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Questions and Answers

What does the assessment of Range of Motion (ROM) typically involve?

  • Gross and goniometric measurements in a planar manner (correct)
  • Only active motion measurements
  • Measurement of pain levels exclusively
  • Multiplanar assessments without testing for irritability

Which plane is shoulder abduction and adduction measured in?

  • Frontal plane (correct)
  • Sagittal plane
  • Transverse plane
  • Coronal plane

What can the presence of pain during active motion indicate?

  • Only muscle injuries
  • Full range of motion is expected
  • The condition is not acute
  • Possible inflammation or irritation of noncontractile tissues (correct)

What is a common misconception held by novice physical therapy students regarding pain during AROM assessment?

<p>Both motions reproduce the patient’s symptoms (A)</p> Signup and view all the answers

Which of the following motions involves shoulder flexion, adduction, and internal rotation?

<p>Reaching the hand to touch the opposite shoulder (B)</p> Signup and view all the answers

What is the primary characteristic of functional motion compared to planar motion?

<p>It typically combines motions in all three planes (C)</p> Signup and view all the answers

Which factor is not typically assessed when evaluating limited Active Range of Motion (AROM)?

<p>Patient's psychological state (D)</p> Signup and view all the answers

What implication does an evaluation of multiplanar motion have on patient treatment?

<p>It indicates that pain might not be reproduced during isolated motion tests (C)</p> Signup and view all the answers

What is a significant consequence of lack of movement in patients?

<p>Common functional impairments (C)</p> Signup and view all the answers

Which factor is generally associated with greater joint range of motion (ROM) in the population?

<p>Female gender (D)</p> Signup and view all the answers

Why might a clinician choose to have a patient lie down during assessment?

<p>To support the body part and improve patient relaxation (C)</p> Signup and view all the answers

How does age affect joint motion in elderly individuals?

<p>Progressive loss of available joint motion occurs (D)</p> Signup and view all the answers

Which scale type does the outer scale of a goniometer NOT include?

<p>One 0° point (C)</p> Signup and view all the answers

What is a potential source of pain during right lateral flexion in a patient?

<p>Left-sided muscular tightness (A)</p> Signup and view all the answers

Excessive soft tissue in a joint may cause which of the following?

<p>Impediment to reaching full range of motion (B)</p> Signup and view all the answers

What percentage of clinical instructors expected students to utilize goniometric measures primarily?

<p>27% (C)</p> Signup and view all the answers

What factor may pose a challenge for patients during PROM assessment of the cervical spine in a seated position?

<p>Difficulty in 'letting go' of the neck (C)</p> Signup and view all the answers

What component of a goniometer is aligned with a nonmoving reference point?

<p>Stationary arm (C)</p> Signup and view all the answers

What can limit the range of motion aside from pain in a patient?

<p>Intra-articular blocks and joint effusion (A)</p> Signup and view all the answers

Which of the following diseases is known to negatively affect joint motion?

<p>Rheumatoid arthritis (C)</p> Signup and view all the answers

What is the primary purpose of conducting a gross screening assessment of range of motion?

<p>To determine if detailed measurement is required (A)</p> Signup and view all the answers

How many scales does the inner scale of a goniometer consist of?

<p>One 0° point and two 180°–360° scales (A)</p> Signup and view all the answers

How does the position of a patient (supine or seated) affect range of motion assessment?

<p>Greater range of motion is often possible when supine (A)</p> Signup and view all the answers

What is an example of an intra-articular block that could limit range of motion?

<p>Bony malformation or cartilage flap (B)</p> Signup and view all the answers

What is the primary purpose of a goniometer in a clinical setting?

<p>To measure joint range of motion (A)</p> Signup and view all the answers

How should joint range of motion be quantified for accurate assessment?

<p>Using a goniometer or other device (A)</p> Signup and view all the answers

Which part of the goniometer allows for free motion in a circular pattern?

<p>Movement arm (B)</p> Signup and view all the answers

What typical changes in joint motion can occur in children under 2 years old?

<p>Mean values differ considerably from those of adults (A)</p> Signup and view all the answers

What should a clinician be cautious of during PROM assessment?

<p>Carrying out assessments with close attention to the patient (D)</p> Signup and view all the answers

Which of the following methods was expected to be used equally by 21% of clinical instructors?

<p>Both estimated ROM and goniometry (A)</p> Signup and view all the answers

What plays a role in clinical decision-making regarding patient positioning during motion assessments?

<p>Expected range of motion differences between positions (A)</p> Signup and view all the answers

What is the axis of rotation in a goniometer referred to as?

<p>Fulcrum (D)</p> Signup and view all the answers

What is the primary consideration when maneuvering a patient's limbs for motion assessment?

<p>Avoiding prolonged positions of pain or discomfort (D)</p> Signup and view all the answers

When is a standard goniometer not the ideal choice for measuring joint motion?

