Week 2 ROM and Stretching Flashcards
What is the basic technique used for examination of movement and for initiating movement into a purposeful therapeutic intervention?
Range of Motion
What is the distance a muscle is capable of shortening after it’s been maximally elongated?
Functional excursion
What type of insufficiency is this: difficulty making a fist when wrist is flexed?
Active insufficiency
What type of insufficiency is this: fingers flex when wrist is extended?
Passive insufficiency
What is a motion produced by an external force, manual or mechanical?
Passive ROM
What is a motion produced by an active contraction of the muscles? self
Active ROM
What is a motion produced by a combination of external force and active muscle contraction?
Active Assistive ROM
Precautions and Contraindications to ROM Exercises
- ROM should not be done when motion is disruptive to the healing process
- ROM should not be done when patient’s response or condition is life threatening
What should you do during your examination, evaluation, and treatment planning?
- determine appropriate level of ROM
- determine safe amount of motion
- decide the pattern of motion to best meet goals
- monitor pt response to ROM intervention
- document and communicate findings
- re-evaluate and modify as possible
Patient prep for ROM includes what 5 things?
- Describe the intervention
- free the area from restriction
- Drape
- Position pt for alignment and stabilization
- Position yourself for proper body mechanics
When applying ROM, you need to support areas of ____ _____ _______.
Poor structural integrity
Move the segment through _____-_____ ______ to the point of resistance.
Pain-free range
If the patient is unable to perform ROM painfree, what should you do?
Choose gravity reduced or eliminated position due to muscle weakness
What is Continuous Passive Motion?
- performed by a mechanical device that moves the joint slowly and continuously through a pre-set, controlled ROM
Benefits of CPM:
- Prevents development of adhesions, contractures
- Stimulates healing of tendons, ligaments
- Enhances healing of incisions
______
______
______
______
- Increases synovial fluid lubrication
- Prevents degrading effects of immobilization
- Quicker return of ROM
- Decreases post-op pain
Benefits of CPM:
______
______
______
* Increases synovial fluid lubrication
* Prevents degrading effects of immobilization
* Quicker return of ROM
* Decreases post-op pain
- Prevents development of adhesions, contractures
- Stimulates healing of tendons, ligaments
- Enhances healing of incisions
General Guidelines for CPM
- Device immediately applied post-op
- Arc of motion is adjustable
- Rate of motion is adjustable
_____
_____
_____
- Duration is determined
- PT included in off periods
- Device is portable & battery operated
General Guidelines for CPM
_____
_____
_____
* Duration is determined
* PT included in off periods
* Device is portable & battery operated
- Device immediately applied post-op
- Arc of motion is adjustable
- Rate of motion is adjustable
What is the purpose of ROM through functional patterns?
- assists in teaching ADLs and IADLs
- helps pt realize purpose and value of ROM
- assists in developing motor patterns
- promotes compliance for “meaningful” exercises
Exercise RX for acute stage
PROM 3-5 reps
within pain tolerance (surgical restrictions) several times per day
Exercise RX for subacute stage
PROM –> AAROM –> AROM: 10-15 reps with brief hold periods (3-5 seconds) within pain free range
2-3 times per day
Exercise RX for Chronic stage
AROM: >30 reps for mm re-education, maintenance of ROM, stretching to gain ROM
What is “any therapeutic maneuver designed to increase mobility of soft tissues”?
Stretching
What does stretching help with?
Improve ROM by elongating structures that have adaptively shortened and have become hypomobile over time
What is dynamic flexibility?
Flexibility due to active movement
What is passive flexibility?
Flexibility due to a passive force
What is it called when you have limited arthrokinematic movement of a joint?
Hypomobility
Which arthrokinematic movement can we help with? can we NOT help with as much?
We can help: glides
We CAN’T help: rolls
What is “designated by location and position the joint is ‘stuck in’”?
Contractures
What is “MT unit is adaptively shortened”?
Myostatic contracture
What is “hypertonicity due to CNS lesions: CVA, TBI, SCI”?
Pseudomyostatic contracture
What is “adhesions, synovial proliferation, joint effusion, osteophytes”?
Arthrogenic and periarticular contractures
What is “fibrous changes in connective tissue leads to adhesions & is difficult to re-establish normal tissue length”?
Fibrotic contracture and irreversible contractures
What is “purposefully stretch or mobilize certain muscles and joints while letting others become hypomobile to improve function”?
Selective Stretching
What is “purposefully overstretch certain muscles or joints to increase function”?
Overstretching and Hypermobility
what is manual or mechanical stretching?
Utilizes an external force to perform a passive stretch
What is passive stretching?
No active contraction of the contractile unit
What is assisted stretching?
patient assistance by themselves, machine or another person
What is “patient performs the stretch”?
Self-stretching
What is neuromuscular facilitation and inhibition?
- PNF
- Increases or decrease in muscle tone
What are 5 interventions to increase mobility of soft tissues?
- Neuromuscular Facilitation and Inhibition
- Muscle Energy Techniques
- Joint Mobilization/Manipulation
- Soft Tissue Mobilization and Manipulation
- Neural Tissue Mobilization
Indications for Stretching Exercises
- Adhesions, Contractures, Scar Tissue Limit ROM
- Potential for Structural Deformity due to limited ROM
*Muscle Weakness, Shortening of Muscles
_____
_____
- Part of a total Fitness Program
- Pre and Post Vigorous Exercise
Indications for Stretching Exercises
_____
_____
_____
* Part of a total Fitness Program
* Pre and Post Vigorous Exercise
- Adhesions, Contractures, Scar Tissue Limit ROM
- Potential for Structural Deformity due to limited ROM
*Muscle Weakness, Shortening of Muscles
Contraindications for Stretching Exercises
- Bony Block
- Non-union fx
- acute inflammation or infection
- Sharp/acute pain with elongation
_____
_____
_____
- Hematoma or tissue trauma
- Hypermobility
- Hypomobility provides stability or neuro-MSK control
Contraindications for Stretching Exercises
_____
_____
_____
_____
* Hematoma or tissue trauma
* Hypermobility
* Hypomobility provides stability or neuro-MSK control
- Bony Block
- Non-union fx
- acute inflammation or infection
- Sharp/acute pain with elongation
What is Elasticity?
Temporary change in tissue length THEN return to previous length once force is removed
Does contractile connective tissue have viscoelasticity?
No, it’s only in non-contractile CT
Non-contractile CT initially resists _____ and _____
Stress and Strain
What is plasticity?
Permanent change in tissue length
What is response to stretch determined by?
Velocity, Duration, and amount of force applied
Muscle Spindle is (faciliatory/Inhibitory)
_____ Afferent
Muscle Spindle: Faciliatory
1a afferent
Golgi Tendon Oran is (faciliatory/Inhibitory)
_____ Afferent
GTO: Inhibitory
1b afferent
What are the 6 types of Connective Tissue?
- Ligaments
- Tendons
- Joint capsules
- Fascia
- Non-Contractile Tissue in Muscles
- Skin
