Quiz 2 Flashcards
ROM Theory and Practice
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
Why Examine ROM
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
Why Assess PROM
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
When Used w/ Other Info, ROM Data can Provide a Basis For…
Determining presence/absence of dysfunction
Establishing diagnosis
Developing treatment goals
Evaluating progress
Modifying treatment
Research effectiveness of therapy
Determining orthoses and/or adaptive equipment
General Instructions
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
Recording ROM
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
Reliability
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
To Improve Reliability
Standardize positions
Stabilize proximal body parts
Use bony landmarks to align goniometer
Use same examiner (intratester)
Factors Affecting ROM
Pathological conditions such as pain and inflammation
Fear
Age - infants/young children vs. adults vs. older adults
Gender
Precautions for ROM
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
Probable Contraindications for ROM
Region of dislocation or unhealed fracture
Immediately following surgical procedures to tendon, ligament, muscle, jt capsule
Myositis ossificans
Normal/Physiological End Feels
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)
Abnormal/Pathological End Feels
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)
Capsular vs. Non-Capsular Patterns
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)
Capsular Pattern Differences - Hip
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
Capsular Pattern Differences - Shoulder
Marked restriction in ER
Limitation in ABD
May be slight limitation in IR
Muscle Length Testing
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
Muscle Imbalance
Can lead to: injury, faulty posture, abnormal mvt patterns
Pain on shortened/lengthened side
Dominant vs. non-dominant
Left side greater than right
Quality vs. Quantity
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)
Range of Jt Measurement
of degrees in motion present in jt
Range of Muscle Length
of degrees of motion in muscle
May be measured w/ tape measure
One Joint Muscles
Muscle length = jt range
Two Joint Muscles
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
Hip Flexion ROM
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
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
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
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
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
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)
Ataxia
Inability to make smooth, accurate coordinated mvts
Gait, truncal, appendicular
Dysmetria
Disturbance in distance or ROM
Athetosis
Involuntary, slow, twisting, writhing, continuous mvts esp seen in distal parts of extremities and perioral area
Smooth, dance-like
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
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
Tics
Simple or complex
Repetitive, stereotyped, involuntary mvts
Occur randomly
Usually don’t interfere w/ function but may interrupt it
Akinesia
W/o mvt
No connection w/ body
Wanted to do mvt, but just couldn’t do it
Muscles innervated, but not paralyzed
Bradykinesia
Slowness of mvt
Dysdiadokinesis
Inability to perform rapidly alternating mvts
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
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
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
Righting Reactions
Serve to maintain body alignment and/or orientation of environment
Tilt certain way, whole body goes
Ex: baby and neck
Protective Reactions
When COM moves too far beyond BOS
Quickly move to get back to BOS
Ex: falling over and hands out
Equilibrium Reactions
Attempt to maintain COM over BOS
Tilting vs. postural fixation
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
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
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
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
Knee Capsular Patten
Gross limitation of flex, slight limitation of ext
Reflexes
Superficial cutaneous reflexes - plantar (Babinski’s), Chaddock’s (Babinski’s w/ LE flex), abdominal
Primitive reflexes - flexor withdrawal, crossed ext
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
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
Developmental Reflexes
Re-appear in CNS insult
Tonic labyrinthine (vestibular system - position in space)
Tonic Neck - asymmetrical, symmetrical (depends on neck orientation)
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
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
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
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
