ROM Flashcards
what structures are involved in ROM?
muscles, tendons, ligaments, joint capsules, articular cartilage, bones, and inflammation
ROM as an assessment
the amount of movement available b/w 2 bony levers
ROM as a treatment
therapeutic intervention of moving a joint through its available range
what is the difference b/w ROM and stretching?
ROM is only trying to keep mobility within the limits of that joint, while stretching is trying to extend those limits
extremity ROM
shoulders, elbows, forearms, wrists, hands, hips, knees, ankles, feet
axial ROM
TMJ, cervical spine, scapulae, ribs, pelvis, and thoracolumbar spine
what is osteokinematics?
movement of one bone in relation to another
a long bone moving around a joint axis
elbow flexion
osteo-bone
what is arthrokinematics?
internal joint motion needed for osteokinematic motion
arthro-joint
what are the cardinal planes of motion?
sagittal, frontal, transverse, and triplanar
what motions are allowed in the sagittal plane?
flexion/extension
what motions are allowed in the frontal plane?
adduction/abduction, lateral flexion at the spine, wrist ulnar and radail deviation
what motions are allowed in the transverse plane?
internal and external rotation, spinal rotation, forearm supination and pronation
what motions are triplanar?
foot inversion/eversion
where is ROM typically performed (what plane)
in straight or diagonal plane
what is diagonal ROM?
PNF
3 components-one from each plane
functional/combined movements
what is muscle excursion/length?
if a muscle crosses one or more joints
what is active ROM (AROM)?
internal muscular force used to move the joint
patient is doing the work with their own muscles/force
what is passive ROM (PROM)?
an external force moves the joint
muscles are not used
can be gravity, machines, or other person
what is active assisted ROM (AAROM)?
requires an external force through part of the range
some portions are supplied by internal force, while other portions are external
theraband, towel, cane, patient’s other limb, wall, etc.
what is resisted ROM?
resistence is applied to AROM
used for strengthening purposes
resistance, weights, theraband used to increase strength of ROM
resistance can be at various points of ROM, but in the middle is usually strongest
what are the beneficial effects of PROM?
stimulates tissue healing
prevents adhesions and joint stiffness
what are the beneficial effects of AROM?
PROM benefits
helps maintain health, integrity, and elasticity of tissues
increases sensory input
promotes tissue alignment
enhances local circulation with skeletal pump
what are benefits of ROM in general?
increased functional ability, pain reduction, decreased stiffness, and movement of synovial fluid in the joint
what are the indications for PROM?
when the patient’s own muscle force can’t produce safe, effective motion at the joint
when active muscle contraction would be harmful
as an assessment technique
as an intervention
what is the Codman’ pendulum exercise?
shoulder PROM or early AAROM
very small shoulder movements assisted by gravity in prone or standing
slight distraction of the joint may reduce pain
what are the PROM contraindications?
when motion will interfere with tissue healing
int he presence of extreme muscle guarding
when strong muscle guarding is accompanied by increased pain
what are PROM precautions?
when it temporarily increases patient’s pain
when it elicits undesired muscle tone
what is SINSS?
used to inform clinical judgement regarding PROM
Severity, Irritability, Nature, Stage, Stability
PROM dosage?
generally 5-12 reps
about 5-10 sec/rep
generally 3-5 times/week
in neuro condition reps tend to be lower with sustained hold of 20-60 seconds at end of range to avoid guarding
what are the AROM contraindications?
PROM contraindications
pain throughout motion/persisting after the activity
development of dysfunctional muscle tone
cardiac distress
what are the AROM precautions?
PROM precautions
generates undesired movements
physiological demands increase patient risk (patient is working way harder than they should have to)
AROM dosage?
determined by patient responses (look for fatigue, pain, changes in quality/accuracy of movement, and changes in vital signs)
body mechanics
have the patient close to you
stand w/ wide BOS facing the direction of movement
position yourself to allow full ROM
you want to move towards your front leg
ROM procedure
stabilize the proximal joint
use lumbrical grip
CCDD
AMAP/ANAP (as much as possible, as naturally as possible)
minimize position changes necessary
systematic approach
- limit position changes
- supportive position/free from resitrictions
- assess the pre-activity state
- position yourself close to extremity height of source, and ability to shift your weight
- engage patient-ask patient to stay focused (EXPLAIN)
- start in supine/sitting
- head to toe
PROM procedure
move through range slowly and with brief hold at the end range
light overpressure at end of range as appropriate
AROM procedure
instruct patient in movement
watch for form and quality
monitor patient’s response to activity (facials, verbal, and vitals)
what are some observations and findings from ROM
quantity of movement
quality of movement
patterns of movement
endfeels
pain
muscle tone, spasms, guarding
audible sounds
what is a soft endfeel?
gradual onset typically from soft tissue (muscle and fat)
elbow flexion
what is a firm endfeel?
tension of tendon/ligament
ankle dorsiflexion
what is a hard endfeel?
bone to bone
painless when normal
elbow extension
what is an empty endfeel?
range is stopped bc of pain and is always abnormal
what is an abnormal endfeel?
one that is inappropriate for that joint
what are the 3 patterns of movement?
joint capsular patterns
noncapsular patterns
poorly coordinated movements
what is self ROM?
patients do the ROM on their own with use of other extremities or equipment such as towels, pulleys, or a cane to assist in PROM or AROM
