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Ortho Eval > Week 4 - Problem Solving: ROM > Flashcards

Week 4 - Problem Solving: ROM Flashcards

1
Q

What is the ultimate goal of restoring motions?

A

-to reduce impairments and enhance functional performance for ADLs and work and leisure activities.

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2
Q

Name 3 complications of immobility on musculature.

A
  • reduced muscle mass (strength)
  • muscles become stiff/sore so movement becomes more difficult
  • contractures may develop in 4 days
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3
Q

What is the percentage of weekly muscle mass (strength) loss in elders due to immobilization?

A

10% loss weekly

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4
Q

How long does it take ROM to go away due to contractures?

A

14 or 15 days

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5
Q
  • complicate care
  • cause pain
  • ROM lost by day 14,15
A

contractures

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6
Q

ROM

A

the distance a joint can move and the direction in which it can move

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7
Q

the available arc of motion within a joint which is assessed by goniometric measurements.

A

ROM assessment

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8
Q

Name 4 causes of decreased ROM

A
  • problem within the joint.
  • swelling of tissue around the joint.
  • stiffness of muscles
  • pain
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9
Q

the arc of motion achieved when the individual uses his own muscle power to effect joint motion.

A

active ROM

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10
Q

the arc of motion achieved when the examiner applies an external force to the joint

A

passive ROM

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11
Q

Name 3 things that passive ROM determines.

A
  • limitation of movement
  • joint stability
  • muscle and other soft tissue elasticity
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12
Q

a form of controlled PROM whereby the amount of external force applied by the examiner is measured; way to measure the force that it takes to move a joint passively.

A

torque ROM

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13
Q

Name 7 causes of limited joint ROM.

A
  • joint dislocation
  • fracture - immobilization leads to peri-articular connective tissue changes.
  • joint swelling
  • arthritis
  • muscle tear (RC tendonitis)
  • peripheral nerve injury
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14
Q

Name 7 factors affecting the outcome of ROM measurements.

A
  • edema
  • pain
  • adhesions
  • capsular tightness/laxity
  • tendon excursion
  • strength deficits
  • muscle hypertrophy
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15
Q

ROM measurements are ____ measures of factors other than ROM.

A

never

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16
Q

T/F - ROM measurements may suggest a problem in other factors effecting the outcome, but they do not directly measure the other factors.

A

true

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17
Q

movement within the UNRESTRICTED range in a joint that is produced by an external force.

A

passive ROM

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18
Q

Name 4 examples of passive ROM.

A
  • gravity
  • machine
  • therapist
  • another part of pts. own body
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19
Q

PROM is typically practiced on a joint that is _____.

A

inactive

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20
Q

OT may perform PROM on pts. who are ____ or unable to ____ a specific joint.

A

paralyzed, mobilize

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21
Q

PROM can help prevent what from occurring?

A

stiffness

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22
Q

Codman’s exercise

A
  • pendulum exercise
  • pt. bends over, places one hand on table, trunk parallel with floor, move trunk so other arm swings with gravity (forward and back, L & R). As pt. bends down and joint is relaxed, there is a slight distraction within the joint (due to the weight of arm) which is helpful - gives it some space.
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23
Q

PROM is produced by ___ ____.

A

external force

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24
Q

Can the patient be asleep during PROM?

A

No - pt. must be relaxed but not asleep.

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25
Q

movement within the UNRESTRICTED range in a joint that is produced by an active contraction of the muscles crossing the joint. exercises are highly independent, performed solely by the pt./client. OT’s role may be simply to provide verbal cues.

A

AROM

26
Q

What is the goal of AROM?

A

to keep joints and soft tissue moving.

27
Q

How is AROM produced?

A

produced by active contraction of muscle crossing joint.

28
Q

-AROM in which ASSISTANCE is provided by an outside force (manual or mechanical) bc the prime movers (muscles) require assistance to complete the motion.

A

Active Assistive Exercise (AA ROM)

29
Q

Describe Active Assistive Exercise (AA ROM) exercises.

A
  • more progressive, intended for the pt. to perform with manual assistance from the therapist or other force.
  • exercises may feel painful and the muscles can feel weak. increasing ROM with these exercises should be a gradual advancement.
30
Q

assistance is provided (by outside force) when prime mover cannot complete motion.

A

Active Assistive Exercise (AA ROM)

31
Q

Name 2 methods of Active Assistive Exercise (AA ROM).

A
  • supination bar

- wall ladder

32
Q

Is Active Assistive Exercise (AA ROM) the same as PROM?

A

NO

33
Q
  • OT assists with the rest of motion.
  • pt. begins and then OT assists to get to full ROM.
  • looks like it’s passive but pt. starts then OT helps.
A

Active Assistive Exercise (AA ROM)

34
Q

When should PROM be used?

