Week 2 - Goniometry Flashcards
Where would Goniometry fall under the Guide to Physical Therapist Practice and HOAC?
Range of Motion & Muscle Length under Test and Measurements under the Data Gathering (hands-on) of Examination.
When will a physical therapist use Goniometry?
When they want to objectively quantify joint range of motion as well as muscle length.
What are the reasons for selecting Test & Measurements? (4)
- To assist in confirming or rejecting proposed hypotheses. 2. To confirm or document an impaired Body Structure or Function 3. To guide or direct treatment 4. Use as an intervention Outcome Measure
For which Reason for Selecting Test & Measurements would a PT select the Lachman Test for the knee based on subjective information provided by the patient that they have an injury to the ACL?
- To assist in confirming or rejecting proposed hypotheses: (We may hypothesize based on the subjective information provided by the patient that they have an injury to the ACL, thus we might select the Lachman Test as one of our test and measures to asses the integrity of the ACL.)
For which Reason for Selecting Test & Measurements would a PT select MMT if they feel the patient has a muscle strength deficit based on the history and subjective information?
- To confirm or document an impaired Body Structure or Function (We may feel that the patient has a muscle strength deficit based on the history and subjective information that we have obtained, thus we would use Manual Muscle Testing to confirm or document that indeed the patient has a muscle strength deficit.)
For which Reason for Selecting Test & Measurements would a PT select Joint Play Assessment do decide whether to include joint mobilization as part as our intervention?
- To guide or direct treatment (If we determine by assessing joint play that we feel the individual has a restricted glide, then joint play would help us understand the need for doing joint mobilization as part as our intervention.)
For which Reason for Selecting Test & Measurements would a PT select Goniometry as a way to document the impaired range of motion as we begin treatment, and to reassess the patients range of motion after we have performed X number of treatments to show change?
- Use as an intervention Outcome Measure (We may believe that the patient has a restriction in range of motion and indeed observing the patient move actively we see that they do have a restriction in joint range of motion. Thus we would use Goniometry as a way to not only document the impaired range of motion as we begin treatment, but to use Goniometry to reassess the patients range of motion after we have performed X number of treatments to show that we have made a change in the patients range of motion.
Full ROM across a joint is dependent on what two components? (2)
- Joint ROM 2. Muscle Length
What is Joint ROM?
The motion available at any single joint in the body.
What is full or complete Joint ROM influenced by? (2)
- Associated bony structure 2. Physiologic characteristics of the connective tissue surrounding the joint -Especially Ligaments and Joint Capsule
When we reference joint range of motion, what are we technically referring to?
Joint Kinematics
What is Joint Kinematics?
Refers to motion of the body, without regard to forces or torques that may produce motion.
What is an example of Kinematics using walking?
Kinematics describes human movement such as walking, but in considering how we walk and the movements associated with walking, kinematics ignores the causes of the motion which are usually produced by forces, momentum, & energy which we term kinetics.
What are the 2 subcategories of Joint Motion or Kinematics?
- Osteokinematics 2. Arthrokinematics
What is another term for Osteokinematics?
Physiologic Motion
What is another term for Arthrokinematics?
Accessory Motion
Define Osteokinematics (Physiologic Motion).
Movement of a bone segment (ie; humerus or femur) as it moves away from the trunk or pelvis about the joint axis.
Define Arthrokinematics (Accessory Motion).
Refers to the action movement of the articular or joint surfaces in relatinon to one another during osteokinematic motion.
If we describe “flexion of the shoulder,” is this: A. Osteokinematics B. Arthrokinematics
A. Osteokinematics (Moving the humerus away from the trunk about the axis passing through the glenohumeral joint.)
If we describe “the movement of the head of the humerus and the glenoid fossa” as we perform shoulder flexion, is this: A. Osteokinematics B. Arthrokinematics
B. Arthrokinematics (Movement of the articular or joint surfaces in relatinon to one another during osteokinematic motion.)
T/F: Osteokinematic or Physiologic Motion occur between the articular or joint surfaces as we perform Arthrokinematic or Acessory Movements.
False: Arthrokinematic or Acessory Movements occur between the articular or joint surfaces as we perform Osteokinematic or Physiologic Motion.
What are the 3 components of arthrokinematic or accessory movement ?
- Glide or Slide 2. Roll 3. Spin
What is used to assess the 3 components of arthrokinematic or accessory movement?
Joint Play
What is used to assess osteokinematics or physiologic motion?
Goniometry
When we perform a goniometric measurement of joint ROM, what is used as a reference point?
Anatomical Position
Define Anatomical Position.
Standing erect with head,toes, and palms of hands facing forward with fingers extended.
When is a reference point required?
to describe PLANES & AXES OF MOVEMENT that we are measuring with goniometry.