<p>When assessing motion in the thoracolumbar spine (A)</p> Signup and view all the answers

What should be noted before the patient moves through their range of motion?

<p>The starting measurement on the goniometer (D)</p> Signup and view all the answers

Which method provides adequate objective information for assessing thoracolumbar spine motion?

<p>Utilizing a tape measure (A)</p> Signup and view all the answers

What should be documented if an alternate testing position is used?

<p>The reason for the alternate position (A)</p> Signup and view all the answers

Which of the following statements about palpating bony landmarks is correct?

<p>It is essential for proper goniometer alignment (B)</p> Signup and view all the answers

Which of the following is a recommended practice when assessing joint motion?

<p>Ensuring the goniometer is repositioned between measurements (A)</p> Signup and view all the answers

What should be documented when documenting the goniometer's position?

<p>The alignment of the fulcrum, stationary arm, and movement arm (B)</p> Signup and view all the answers

What is the primary purpose of assessing passive range of motion (PROM) in a clinical setting?

<p>To evaluate the integrity of joint surfaces and local tissues (A)</p> Signup and view all the answers

Which statement regarding patient movements and limitations is accurate?

<p>Critical evaluation of movement patterns can help identify the source of limitations. (D)</p> Signup and view all the answers

Why is it essential to avoid assumptions about the type and localization of pain during assessment?

<p>Assumptions can lead to misdiagnosis and inappropriate treatment. (B)</p> Signup and view all the answers

What might cause a patient's perception of pain to differ during active and passive range of motion assessments?

<p>Reflexive muscle resistance may influence perceived pain levels. (C)</p> Signup and view all the answers

How should outcomes of PROM assessments be interpreted when a patient experiences pain?

<p>Specific focus should be placed on the location and characteristics of the pain. (C)</p> Signup and view all the answers

In the example given, why does the patient stop the knee flexion at approximately 75% of the expected normal range during active range of motion (AROM)?

<p>The patient experiences significant anterior knee pain. (C)</p> Signup and view all the answers

What is the implication of observing moderate effusion in a patient's knee during an assessment?

<p>Effusion suggests underlying inflammation or pathology. (A)</p> Signup and view all the answers

Why is it important to take note of how a patient describes their limitation in movement?

<p>A patient's description can inform potential sources of their limitations. (C)</p> Signup and view all the answers

Flashcards

Range of Motion (ROM)

The amount of movement possible at a joint.

Gross Screen of ROM

A quick initial assessment of the range of movement at a joint, often without precise measurement.

Active ROM

The range of motion a person can achieve by themselves.

Passive ROM

The range of motion a person can achieve when their joint is moved by another person.

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Goniometer

A tool used to measure the angle of a joint.

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Factors affecting ROM

Various elements that can restrict or increase the amount of a joint's movement (e.g., age, gender, body mass index, disease).

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Patient Problems

Problems related to limited or inefficient movement of the body.

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Physical Therapy Examination

Assessment of patient's movement and function to develop a treatment plan.

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Active Range of Motion (AROM)

The amount of movement a patient can achieve at a joint by themselves, requiring muscle contraction.

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Painful AROM

Limited or painful movement during active range of motion exercises, which could stem from various muscle and non-muscle (ligament, joint capsule) issues.

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Multiplanar Motion

Movement involving a combination of motions in multiple planes (e.g., flexion, extension, abduction, adduction).

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Planar Motion

Movement occurring within a single plane (e.g., sagittal, frontal, transverse).

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Irritated Tissues

Inflamed tissues (ligaments, joints, cartilage etc.), which can cause pain during both active and passive motion.

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Pain Description

Crucial to understand the nature of patient's pain and its relation to specific movements, to discover the source of the pain.

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Pain Reproduction

Determining if the pain reported during active motion is related to the patient’s usual pain or a different type of pain.

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Novice Error

Assuming both similar motions produce the same symptoms, without fully understanding the nature of the reported pain.

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Supine Position for PROM

Lying on the back for passive range of motion (PROM) assessment, often helpful for patient relaxation and accurate assessment, especially for the cervical spine.

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Pain & ROM

Pain can limit range of motion, possibly due to irritated joint structures or protective muscle guarding.

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PROM in Seated vs Supine

Passive range of motion (PROM) assessment may be more accurate and comfortable in the supine position compared to a seated position, especially for the cervical spine.

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Factors limiting ROM

Range of motion (ROM) can be limited by factors like joint issues (blocks, effusions, etc.), muscle tightness, or insufficient muscle strength.

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Articular Dysfunction

Problems within a joint, like inflammation or damage, can cause pain and limit movement.

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Protective Guarding

Muscle tightness developed in response to pain or injury to protect a specific part of the body. This can mimic restricted ROM.

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Supine Assessment Benefit

Lying down (supine) supports the body, potentially improving patient relaxation and more precise measurement of passive ROM.

