Range of Motion - Class 2 Flashcards
what is range of motion used for
basic technique
used for examination of movement
initiating movement into a program of therapeutic intervention
ROM
movement of each joint and muscle through its available arc of motion
what affects ROM
structure of the joints
integrity/flexibility of soft tissues that cross over the joints
muscle range
actual fxnal excursion of muscles
how can muscle range be measured
flexibility testing or mm length tests
fxnal excursion/extensibility of muscles
neuromuscular skill
necessary when a pt is actively involved in a mobility exercise
what does neuromuscular skill provide
control
what does neuromuscular skill require
mm strength and endurance
how is neuromuscular skill assesed
using active mobility tests
what allows for normal ROM to occur
constant interplay b/w joint ROM, muscle length and neuromuscular skill
maintaining normal ROM
important for different body segments to be moved regularly
factors that could lead to decreased ROM
systemic
joint
neurological
muscular dzs
surgical or traumatic injuries
general inactivity
fxnal ROM
ability of structures or segments of the body to move or be moved to allow the presence of ROM for fxnal activity
fxnal mobility
ability of an individual to initiate, control, or sustain active movements of the body to perform simple to complex motor skills
normal mobility requires
adequate tissue length to allow full ROM
neuromuscular skill to accomplish movement
adequate tissue length to allow full ROM –> normal mobility
passive mobility
neuromuscular skill to accomplish movement –> normal mobility
active mobility
how can ROM be used as an ongoing assessment
IE
follow up visits
ROM as a treatment
PROM
AROM
how can ROM be used as a treatment
specific exercises is form of ROM activities to improve ROM around a joint
can be performed in cardinal planes
can be performed in multiple planes
ROM in the cardinal planes
flexion-extension
ABD-ADD
ROM in multiple planes
PNF mobility
fxnal mobility
multiple planes –> PNF
D1 flexion-extension
–> flexion/ABD/ER
multiple planes –> fxnal mobility
movement through full motion to allow for normal performance of a fxnal task
when should I start using ROM exercises
as soon as possible
-if restricted PROM
-if limited/painful AAROM
-if weak/painful AROM
types of ROM
PROM
AAROM
AROM
PROM
movement of a segment w/in the unrestricted ROM that is produced by an external force
there is little or no voluntary muscle contraction
PROM –> external force
gravity
machine
another individual
another part of a person’s own body
are PROM and passive stretching the same thing?
NO
possible equipment used w/ PROM
pulleys
continuous passive motion devices
towel
bands
hands
when is PROM used
active movement may disrupt the healing process/unable to move body part d/t medial or surgical reasons
when the pt is physically or cognitively unable to move actively
active movement is too painful to perform
PROM possible pts
comatose
paralyzed
bed rest
post operatively
clinicians skill –> PROM
clinicians handling techniques can affect the pts comfort and ability to relax during treatment
proper positioning of pt and clinician allows adequate stabilization
be mindful of clinician grip and any bony prominences
at what pace should PROM be performed
smooth and steady
avoiding abrupt movements or excessive speed that may cause a protective muscle contraction
what should we monitor –> PROM
pts response
motions should be performed in –> PROM
cardinals planes
combined motions
fxnal movement patterns
goals of PROM (1)
prevention of joint contractures and soft tissue stiffness or adaptive shortening
maintenance of the normal mobile relationship b/w soft tissue layers
decrease pain
goals of PROM (2)
assist circulation
maintenance of awareness of movement
assist with healing process
enhance synovial movement for cartilage nutrition and diffusion of materials int he joint
uses of PROM during and examination
determine limitations in movement
joint stability
mm flexibility
soft tissue elasticity
other uses for PROM
during education of an active exercise program
while preparing for passive stretching
limitation of PROM
does not prevent muscle atrophy
does not increase mm strength or endurance
does not assist circulation
what helps with circulation –> PROM
active/voluntary muscle contraction
AAROM
mobility in which some muscle activation takes place
when should AAROM be used
pt is unable (weakness or pain) or not allowed to fully activate the muscle
when does AAROM occur
prior to tissue restrictions
goals of AAROM
same as PROM w/ added benefits of some active muscle contraction
specific goal of AAROM
increase confidence
decrease pain
kinesiophobia w/ active movements
begin strengthening/load tolerance
benefits of active mm contraction
circulation
stimulus of bone activity
proprioception and kinesthesia
little impact on strength
involves active participation from pts
little impact of strength –> benefits of AAROM
teaches pt how to actively fire the muscle
what is AROM also called
dynamic flexibility
how can AROM be performed
against gravity or in gravity min position
motions in cardinal planes
combination of movement patterns
fxnal activities
AROM
mobility activities performed by active muscle contraction
goals of AROM
those associated w/ PROM and AAROM
specific goals AROM
greater strength gains
muscle coordination
motor skill development for fxnal activities
help prevent DVT
great pt involvement
when should we do AROM
following any passive technique to reinforce proper movement patterns
as new mobility is achieved –> AROM
active exercise ensures the ability to use the new range effectively and reinforce “sticking” movement
limitations of AROM
only develops skill and coordination in the movement pattern used
does not provide adequate load to increase mm strength
precautions and contraindications of ROM
when motion is disruptive to the healing process
when pt response or condition is life threatening
principles and procedures of ROM
examine and evaluate the pts current level of fxn
determine what type of ROM activity is best at this stage in the pts rehab
how much motion can be applied considering the current condition
what patterns would be best suited for my pt
principles and procedures (2)
monitor pt before, during and after ROM exam and intervention
document and communicate findings and intervention that was given
re-evaluate and modify the intervention as necessary
pt prep
communicate w/ pt
free the region from restrictive clothing –> appropriately drape
position the pt comfortably while allowing for adequate alignment and stabilization
safe body mechanics
PROM application
force of movement is completely external
no movement may occur from the pt or it becomes an active exercise
motion must be carried out w/in the free ROM
–> range that is available w/o forced motion or pain
AROM application
demonstrate the required motion using PROM
ask pt to perform movement
be ready to help if necessary
when to provide assistance –> AROM
only if necessary for smooth motion
motion is performed –> AROM
within available range