Sagittal Plane 1. Axes 2. Movement occurs
- Medial-Lateral Axis 2. Movement is occurring within the sagittal plane which is cutting the body into a left and right half.
Frontal Plane 1. Axes 2. Movement occurs
- Anterior-Posterior Axis 2. Movement is occurring within the frontal plane that is cutting the body into an anterior and posterior half.
Transverse Plane 1. Axes 2. Movement occurs
- Vertical Axis 2. Movement is occurring within the transverse plane which is cutting the body into a superior and inferior half.
Movement about the Medial-Lateral Axis in which plane?
Sagittal Plane
Movement about the Anterior-Posterior Axis in which plane?
Frontal Plane
Movement about the Vertical Axis in which plane?
Transverse Plane
Which plane cuts the body into a left and right half?
Sagittal Plane
Which plane cuts the body into a anterior and posterior half?
Frontal Plane
Which plane cuts the body into a superior and inferior half?
Transverse Plane
When is Goniometry used?
Used by a PT to assess joint range of motion (ROM)
What 3 things is ROM a function of?
- Joint Morphology 2. Capsule and Ligaments 3. Muscles and Tendons that cross the joint being assessed
What are INERT tissues?
Capsule and Ligaments
What are CONTRACTILE tissues?
Muscles and Tendons
What are the purposes for using for using Goniometry? (3)
- Assessing existing ROM for comparison to normative values or non-involved side. 2. Determine joint function for both active and passive ROM 3. Assess Hypo-mobility vs. Hyper-mobility of a joint.
What instruments are used to measure joint ROM (Goniometry)? (5)
- Universal Goniometer (most common) 2. Inclinometer 3. Electrogoniometer 4. Photography & Video Recording 5. Radiographs
What is the most common method used to document Joint ROM?
0-180 System (Silver in 1923)
In the 0-180 system, what is define as the 0-degree starting position?
Anatomical Position
What is the one exception to 0-degree starting position being anatomical position for the 0-180 system?
Forearm (pronation-supination)
What is starting position also referred to as?
neutral extension
What is the starting position (neutral extension) of each joint recorded as?
0-degrees
As a joint flexes, motion progresses to what degree?
180-degrees
Whenever we are assessing joint ROM utilizing goniometry, it is critical we always apply ___.
Stabilization
Prior to asking the patient to actively perform the desired motion or before we passively move the patient’s extremity, we must ensure ____.
that the proximal segment is stabilized.
When measuring hip joint flexion, the ____ must be stabilized.
the proximal segment (pelvis)
What affects the reliability of our joint ROM measurement?
Lack of stabilization
Select the proper Goniometer component: Aligned to a bony landmark on the moving segment. A. Protractor B. Stationary Arm C. Moving Arm
C. Moving Arm
Select the proper Goniometer component: Can be a half or full circle. A. Protractor B. Stationary Arm C. Moving Arm
A. Protractor
Select the proper Goniometer component: Aligned to a bony landmark on the fixed segment. A. Protractor B. Stationary Arm C. Moving Arm
B. Stationary Arm
Select the proper Goniometer component: “Proximal Segment” A. Protractor B. Stationary Arm C. Moving Arm
B. Stationary Arm
Select the proper Goniometer component: Extends from the protractor. A. Protractor B. Stationary Arm C. Moving Arm
B. Stationary Arm
Select the proper Goniometer component: “Distal Segment” A. Protractor B. Stationary Arm C. Moving Arm
C. Moving Arm
Select the proper Goniometer component: The axis or fulcrum of the ____ is aligned to the joint axis. A. Protractor B. Stationary Arm C. Moving Arm
A. Protractor
What is one of the first things we must do when assessing Joint ROM using Goniometry?
Determine if we will assess Passive or Active ROM.
In general, do we usually assessAROM or PROM first?
Active ROM.
Why in general do we usually assess AROM first? (2)
1) Allows patient to voluntarily move through their available AROM, without risk of causing pain. 2. Permits assessment of the consistency of available AROM if appears limited
How do we assess the consistency of available ROM if appears limited?
Ask patient to repeat AROM 1 to 2 times. (see if they are always going through the same amount of ROM)
T/F: You don’t have to document if assessed AROM or PROM as variability shouldn’t exist between the two types.
FALSE: You MUST document if assessed AROM or PROM as variability CAN exist between the two types.
After we determine if we are assessing AROM or PROM, what is done next?
Explain purpose of the procedure to the patient.
After explaining the purpose of the Goniometry to a patient, what is done next?
Position the patient in the preferred position.
How should explaining the purpose of the procedure to the patient be done?
using layman’s terms.
What 2 things should we do after positioning the patient in our preferred position?
