ROM, Goniometry and Joints Flashcards
AROM
Active Range of Motion.
When joint is moved by surrounding muscles and tendons. Voluntary movement able to be done by patient.
PROM
Passive Range of Motion.
When the joint is moved by an outside force (ie: OTA) while patient is relaxed. Usually gives a greater ROM because force can provide overpressure. Significantly higher measurement can indicate problems with muscles/nerves/tendons.
Guarding
When patient creates resistance to movement—pulling away, etc. Due to injury, fear, etc.
Causes for decreased ROM?
- Injury
- Disease (CP, Arthritis)
- Joint trauma
- Soft tissue tightness (tight hips from sitting)
- Spasticity (nerve-based tension in muscles)
Why measure ROM?
Helps therapist:
1) Select intervention goals
2) Select treatment techniques
3) Determine availability of ROM for tasks (ie: hip to rise from seated)
4) Determine effectiveness of intervention (validates improvement)
Normal Hip ROM Requirements
- Normal hip flexion is 0˚ - 100˚
- Don’t need full range for some ADLs
- Ascending stairs needs 67˚ flexion
- Descending stairs needs 32˚ flexion
- Sit-to-stand needs 100˚+ flexion
- Sitting needs 84˚ flexion
Contraindications to Measuring ROM
- New soft tissue injury
- Newly united fracture
- Recent prolonged immobilization
- Bone carcinoma or other fragile bone condition
Factors of Variability in Measuring ROM
- Age (children are hypermobile)
- Gender (females more flexible after age 14)
- Lifestyle factors (gymnast vs. desk job)
- Occupation (people who move vs. stationary ppl)
Tips for PROM
- Approach client on side to be measured
- Use good body mechanics
- Have relaxed/conformed grasp on body part
- Client relaxed and resting weight of body part in your hands
- Start movement at beginning of range, move slowly and stop when you feel resistance or there is pain
REMEMBER:
- *Compare injured to non-injured side!
- *Ask about previous injuries/arthritis before test!
- *Monitor for crepitus and pain!
Crepitus
“Popping” sound in joint, or non-smooth/bumpy movement.
End Feels
This is the feel when the movement reaches it’s furthest point (its “end”). Three types:
HARD= Bone on bone, like in elbow extension. SOFT= Soft tissue impedes motion, like knee or elbow flexion. FIRM= Firm, springy sensation, limited by tension on surrounding tissue, like in ankle dorsiflexion or wrist flexion/extension.
Procedure for Measuring ROM
1) OBSERVE the motion from the patient. Look for compensatory motion, posture, muscle contours, skin color, edema. Know what that patient’s normal motion looks like; compare both sides.
2) PALPATE around the joint. Feel the bony landmarks important to goniometer use. Palpate surrounding soft tissue using your index and middle finger.
3) POSITION client and self conducive to goniometer and body mechanics. Approach client on side being tested; avoid restrictions to movement.
How to Document Goniometer Measurement
- Always start measurement at 0˚ and only move mobile arm to measure.
- Write as range of motion in degrees ie: 0˚ to 140˚
- Use a plus (+) sign for hyperextension: ex: if hyperextends 20˚ and flexes 50˚, you would write “+20/50”
- If lacking full extension, use negative (-) before number: ex: if lacking full extension of 15˚, you would write “-15”
Ways to Classify Joints
1) ANATOMY of the joint (Fibrous, Cartilaginous, Synovial)
2) AMOUNT OF MOVEMENT of the joint (Uniaxial, Biaxial, Triaxial)
3) SHAPE of the joint (Saddle, Hinge, Pivot)
Anatomical Joint Classification
1) Fibrous joints: synarthrotic (w/o movement, as in skull sutures)
2) Cartilaginous joints: amphiarthrotic (slight movement, as in spine or pubic symphasis)
3) Synovial joints: diarthrotic (moves 2 ways, as in our major movers—knees, elbows)
