Educational Psychology Quiz

Range of Motion (ROM)

• Range of motion is the amount of movement possible at a joint.
• It's a crucial technique for assessing movement (goniometry) and initiating therapeutic interventions.

Physical and Physiological Considerations Related To Joint ROM

• Intrinsic Factors:
  • Joint shape and congruency (how well the bones fit together)
  • Pliability of the joint capsule, ligaments, and collagenous tissues.
  • Strength and flexibility of the musculature crossing the joint.
• Extrinsic Factors:
  • Aging
  • Body segment size (related to muscle and fat)
  • Disease, injury, overuse, immobilization.

Types of ROM Exercises

• Passive ROM (PROM): Movement of a body segment entirely by an external force, without voluntary muscle contraction by the patient.
  • Sources of external force: Gravity, machines (Continuous Passive Motion - CPM), another person, another part of the individual's body.
  • Manual: Therapist; patient's unaffected limb.
  • Mechanical: CPM machine. (Examples of equipment include wands, T-bars, finger ladders, wall climbing, ball rolling and pulleys)
• Active ROM (AROM): Movement performed by the patient's voluntary muscle contractions.
  • Classifications: Free Exercise, Assisted Exercise, and Resisted Exercise
• Active-Assistive ROM (A-AROM): Movement initiated and completed by the patient's voluntary muscle contraction with assistance from another source (therapist or another part of the body) when the patient has limited strength.

Uses of Passive Range of Motion

• Relaxed Passive Movement: Maintaining full range of motion without restrictions
• Passive Movement for Mobilization: Breaking down adhesions and increasing mobility
• Passive movement for stretching: Lengthening shortened tissues (for increased range)

Indications of Passive ROM

• Coma
• Paralysis
• Immobilized joint
• Muscle re-education
• Used as a screening/preliminary procedure
• Examination

Goals for Passive ROM

• Decrease complications of immobilization (cartilage degeneration, adhesions, contractures, sluggish circulation)
• Maintain joint and connective tissue mobility
• Minimize contracture formation
• Maintain muscle elasticity
• Assist circulation and vascular dynamics
• Enhance synovial movement for cartilage nourishment
• Decrease pain
• Assist with healing after injury/surgery
• Maintain awareness of movement

Limitations of Passive ROM

• Does not prevent muscle atrophy
• Does not increase strength or endurance
• May limit circulation (to the extent that active voluntary muscle contraction isn't done)

Precautions and Contraindications For Passive ROM

• Disruptive motions for healing processes (unhealed fractures, open wounds, inflamed joints)
• Excessive or improper motion leading to increased pain or inflammation
• Site of effusion (buildup of fluid) and swelling
• Immediately after a ligament/tendon tear.
• Uncontrolled high blood pressure

Principles and Procedures for Applying ROM Techniques

• 1) Examination, Evaluation, and Treatment Planning:

  • History taking (patient and relative input)
  • General examination (active/passive ROM, muscle strength evaluation)
  • Select appropriate technique (AROM, PROM, AAROM).

• Monitoring: Response to exercises, vital signs, pain, ROM, quality of movement, warmth/color of the affected area.

• Re-evaluation: Re-evaluate and modify intervention as needed.

• 2) Patient Preparation: Communicate with patient, remove restrictive clothing/equipment, cover other body parts, position the patient for comfort and proper body alignment, position yourself for proper body mechanics.

• 3) Application of Techniques:

  • Control movement (firm but not harmful grasps, proximal/distal to the target joint).
  • Support areas of poor structural integrity (like hypermobility/recent fracture).
  • Move through full pain-free range (stop at tissue resistance)
  • Smooth/rhythmical motions (5-10 repetitions).
  • Repetition depends on program goals, patient response, and treatment.
  • Characteristics of Relaxed Passive Movement: Slow, rhythmic, regular, and through full available ROM.

Active Movement (AROM)

• Movements within unrestricted ROM controlled by voluntary muscle contractions.
  • Classification:
    • Free Exercise: No external forces other than gravity
    • Assisted Exercise: External force to complete the range (manual or mechanical)
    • Resisted Exercise: External forces increase resistance against the active movement

Active-Assistive Exercises (AAROM)

• Movement initiated by the patient's muscles, with assistance (either manual or mechanical) to complete the full range if the patient is unable to do it on their own.

