PPT ROM and MMT Flashcards
Biomechanical Frame of Reference (BFOR)
- Became prevalent in 1940s
- Addresses musculoskeletal capacity and problems which underlie movement in daily occupational performance
- -ROM, Strength, Endurance
BFOR is concerned with…
- musculoskeletal capacity
- peripheral nerve involvement/dysfunction
- cardiopulmonary system dysfunction
BFOR is best suited for clients with ___
Isolated/selective motor control aka an intact nervous central nervous system
Assumptions of the BFOR
- Occupational performance requires the ability to move the limbs and the endurance to sustain activity/movement until a goal is accomplished.
- Purposeful activities can be used to treat loss of ROM, strength, and endurance
- This is a bottom-up approach
Limitations of BFOR
- Does not provide a lens for understanding “occupational” problems that do not result from musculoskeletal problems…cannot be used in isolation.
- Sometimes resolving/remediating these musculoskeletal impairments may not result in changes in occupation.
Indicators for Assessment Selection (in a top-down assessment)
- In thinking of TOP-DOWN ASSESSMENT… you now have completed your occupational performance assessment (ADL), and NOW, need to decide what other assessments are needed…
- After your observations during the interview/ADL assessments you can consider:
Client’s goals: ( i.e., fine coordination, difficulty with buttoning pants, tying shoes, etc.)
Observations… What might be interfering with ADL performance? What are you noticing?
Diagnosis: Will indicate suspected problems (I.e., Guillain-Barre–strength; SCI–strength and sensation); but still “screen” for others.
Setting: your involvement/role, insurance coverage, client’s course…
Definition of ROM
The arc of motion through which a joint moves
Passive ROM
Movement by an external force
Active ROM
Movement by the muscles surrounding a joint
Functional ROM
Amount of joint range necessary to perform essential ADLs and IADLs
PROM vs. AROM
Passive tested FIRST, flexibility, looks @ joint structure itself. Active may be influenced by tendon integrity (hands), may supplement MMT for more specific muscle grading (to document small changes)…
With ROM limitations – is it muscular or tendon related? What’s causing the difference between PROM & AROM? Is it a problem of muscle weakness or tendon integrity in the hands?
ROM: Rationale for Assessment in OT
- Determine a limitation that is interfering with occupation
- Identify specific areas needing intervention:
ROM: which joint is causing functional problem?
Strength: a muscle imbalance leading to deformity?
Ability to benefit from/use assistive devices?
Document changes/effectiveness of intervention – “If you treat it…measure it”
ROM: “Normal” Determinants
- Structure of the joint (i.e. mechanics – is it a ball and socket joint, etc.)
- Stretch of joint capsule and ligaments
- Muscle tone and tendons (bulkiness)
- Dominance (more flexible in dominant hand)
- Temperature/Climate (warmer temperature = 2 degrees more flexible)
- Circadian Rhythms (rhythms to patterns of stiffness and tone, especially with arthritis)
ROM Limitations
- Skin contracture due to adhesions or scar tissue
- Soft tissue contractures such as tendon, muscle or ligament shortening
- Diseases of the joint, e.g arthritis
- Fractures – bony obstruction or destruction
- Burns
- Hand trauma
- Displacement of fibrocartilage or presence of other foreign bodies in the joint, e.g. tumor
- Tumors
- LMN (SCI, Guillain-Barre, myasthenia gravis, polio, PNI
- UMN (TBI, CVA
- Iatrogenic disorders (physican-induced such as tardive dyskinesia)
All of these can cause secondary effects (spasticity, muscle weakness, pain, edema, and immobility), which limit ROM
ROM – end feel
End feel is the feeling that is elicited when the joint is brought through the entire available ROM.
It is normally hard, soft, or firm:
- Hard: bone on bone (olecranon process/fossa) with elbow extension
- Soft: elbow flexion – soft tissue opposition of biceps/supinator and radial wrist flexors
- Firm or springy sensation that has some give, as in shoulder flexion
End-feel is abnormal when movement is stopped by structures other than normal anatomy
ROM: Measurement Procedures
- Assess less involved side first.
- Assess Proximal to Distal
- Ask the client to move and observe (Perform Functional AROM Scan)
- Therapist passively moves part to its limit of motion (if limitations observed during functional AROM scan)
Stabilize proximally - If no passive limitations: Problem is AROM = muscle strength. (May measure AROM)
ROM: Documentation
The “Neutral Zero Method” or “180-degree system”:
- All joint motions begin at 0 degree and increase toward 180 degrees.
- Joints in which ending position of one joint motion is starting position of opposite motion (Example: elbow flexion/extension) get one set of measurements
- Joints in which starting position of both joint motions is the same = neutral/zero (Example: wrist flexion/extension) get two sets of measurements
Reporting ROM
- After ROM assessment has been completed and evaluation form is filled out, take note of any limitations which are “significant” or which interfere with function or are producing deformity/causing pain
- If several joint ranges have similar measurements, group them together, ie: Shoulder and elbow present with normal ROM; wrist flexion is 0-45 after surgery
- Address ROM and relate to function: “Due to severe flexion contractures of the MP (80-90 degrees) and PIP (70-110) and DIP (20-90) joints, the client is unable to extend fingers to grasp objects that are larger than two inches in diameter.”
- Using the words: slight, moderate, severe
Slight: limitations are present, but client is able to function fairly well
Moderate: limitations are present, interfere with function but client can overcome with use of AE
Severe: limitations severely limit function, contractures present, difficult for client to function even with AE (lacks half or more of normal range usually available at joint).
Definition of Strength
Strength is defined as the tension-producing capacity of a muscle/group of muscles; “demonstrating a degree of muscle power when movement is resisted, as with objects or gravity”