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Quiz 2 Flashcards

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1
Q

ROM Theory and Practice

A

ROM amount of motion that is available at any given joint

AROM is amt of jt motion attained by voluntary jt motion

PROM is amount of jt motion attained by examiner w/o assistance from client

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2
Q

Why Examine ROM

A

Provides info regarding: muscle strength, coordination, willingness to move, ability to follow directions, level of consciousness, attention span, joint ROM,

May be limited to: muscle weakness, pain, edema, restricted jt mobility

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3
Q

Why Assess PROM

A

Provides info about - integrity of articular surfaces, extensibility of joint capsule, ligaments, muscles

Additional pts - PROM is usually slightly greater than AROM, comparison of PROM/AROM is useful esp w/ hands to determine soft tissue vs. bony vs. jt pathology

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4
Q

When Used w/ Other Info, ROM Data can Provide a Basis For…

A

Determining presence/absence of dysfunction

Establishing diagnosis

Developing treatment goals

Evaluating progress

Modifying treatment

Research effectiveness of therapy

Determining orthoses and/or adaptive equipment

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5
Q

General Instructions

A

Intro, explanation, and demonstration

Place subject in recommended test position

Have client perform AROM and observe for substitutions/quality of motion

Expose jt

Stabilize proximal jt segment if necessary and move limb through its PROM - note crepitus, examine and feel

Palpate and identify landmarks

Align goniometer w/ its axis on jt axis

Stationary arm is aligned parallel to longitudinal axis of proximal limb segment

Moving arm is aligned parallel to the longitudinal axis of distal limb segment

Read and record starting position. Remove goniometer

Stabilize proximal component

Move distal component through full AROM/PROM

Replace/realign goniometer. Palpate anatomical landmarks if necessary

Record AROM/PROM

Compared ROM to opposite side

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6
Q

Recording ROM

A

Include start and end position to define jt range

Motion that begins at 0 and ends at 150 - 0-150

Motion that begins at 20 and ends at 120 is recorded as 20-120 (some may record -20 ext)

If hyperext occurs, - 20-0-150

If jt doesn’t need to be measured w/ device, ROM may be recorded as full, WFLs, WNLs

Every space on ROM form should have notation

Use NT if not tested

Usually, PROM is recorded before AROM (even though active range is examined first) - knee flex = 0-120/10-95

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7
Q

Reliability

A

Depends on jt - Intertester always lower than intratester reliability, hinge jts (knee/elbow) more reliable than multiaxis jts, such as shoulder/ankle

Depends on motion - shoulder flex/abd > ext, ankle DF/PF > inversion/eversion

Depends on test position - SLR changes w/ opp. leg position, shoulder range in sitting vs. supine

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8
Q

To Improve Reliability

A

Standardize positions

Stabilize proximal body parts

Use bony landmarks to align goniometer

Use same examiner (intratester)

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9
Q

Factors Affecting ROM

A

Pathological conditions such as pain and inflammation

Fear

Age - infants/young children vs. adults vs. older adults

Gender

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10
Q

Precautions for ROM

A

Infection or inflammatory process in jt

Meds for muscle rxn and pain

Osteoporosis (esp. PROM)

Jt hypermobility

Pain

Hemophilia

Jt in region of hematoma

Immediately after an injury where disruption of soft tissue, tendon, muscle, ligament is suspected

Cervical pain

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11
Q

Probable Contraindications for ROM

A

Region of dislocation or unhealed fracture

Immediately following surgical procedures to tendon, ligament, muscle, jt capsule

Myositis ossificans

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12
Q

Normal/Physiological End Feels

A

Soft - soft tissue approx. (knee flex, elbow flex)

Firm - muscular stretch, capsular stretch, ligamentous stretch (SLR, MCP ext, forearm supination)

Hard - bone contacting bone (elbow ext)

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13
Q

Abnormal/Pathological End Feels

A

Soft: occurs sooner/later in range than usual or in jt that normally has firm/hard end feel - feels boggy (swelling - jt effusion)

Firm: occurs sooner/later in range than usual or in jt that normally has soft/hard end feel (capsule tightness, ligamentous shortening)

Hard: occurs sooner or later in range than usual or in joint that normally has soft or firm end feel. Bony grating or bony block is felt (fracture, OA, osteophytes)

Empty: no real end feel b/c pain prevents reaching end of range. No resistance is felt except for muscle guard or spasm (acute bursitis, neoplasm, fracture, hysteria)

