ROM EXERCISES Flashcards
basic technique used for examining movement and for initiating movement into a program of therapeutic interventions
Range of motion
give 3 structures that affect ROM
- joint synovial fluid
- joint capsules
- muscles
- ligaments
- fascia
- vessels
- nerves
described as the distance that a muscle is capable of shortening after it has been elongated to its maximum
functional excursion
factors that can lead to decrease in ROM
- systemic/joint/neurologic/muscular disease
- surgical/traumatic insults
- inactivity/immobilization
General use of ROM exercise
to maintain joint and ST integrity/mobility and to minimize loss of tissue flexibility & contracture formation
T/F: ROM exercises can increase a patients current ROM
false
movement of a segment within the unrestricted ROM that is produced entirely by an external force
PROM/Passive ROM
indications for PROM exercise (give at least 3)
- region where there is acute inflamed tissue
- active motion will be detrimental to the healing process
- 2-6 days post surgery (inflammation usually lasts this long)
- when a patient is not able/supposed to move a segment actively
- post-surgical repair of contractile tissues when active motion would compromise the repaired muscle
Goals for PROM exercises
- decrease complications of immobilization
- maintain joint and connective tissue mobility
- minimize effects of the formation of contractures
- maintain mechanical elasticity of muscle
- assist in circulation and vascular dynamics
- enhance synovial movement for cartilage nutrition and diffusion of materials in joint
- decrease or inhibit pain
- assist with the healing process after injury/surgery
- help maintain patient’s awareness of movement
When is it difficult to perform PROM
when muscle is innervated and pt is conscious
What can’t PROM do?
- prevent atrophy
- inc strength/endurance
- assist circulation to the extent that active, voluntary muscle contraction does
This can act as a way of gaining information on the patient’s mm strength, movement coordination, and functional ability
AROM
When to use AROM?
- when pt is able to actively contract & move a segment c or s assist
- improve cardiovascular & respiratory responses if done repetitively
- can be used on regions above & below an immobilized segment for a period of time
- relieve stress from sustained postures
- aerobic conditioning programs
Limitations of AROM
- does not maintain/increase strength
- does not develop skill/coordination, except in the movement patterns used
Type of ROM exercise wherein an external force is used to provide assistance to complete ROM
active-assisted range of motion / AAROM
when do we use AAROM?
- when pt has weak musculature and unable to move the joint through the desired range against gravity
- little to less capacity of mm to move in full range
- provide assistance to the muscles in a carefully controlled manner
- progressed to AROM then resistance exercises
goals for both AROM & AAROM
- maintain physiologic elasticity & contractility
- provide sensory feedback
- provide stimulus for bone & soft tissue integrity
- inc circulation & prevent thrombus formation
- develops coordination & motor skills
Give at least 3 precautions and contraindications to ROM exercises
- signs of too much/wrong motion include inc pain & inflammation
- when pt response or condition is life-threatening (PROM on major joints c AROM to ankle & foot may be done to prevent venous stasis & thrombus formation)
- when motion is disruptive to healing process (e.g. Fx s callus formation)
- stays within the careful controlled range (precaution), speed and tolerance of the patient during the acute phase
- after myocardial infarction, coronary artery bypass graft, or percutaneous transluminal coronary angioplasty (AROM of both UE & limited walking c careful monitoring of Sx)
Steps in examining, evaluating, and treatment planning for ROM
- examine & evaluate pt’s impairments & level of function, determine any precautions, prognosis, and plan of intervention
- determine pt’s ability to participate in the ROM activity & whether PROM, AAROM, or AROM can meet the immed. goals
- determine the amount of motion that can be applied safely for the condition of the tissues & health of the individual
- decide what patterns can best meet the goals. ROM techniques may be performed
- monitor the pt’s general condition & responses during and after the examination and intervention. Note any changes in VS, warmth & color of the segment, and in the ROM, pain or quality of movement while performing the exercises
- docu and communicate findings and intervention
- re-evaluate & modify intervention as necessary
Steps in patient preparation for ROM
- communicate with the patient. describe the plan and method of intervention to meet the goals
- free the region from restrictive clothing, linen, splints, and dressings. drape the pt as necessary
- position the pt in a comfortable position c proper body alignment & stabilization but that also allows you to move the segment through the available ROM
- position yourself so proper body mechanics can be used
general steps in applying PROM
- during PROM, the force of movement is external; it is provided by PT or a device. when appropriate, a pt may provide the force and be taught to move the part using a normal extremity (Self-ROM)
- no active resistance or assistance is given by the pt’s mm that cross the joint. if muscles contract, it becomes an active exercise
- motion is carried out within the PAIN-FREE ROM
general steps in applying AROM
- demo the motion using PROM; then ask the pt to perform the motion. have your hands in position to assist/guide the pt if needed
- provide assistance only as needed for smooth motion. when there is weakness, assistance may be required only at the beginning/end of the ROM or when the effect of gravity has the greatest movement arm
- the motion is performed within the available ROM
used with cases of unilateral weakness or paralysis during early stages of recovery after trauma surgery
manual assistance
this technique is used to protect the healing tissues when more intensive muscle contraction is contraindicated after surgery/traumatic injury
self-assisted ROM
what plays an important role as this provides assistive force against the prime motion
Gravity
give all the equipments that can be used in ROM exercises
- wand (t-bar)
- wall climbing (finger ladder)
- overhead pulley
- skateboard/power board
- reciprocal exercise unit
this equipment is indicated when there is presence of voluntary mm control in the involved UE but needs guidance/motivation to complete ROM in the area of the shoulder/elbow
Wand/T-bar
equipment used for shoulder flexion & abduction and provides pt c objective reinforcement and motivation for performing said motion
Finger Ladder/ Wall Climbing
What is important to remember when doing shoulder abduction
at 90 degrees of abduction, externally rotate the shoulder to avoid impingement
if properly taught, this equipment can be effectively used to assist an involved extremity in performing ROM
overhead pulleys
what needs to be avoided when using overhead pulleys
substitute motions (e.g. shoulder shrugging and trunk leaning)
this equipment is used for horizontal abduction/adduction of the shoulder in sitting
skateboard/power board
this equipment provides flexion & extension of the involved extremity using the strength of the normal extremity
reciprocal exercise unit
this refers to passive motion performed by a mechanical device that moves a joint slowly and continuously through a controlled ROM
continuous passive motion (CPM)
give at least 2 benefits of CPM
- preventing development of adhesions & contractures and thus, jt stiffness
- provides a stimulating effect on the healing of tendons & ligaments
- enhances the healing of incisions over the moving jt
- inc synovial fluid lubrication of the jt thus inc rate of intra-articular cartilage healing & regeneration
- prevent the degrading effects of immobilization
- provides a quicker return of ROM
- dec post-op pain
give all the ROM exercises that are done in SUPINE
- shoulder flexion & extension
- shoulder hyperextension
- shoulder abduction & adduction
- shoulder IR & ER
- shoulder horizontal abduct/adduct
- elbow flex/extend
- forearm pronation/supination
- elongation of two-joint biceps brachii muscle
- elongation of two-joint long head of the triceps brachii muscle
- combined hip and knee flex/extend
- elongation of the two-joint hamstring muscle group
- elongation of the two-joint rectus femoris muscle
- hip abduct/adduct
- hip IR/ER
- ankle dorsiflexion/plantarflexion
- ankle inversion/eversion
- cervical flexion/extension/lat flexion/rotation
- lumbar flexion/rotation
give all the ROM that are done in prone
- scapula elevation/depression/protract/retract/upward rotation/downward rotation
- shoulder hyperextension
- hip extension
- lumbar extension