Effects and Uses of AAROM

• Strengthens muscles, maintains elasticity and contractility.
• Provides sensory feedback, improves neuromuscular re-education.
• Stimulates bone/joint integrity.
• Improves/increases blood circulation to prevent DVT (Deep Vein Thrombosis).
• Develops coordination and motor skills for functional activities, improves patient confidence, and promotes cooperation.
• Increases metabolism for weight loss and stress decrease.
• Helps prevent heart disease risk.

Contraindications of AAROM

• Gross swelling, fever and redness
• Myocardial infarction (heart attack) immediately beforehand
• Acute intolerable pain
• Cardiopulmonary dysfunction
• Unhealed/unprotected recent fractures/surgical wounds (acute tears)
• Cases of DVT

Indications of AAROM

• Muscle weakness (disuse or after a plaster cast)
• Muscle re-education
• Inability to perform daily living activities
• To increase range of motion (ROM)
• Following a tendon/muscle transplant

Precautions of AAROM

• ROM exercises proximal and distal to the injured/immobilized joint to minimize venous thrombosis formation.

Technique of Assisted Exercises

• Starting Position: Ensures maximum postural efficiency and concentrates patient attention.
• Pattern of Movement: Explain to the patient—demonstrate passively or actively on the sound limb.
• Fixation: Improves prime mover efficiency by fixing the proximal part. Avoid trick movements.
• Support: Used to reduce load on the weak muscle, provided by pillows, boards, slings, or therapist's hands. This enables the patient to focus and remain relaxed.
• Traction: preliminary stretching provides a powerful stimulus to contraction by stimulating the muscle spindle, aiding initial movement.
• The Antagonistic Muscle: Proper starting position minimizes stress on the muscles opposing the movement that's being assisted.
• The Assistance Force: Directed toward the desired movement, adjusting in intensity based on the movement phase (adjust intensity at start and end).
• The Character of the Movement: Smooth and efficient.
• Repetitions: Depends on patient condition, and rate of fatigue.
• The Cooperation of the Patient: Encourage maximum effort to improve outcomes.

Active Free Exercise (AROM)

• Exercises performed using only the patient's own muscular effort within the unrestricted ROM; without any external assistance or resistance except for gravity.

Active Free Exercises (AROM): Types

- Localized: strengthening a specific muscle group

• Generalized: using many muscles across the body.

Principles of Active FREE Exercises

• Relaxation: Encourage through rhythmic or pendulum (swinging) movements.
• Joint Mobility: Maintaining full range of movement.
• Strength and Endurance: Developing strength by doing exercises.
• Coordination: Improving coordination through the exercises.
• Circulatory and Respiratory Cooperation: Increases respiratory depth for increased heat production and enhanced blood circulation.

Goals of AROM

• Maintain muscle elasticity and contractility
• Provide sensory feedback from contracting muscles
• Stimulates bone and joint integrity
• Increases circulation and prevents thrombus (blood clot) formation
• Develops coordination

Technique of Active Free Exercise

• Starting Position: Maximum postural efficiency as a basis for movement.
• Instructions: To gain patient interest and cooperation.
• Speed: Depends on the desired result.
• Duration: Depends on patient capacity without reaching fatigue.
• Demonstration and Guidance: Demonstrate the exercise using PROM techniques and allow patient to perform movement, supporting or assisting as needed.

Passive vs. Active ROM

• Passive ROM: Only ligament/joint capsule complex is stressed; mover muscles are relaxed and not stressed.
• Active ROM: Both mover muscles and the ligament/joint capsule are stressed, potentially causing pain if the muscles/tendons are injured.

Manual Resistance

• Only the mover muscles are stressed during manual resistance, as the joint movement is stopped. Ligaments/joint capsule are not stressed.

Effects of Immobilization

• Fractures, surgeries, paralysis, muscle spasticity, arthritis, and pain result in extended immobilization periods.
• Bone Loss: Lack of muscle contraction and weight bearing leads to bone density loss.
• Cartilage Damage: Cartilage becomes thinner and loses its ability to absorb and dissipate force.
• Connective Tissue Changes: Fibrosis and adhesions can develop due to excess collagen fiber cross-links.
• Muscle Atrophy: Reduction in muscle size and contractile force can occur—slow-twitch fibers are impacted more.

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