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14
Q

Capsular vs. Non-Capsular Patterns

A

Analyze pattern of jt range limitation

Particular capsular patterns exist for each jt to indicate jt capsule involvement (pattern specific to anatomy of specific capsule - causes include arthritis, prolonged immobilization, acute trauma w/ effusion)

When limitations don’t follow capsular patterns, then limitation can be considered non-capsular pattern. May be due to ligamentous adhesions, internal derangement (fragments in jts), extra-articular limitation (contractures)

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15
Q

Capsular Pattern Differences - Hip

A

Need to go in specific ordered

Marked restriction in IR

Limitations in flex and abd

May be slight in ext

No limitations in ER or ADD

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16
Q

Capsular Pattern Differences - Shoulder

A

Marked restriction in ER

Limitation in ABD

May be slight limitation in IR

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17
Q

Muscle Length Testing

A

To determine if range of muscle length is normal, excessive, limited

Muscles w/ limited length are usually strong, promoting lengthening of opposing muscles

Muscles w/ excessive length are usually weak, allowing for adaptive shortening of opposing muscle

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18
Q

Muscle Imbalance

A

Can lead to: injury, faulty posture, abnormal mvt patterns

Pain on shortened/lengthened side

Dominant vs. non-dominant

Left side greater than right

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19
Q

Quality vs. Quantity

A

Assess quality of mvt - substitutions may be occurring

Total range may be WNLs but disproportionate amt of mobility may be arising from one structure, thus leading to abnormal stress (gastroc, hamstrings)

