Passive and Active Range of Motion Quiz

ROM Exercise Overview

• ROM exercise is a technique to examine and initiate movement for therapeutic intervention.
• Joint structure, soft tissue integrity and flexibility impact the amount of motion possible.
• The full range of motion is called ROM.

Types of ROM Exercises

• Passive ROM (PROM): Movement produced by an external force, no voluntary muscle contraction. Not synonymous with passive stretching.

• Active ROM (AROM): Movement produced by active contraction of muscles crossing the joint.

• Active-Assisted ROM (A-AROM): A type of AROM with assistance from an outside force.

Indications for Passive ROM (PROM)

• Acute, inflamed tissue.
• Patient unable to actively move (e.g., comatose, paralyzed, complete bed rest).

Goals for Passive ROM (PROM)

• Reduce complications of immobilization
• Maintain joint and connective tissue mobility.
• Minimize formation of contractures.
• Maintain muscle elasticity.
• Assist circulation and vascular dynamics.
• Enhance synovial movement for cartilage nutrition and material diffusion.
• Decrease or inhibit pain.
• Aid in healing after injury or surgery.
• Maintain patient awareness of movement.

Other Uses for PROM

• Determine limitations of motion, joint stability, muscle flexibility, and soft tissue elasticity during examinations.
• Demonstrate desired motion when teaching active exercises.
• Prepare patients for stretching using passive stretching techniques.
• Determine end-feels of range.

Limitations of Passive ROM (PROM)

• Difficult to obtain true passive range when muscles are innervated and the patient is conscious.
• Does not prevent muscle atrophy, increase strength, or significantly assist circulation compared to active muscle contractions.

Indications for Active ROM (AROM) and Active-Assisted ROM (A-AROM)

• When a patient can contract muscles actively, with or without assistance.
• Aerobic conditioning programs.
• Relieving stress from sustained postures.
• Weak musculature or inability to move through full range of motion.
• Immobilized body segments to maintain nearby areas in a normal condition and prepare for new activities.

Goals for Active ROM (AROM)

• Maintain physiological elasticity and contractility of muscles involved.
• Provide sensory feedback from contracting muscles.
• Stimulate bone and joint tissue integrity.
• Enhance circulation and prevent thrombus formation.
• Develop coordination and motor skills for functional activities.

Limitations of Active ROM (AROM)

• Does not maintain or increase strength in strong muscles.
• Does not develop motor skills or coordination except for used movement patterns.

Precautions and Contraindications to ROM Exercises

• Contraindicated immediately after acute tears, fractures, or surgery, but early controlled motion is acceptable if patient tolerates it.
• Avoid disruptive motions to the healing process.
• Avoid signs of excessive pain or inflammation.
• Don't proceed with ROM if the patient's condition is life-threatening.
• Use caution with patients who have unstable fractures, uncontrolled infections, spasticity, deep vein thrombosis (DVT) or poor compliance.
• Avoid motions that cause significant bleeding, sensory impairments, compromised joint soft tissue constraints, skin irritation, or pain in the involved extremity.

Self-Assisted ROM

• Patient involvement begins as soon as possible to understand and learn self-care.
• Used after surgery or trauma to protect healing tissues from more intensive muscle contraction.
• May be incorporated into a home exercise program.
• Patients with unilateral weakness or paralysis during early recovery may use uninvolved extremity.

Equipment for ROM Exercises

• Wand (T-Bar)
• Wall climbing/finger ladder
• Overhead pulleys
• Skateboard/powder board
• Reciprocal exercise unit

Continuous Passive Motion (CPM)

• Passive motion performed by a mechanical device that moves a joint.
• Controlled range of motion.
• Helpful after certain surgical procedures to lessen negative effects of immobilization and improve recovery rate.

Benefits of CPM

• Reduces immobilization's negative impacts.
• Can improve recovery rate.
• Prevents adhesions, contractures, and joint stiffness.
• Enhances tendon and ligament healing.
• Enhances synovial fluid lubrication for cartilage healing.
• Prevents immobilization's degrading effects.
• Reduces post-operative pain.

General Guidelines for CPM

• Apply the device to the affected extremity immediately after surgery or as soon as possible.
• Start with a limited arc of motion (e.g., 20-30 degrees).
• Gradually increase the arc of motion by 10-15 degrees per day as tolerated.
• Maintain a consistent rate of motion (e.g., 1 cycle every 45 seconds or 2 minutes).

Duration of CPM

• Usually less than a week or until satisfactory range of motion is achieved.
• Can sometimes be used at home.

Indications for CPM

• Chronic low back pain (LBP).
• Extensive joint contractures.
• Joint reconstructive surgery or arthroplasty (e.g., knee, ACL reconstruction, rotator cuff, elbow).
• Surgical procedures involving cartilage that require non-weight bearing.

Contraindications for CPM

• Unstable fracture.
• Uncontrolled/untreated infection.
• Spastic paralysis.
• Deep vein thrombosis (DVT).
• Poor patient compliance

CPM Precautions

• Significant bleeding.
• Sensory impairments.
• Compromised joint soft tissues.
• Skin irritation.
• May cause extremity pain.

Principles and Procedures for Applying ROM Techniques

• Grasp the extremity around the joints. Modify grip if joints are painful.
• Support areas with poor structural integrity (hypermobile joints, recent fractures, paralysis).
• Move the segment through its complete pain-free range up to the point of resistance. Avoid forcing beyond available range.
• Perform motions smoothly and rhythmically, with 5 to 10 repetitions (depending on the program's goals and patient's response).

Examination, Evaluation, and Treatment Planning

• Evaluate patient's impairment and function.
• Determine patient's ability to participate.
• Determine safe ROM application amounts.
• Identify anatomic and functional motion patterns.
• Monitor the patient's conditions and responses.
• Document and communicate findings and interventions.
• Re-evaluate and modify interventions as needed.

Patient Preparation

• Communicate treatment plan to the patient.
• Free the affected area from restrictive clothing, linens, splints, and dressings.
• Position the patient comfortably with proper body alignment and stabilization for available ROM.
• Position yourself for proper body mechanics.

Examination, Evaluation, and Treatment Planning for ROM Techniques

• Evaluate patient impairments and functionality.
• Assess patient's participation ability and suitability for varied ROM exercises (PROM, A-AROM, AROM)..
• Determine safe amount of movement possible.
• Decide on appropriate motion patterns for treatment (anatomical planes, muscle range elongation, combined patterns, functional patterns).
• Monitor patient's overall condition and responses during treatment.
• Document and communicate findings and treatment plan.
• Reassess and regularly modify the course of action if necessary.

Test your understanding of Passive Range of Motion (PROM) and Active Range of Motion (AROM) with this quiz. It covers essential concepts including joint movement, muscle function, and limitations of ROM exercises. Perfect for students in physical therapy or related fields.