A

when pt. is unable to or should not move a segment.

35
Q

Name 5 conditions in which PROM would be necessary.

A
  • coma
  • paralysis
  • bed rest
  • inflammatory process
  • surgical repair of soft tissue
36
Q

Name 7 goals of PROM treatment.

A
  1. maintain joint and soft tissue integrity.
  2. maintain mechanical elasticity of muscle.
  3. maintain awareness of movement.
  4. prevent contractures
  5. assist circulation and vascular dynamics
  6. enhance synovial movement for cartilage nutrition.
37
Q

Name 4 indications for AROM and AAROM.

A
  • same as PROM but with added benefits of muscle contraction.
  • maintain physiologic and contractility of muscles
  • sensory feedback
  • circulation
38
Q

What is the goal of Active Assistive Exercise (AA ROM).

A

-when pt. has weak muscles, AAROM is used to give enough assistance so that muscles can function at a maximum level and progressively be strengthened.

39
Q

Name 3 limitations of PROM.

A

PROM will not:

  • prevent muscle atrophy
  • increase strength or endurance
  • assist circulation to the same extent as an active muscle contraction
40
Q

Name 2 limitations of AROM.

A

AROM will not:

  • maintain or strengthen already strong muscle.
  • develop skill/coordination except in patterns used.
41
Q

Name 3 strategies to improve ROM.

A
  • orthotics (splinting) and casting
  • joint mobilization
  • exercises - PROM, stretching, muscle strengthening
42
Q

passively moving joint

A

joint mobilization

43
Q

Name 3 clinical examples of when PROM or AROM will disrupt the healing process.

A
  • tendon injury (don’t do AROM early on)
  • open wound (limited in range)
  • wrist fracture (passive - no, active - yes)
44
Q

AROM is contraindicated when _____ ____ is unstable.

A

cardiovascular status

45
Q

PROM is not synonymous with ______.

A

stretching

46
Q

why should you not perform PROM on a pt. with a fracture (Ex: 12 days post ORIF for distal radius fracture).

A

-can disrupt hardware. must wait for passive stretch.

47
Q

what should you do for a pt. with a fracture with deep tendon lacerations across the wrist?

A
  • wound care
  • pt. education
  • elevation (gravity will help the edema)
  • start with PROM since tendons have been injured.
48
Q

Is PROM or AROM used early in fracture care?

A

AROM

49
Q

Is PROM or AROM used early in tendon injuries?

A

PROM

50
Q

Why should AROM not be used in pts. with flexor tendon lacerations?

A
  • tendon and muscle injuries that are 2 parts sewn together - cannot do AROM until about 3 weeks out from surgery.
  • can do active extension but not active flexion.
51
Q

How long should a pt. or OT wait to do AROM with tendon lacerations?

A

about 3 weeks out from surgery.

52
Q

a commonly used method of stretching in which soft tissues are elongated just past the point of tissue resistance and then held in the lengthened position with a sustained stretch force over a period of time.

A

static stretching

53
Q

How long should you wait to do any motion with pts. with skin grafts? What type of motion should be used?

A

7-10 days and then its AROM.

54
Q

Mirror imaging

A

pt. keeps their unaffected side outside of mirror while affected side is inside mirror box. It looks like R & L sides and reflection looks like affected side is working and can lead to increased movement. helps brain relearn how to move.

55
Q

contract/relax

A

pt. contracts tight muscle against resistance applied by OT at point of limitation and holds for 2-5 seconds. pt. then relaxes and OT moves part in OPPOSITE direction.

56
Q

Describe an example of contract/relax.

A

-goal is for pt. to extend elbow better.
-ask pt. to flex against resistance, tell pt. to keep it there for 2-5 seconds and pull it out.
-biceps get fatigued from holding and then extension is better.
OR
-hold against resistance. OT pushes toward flexion while pt. tries to push toward extension then release and extend arm.

57
Q

maximal manual stretch of tight muscle, followed by isotonic contraction of OPPOSITE muscle.

A

agonist contraction

58
Q

combination of contract/relax but done quickly.

A

contract/relax/contract

59
Q
  • small amplitude rhythmic oscillating movement at the beginning of ROM
  • manage pain and spasm
A

Grade 1 - Maitland Joint Mobilization Grading Scale

60
Q
  • large amplitude rhythmic oscillating movement within midrange of movement
  • manage pain and spasm
A

Grade 2 - Maitland Joint Mobilization Grading Scale

61
Q

grading based on amplitude of movement and where within available ROM the force is applied.

A

Maitland Joint Mobilization Grading Scale

Ortho Eval (24 decks)

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