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20
Q

Range of Jt Measurement

A

of degrees in motion present in jt

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21
Q

Range of Muscle Length

A

of degrees of motion in muscle

May be measured w/ tape measure

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22
Q

One Joint Muscles

A

Muscle length = jt range

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23
Q

Two Joint Muscles

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A

Muscle length range < jt range

May be elongated over 1 jt but not over both

Ex: iliopsoas and quads, hamstrings in pts w/ back pain

24
Q

Hip Flexion ROM

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A

Supine/side

Axis - greater trochanter

Stationary arm - lateral midline of pelvis

Moving arm - lateral midline of femur toward lateral epicondyle

Substitution - posterior pelvic tilt

Normal PROM - 0-100/120

End feel - soft

25
Hip Extension ROM
Prone/side Axis - greater trochanter Stationary arm - lateral midline of pelvis Moving arm - lateral midline of femur toward lateral epicondyle Substitution - anterior pelvic tilt Normal PROM - 0-30 End feel - firm
26
Hip ABD/ADD ROM
Supine Axis - ASIS Stationary arm - line connecting bilateral ASIS Moving arm - anterior midline of femur toward midline of patella Substitution - lateral pelvic tilt Normal PROM - abd - 0-40/45 Normal PROM - add - 0-20/30 End feel - firm
27
Hip IR/ER
Sitting (supine, hip flex/knee flexed at 90 degrees) Axis - midpoint of patella Stationary arm - perpendicular to floor Moving arm - anterior midline of tibia/along tibial crest Substitution - trunk lateral flex or lifting thigh Normal PROM - 0-45 End feel - both firm
28
Knee Flex/Ext ROM
Supine (side or prone - watch rec fem length) Axis - lateral epicondyle Stationary arm - lateral midline of femur toward greater trochanter Moving arm - lateral midline of fibula, in line w/ fibular head and lat malleolus Flex - 0-135/150 - soft Ext - 0-10 - firm
29
Coordination
Ability to execute smooth, accurate, controlled mvts Sense from functional exam - look for unsteadiness, extraneous mvts Deficits are often related to CNS disorders - cerebellum, basal ganglia, dorsal (posterior column)
30
Ataxia
Inability to make smooth, accurate coordinated mvts Gait, truncal, appendicular
31
Dysmetria
Disturbance in distance or ROM
32
Athetosis
Involuntary, slow, twisting, writhing, continuous mvts esp seen in distal parts of extremities and perioral area Smooth, dance-like
33
Chorea
Involuntary, abrupt, rapid, brief, unsustained, arhythmical, random mvts Most often at proximal jts Worse at rest, unchanged or improved w/ mvt Jerky, worse when moving Once they start moving, it will reduce or go away
34
Tremor
Intention - cerebellar diseases - as soon as they move, tremor begins Resting - Parkinson's - disappears or slows w/ mvt, happens when they are moving Postural - seen when body part is held against gravity
35
Tics
Simple or complex Repetitive, stereotyped, involuntary mvts Occur randomly Usually don't interfere w/ function but may interrupt it
36
Akinesia
W/o mvt No connection w/ body Wanted to do mvt, but just couldn't do it Muscles innervated, but not paralyzed
37
Bradykinesia
Slowness of mvt
38
Dysdiadokinesis
Inability to perform rapidly alternating mvts
39
Coordination Examination
Non-equilibrium (pt doesn't need to be balanced) vs. equilibrium tests Gross vs. fine motor tests 5 main areas of assessment - alternate/reciprocal mvt, mvt synergy/composition, mvt accuracy, fixation/limb holding, equilibrium/posture holding
40
Non-Equilibrium Tests
``` Finger to nose Finger to examiner’s finger Finger to finger Alternate nose to examiner’s finger Finger opposition Mass grasp Pronation/supination Rebound test Tapping (foot, hand) Pointing and past pointing Alternate heel to knee, heel to toe Toe to examiner’s finger Heel on shin Drawing circle Fixation/holding ```
41
Balance
Defined as stability produced on each side of vertical axis: center of mass is maintained over base of support Achieved via multiple CNS inputs/outputs Assessed using standardized tools or observation of functional activities (BERG, Tinetti) Static - standing in one place Dynamic - gait
42
Righting Reactions
Serve to maintain body alignment and/or orientation of environment Tilt certain way, whole body goes Ex: baby and neck
43
Protective Reactions
When COM moves too far beyond BOS Quickly move to get back to BOS Ex: falling over and hands out
44
Equilibrium Reactions
Attempt to maintain COM over BOS Tilting vs. postural fixation
45
Static Equilibrium Tests
``` Standing -Eyes open (EO) -Eyes closed (EC) Standing with feet together Standing with one foot directly in front of the other (tandem) EO & EC Unilateral standing Standing, trunk flexion to neutral Standing lateral trunk flexion Alter arm position in standing ```
46
Dynamic Equilibrium Tests
``` March in place Walking, foot directly in front (tandem) Walking a line Walk to sides, backwards, & cross stepping Alter walking speed Stop & start abruptly Walk & pivot Walk in circle Walk on heels or toes Walk with head movements Stair climbing Agility activities ```
47
Recording Results
Note ``` Number of extremities involved Distribution (proximal/distal) Situations that alter coordination/balance Amount of time to perform Level of safety History of falls ```
48
Community Balance and Mobility Scale
Higher level patients 6 levels of measurement Higher scores indicate better balance and mobility Includes some equilibrium tests (unilateral stance, tandem walking, pivot) Lateral scooting, hopping, walking in crouch, running with controlled stop, forward to backward walking, stairs
49
Knee Capsular Patten
Gross limitation of flex, slight limitation of ext
50
Reflexes
Superficial cutaneous reflexes - plantar (Babinski's), Chaddock's (Babinski's w/ LE flex), abdominal Primitive reflexes - flexor withdrawal, crossed ext
51
Abdominal Reflexes
Begin at T7 and test each dermatone down to T12 Normal response is contraction of abdominals w/ umbilical deviation toward stimulus Draw toward umbilicus - skin will twitch
52
Plantar or Babinski Reflex
Pressure is firm but not painful Normal response: flex and adduction of toes, can be accompanied by hip/knee flex Abnormal response (called Babinski sign): ext of great toe along w/ abduction or fanning of lateral 4 toes
53
Developmental Reflexes
Re-appear in CNS insult Tonic labyrinthine (vestibular system - position in space) Tonic Neck - asymmetrical, symmetrical (depends on neck orientation)
54
Tonic Labyrinthine (Prone)
Increase in flexor tone Change in tone - change in position in space Normal (negative) response - no increase in flexor tone Abnormal (positive) response - unable to extend head, trunk, arms, legs, retract shoulders
55
Tonic Labyrinthine (Supine)
Increase in extensor tone Normal (negative) response - no increase in extensor tone Abnormal (positive) response - unable to flex head, trunk, arms, legs
56
ATNR (Asymmetrical)
Normal response - no run to head rotation Abnormal response - ext on face side of increase in extensor tone, flex on skull side or increase in flexor tone
57
STNR (Symmetrical)
Normal response - no rxn to neck ext/flex Abnormal (positive) - Neck extends - arms extend or increase in ext tone, legs flex or increase flex tone - Neck flexes - arms flex or increase in flex tone, legs extend or increase in ext tone

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