- properly DRAPE patient if necessary 2. if possible, have the patient move the body segment actively through their available ROM
After the patient is properly positioned, what must be done?
Ensure that we have Stabilized the proximal (stationary) segment).
Once the patient is stabilized, what is done next?
Palpate required bony landmarks for fulcrum, stationary, and moving segments.
Which of the landmarks is not as critical and why?
Fulcrum since joint axis can shift.
After the patient has been stabilized and bone landmarks palpated, what is done next?
Have patient move through their maximum available ROM.
Once the patient have moved through their max ROM, what is done next?
Re-palpate bony landmarks, align the goniometer, and read scale for degrees.
Once you have made a reading from a goniometer, what is done next?
Record the patients ROM data.
What is included in a patients ROM data? (6)
- Patient’s name and ID info 2. Date of measurement 3. Name of PT obtaining measurement 4. Type of motion measured (AROM vs PROM) and device used 5. Any modifications to preferred patient position 6. Degree reading at start and end of ROM (use the 0 to 180 notation system)
What do you do when the patient cannot ACTIVELY move through the typical ROM for the joint being assessed? (2)
- Must assess PASSIVE ROM 2. and determine joint END-FEEL
What does moving the patient through their available PASSIVE ROM provide?
Allows us to assess and document any limitations to full ROM for example pain, muscle guarding or tightness, etc.
What does END-FEEL assessment provide?
Provides information on quality of the resistance at the end of the ROM.
With regard to END-FEEL what must we consider?
Each joint has a characteristic end-feel at the end of the available ROM.
What are Typical END-FEELs? (4)
- Bony (hard) 2. Capsular (firm) 3. Muscular (firm) 4. Soft Tissue (soft)
What are Abnormal END-FEELs? (3)
- Empty 2. Springy 3. Muscle Spasm
Match the END-FEEL: Elbow Extension. a. Bony b. Capsular c. Muscular d. Soft Tissue e. Empty f. Springy g. Muscle Spasm
a. Bony (hard)
Match the END-FEEL: Elbow Supination a. Bony b. Capsular c. Muscular d. Soft Tissue e. Empty f. Springy g. Muscle Spasm
b. Capsular (firm)
Match the END-FEEL: Ankle Dorsiflexion with Knee Extension a. Bony b. Capsular c. Muscular d. Soft Tissue e. Empty f. Springy g. Muscle Spasm
c. Muscular (firm)
Match the END-FEEL: Elbow Flexion a. Bony b. Capsular c. Muscular d. Soft Tissue e. Empty f. Springy g. Muscle Spasm
d. Soft Tissue (soft)
Match the END-FEEL: Protective Response a. Bony b. Capsular c. Muscular d. Soft Tissue e. Empty f. Springy g. Muscle Spasm
e. Empty
Match the END-FEEL: No end feel is noted due to pain interfering a. Bony b. Capsular c. Muscular d. Soft Tissue e. Empty f. Springy g. Muscle Spasm
e. Empty
Match the END-FEEL: Rebound at extreme of possible ROM a. Bony b. Capsular c. Muscular d. Soft Tissue e. Empty f. Springy g. Muscle Spasm
f. Springy
When would the END-FEEL Bony be felt?
(hard) - Elbow Extension
When would the END-FEEL Capsular be felt?
(firm) - Elbow Supination
When would the END-FEEL Muscular be felt?
(firm) - Ankle dorsiflexion with Knee extension
When would the END-FEEL Soft Tissue be felt?
(soft) - Elbow flexion
When would the END-FEEL Empty be felt?
No end feel is noted due to pain interfering (protective response)
When would the END-FEEL Springy be felt?
Rebound at extreme of possible ROM
What is a Key issue with any Test & Measurement such as Goniometry?
Reliability of measurements
What two forms of reliability of measurements occur with Goniometry?
Intra- and Inter- rater reliability.
Match the form of rater reliability: Within Rater Reliability a. Intra- b. Inter-
a. Intra-
Define Intra-rater reliability.
How accurate am I when I perform the same measurement more than once?
Match the form of rater reliability: Between Rater Reliability a. Intra- b. Inter-
b. Inter-
Define Inter-rater reliability.
How accurate am I in comparison to another PT when we are taking the same goniometric measurement on the same patient.
In general with most Test & Measurements is Intra- or Inter- rater reliability higher?
Intra (or within) is higher
When we are taking more than one measurement on the same patient, are intra- rater reliability should be within ___.
+/- 5 degrees
What are 4 Factors that improve goniometric accuracy?
- Consistent, standardized test positions & landmarks 2. Use of same instrument for repeated measures 3. Use of larger goniometer on larger joints 4. Consistent manual force for Passive ROM
