot with radial border of
the index finger over anterior aspect of talus and calcaneus.
* End feel: Firm/hard
how is shoulder elevation through flexion assessed
Start position: crook lying (remember to move pillow over). Palm
faces trunk.
* Stabilisation: weight of the trunk. Therapist can stabilise the thorax
* Therapist distal hand placement: Distal humerus
* End position: Slight traction applied to move humerus anteriorly and
upward to limit of flexion. Elbow is maintained in extension to prevent restriction in shoulder flexion due to passive insufficency of triceps
* End feel: firm
how is shoulder elevation through abduction assessed
Humerus needs to be laterally rotated (prior to testing check lateral
rotation ROM)
* Start position: Sitting/supine. GH joint in lateral rotation. Ensure
trunk extension.
* Stabilisation: Therapist stabilises trunk
* Therapist distal hand placement: distal humerus
* End feel: firm
how is GH joint lateral rotation assessed
Start position: Supine. Shoulder at 90° of abduction, elbow at 90°, forearm
in mid-position. Towel under humerus. (note – this start position is contra-
indicated if pt has a hx of anterior dislocation of the GH joint)
* Stabilisation: weight of the trunk. Therapist can stabilise scapula
* Therapist distal hand placement: Distal radius and ulna
* End position: Dorsum of hand towards the floor until end of ROM lateral
rotation (i.e. when scapula movt occurs)
* End feel: firm
what is an alternative position for GH lateral rotation and why might it be needed
sitting if 90 degree abdn not available
how is elbow flexion / extension assessed
Start position: Supine/sitting. Anatomical position – elbow in
extension. Towel under distal end of humerus…why? To
accommodate ROM (of extension/hyperextension)
* Stabilisation: Therapist stabilises humerus
* Therapist distal hand placement: Distal radius and ulna
* End feels: flexion- soft/hard/firm. Extension: hard/firm
how is wrist flexion and extension assessed
Start position: Sitting. Elbow flexed. Forearm resting in pronation,
wrist in neutral. Hand over end of table/pillow
* Stabilisation: Therapist stabilises forearm
* Distal hand placement: Therapist holds metacarpals
* Note: during movt fingers should stay relaxed
* End feels: Wrist flexion: firm; wrist extension: firm/hard