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Patient Relaxation & Assessment

Patient relaxation during a physical examination, particularly when assessing passive range of motion, can lead to more accurate movement evaluation.

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Passive Range of Motion (PROM)

The range of motion a joint can achieve when it's moved by another person, not the patient.

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Evaluating Patient Movement

Assessing patient movement and how they describe it; considering facial expressions, muscle resistance, and quality of motion.

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Patient Pain Description

Gathering information about the location, type, and intensity of patient pain related to movement.

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Anterior Knee Pain

Pain in the front of the knee, often triggered by specific movements like going up stairs or running.

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Knee Effusion

Swelling in the knee, often impacting range of motion.

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Active Range of Motion (AROM)

The range of motion a patient achieves independently in a joint by using their own muscles.

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Limitation in PROM

Restricted range of motion observed when another person moves the patient's joint passively.

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End Feel

The sensation experienced when a joint reaches its limit of motion in PROM. It can help determine the cause of the limitation.

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Goniometer Parts

A goniometer has a fulcrum (center), stationary arm, and a movement arm, which allows for joint angle measurement.

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Goniometer Use (Clinicians)

Clinicians primarily use goniometry to measure joint range of motion (ROM).

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Different ROM Scales

Goniometers have varying scale configurations (0°, 0°–90°, 0°–180°, 180°–360°), accommodating diverse starting positions.

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Fulcrum in Goniometry

The fulcrum (or axis) is located at the center of the joint in its axis of rotation.

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Stationary vs. Moving Arm

The stationary arm is fixed, while the moving arm is attached to the body for precise motion measurement.

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Estimated vs. Measured ROM

Clinicians may estimate ROM; or use goniometry for more precise results.

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Importance of Goniometer Scales

Different scales (e.g., 0-90, 0-180) accurately measure joints from various starting points, enhancing clinical assessment.

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Goniometry Reliability

Goniometry is generally reliable for measuring joint range of motion, though results can vary.

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Goniometer use

A tool to measure joint angles, aligned with bony landmarks for accurate motion measurement based on a pre-defined starting position, moving to the end-position.

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Alternative Measuring Methods

Methods used for measuring motions like lumbar spine flexion, extension, and rotation where a goniometer is not ideal. For example, a tape measure is appropriate for these motions.

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Patient comfort

Prioritizing patient comfort during the measurement process. Avoid prolonged positions of pain or discomfort during assessment procedures.

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Patient Position

Patients should be placed in a comfortable position for testing, but alternate positions may be used if needed, as long as those positions are meticulously documented.

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Limb Movement Assessment

Techniques to assess range of motion (ROM) through a targeted limb movement, such as flexion or abduction, while maintaining the position of the goniometer's parts to track the movement accurately.

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Estimated Range of Motion

Preliminary assessment of a patient's achievable range of motion (ROM), based on previous data or examination.

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Determining the Specific Measurement

Identifying precise measurement methods and appropriate instruments used as the test proceeds.

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Active Range of Motion (AROM)

The maximum range of movement a patient can achieve independently at a joint by themselves.

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Study Notes

Introduction to Range of Motion

  • Physical therapy frequently addresses movement limitations
  • Screening assessments gauge the quantity and quality of joint motion (regional, local, global).
  • Gross ROM screening is sometimes sufficient, while other times formal measurement (goniometry) is needed.
  • Normal ROM varies by age, sex, body mass index and cultural factors.
  • Active ROM (AROM) is movement by the patient; Passive ROM (PROM) involves assistance.

Factors Affecting ROM

  • Age: Children (under 2 years) and elderly show different trends in loss of movement
  • Gender: Females generally exhibit greater tissue elasticity
  • Body mass index (BMI): Excessive tissue can limit possible motion
  • Disease: Inflammatory and degenerative diseases reduce ROM
  • Occupation/recreation: Repeated movements, stretching, result in ROM adaptation
  • Culture: Certain activities or postures are common in some cultures.

Fundamental Concepts of Active Range of Motion (AROM)

  • Observation of AROM reveals a patient's motivation, coordi- nation, motor control, force production and potential limita- tions.
  • Painful or limited ROM requires further investigation.

Fundamental Concepts of Passive Range of Motion (PROM)

  • Assessing a patient's PROM offers insight into joint integrity, tissues extensibility, and potential tissue irritability.
  • PROM is more useful than AROM in detecting sensitive tissue inflammation.

Joint End Feels

  • Provides indications of possible pathology; used to determine the severity and acuity.
  • Classification systems detail normal and abnormal end feels (bone-to-bone, soft tissue approximation, tissue stretch).

Quantifying Gross ROM

  • Goniometry provides precise and objective ROM measurement.
  • Visual estimation may be appropriate in some clinical situa- tions for specific types of assessments.

Documentation

  • Using terms like “within normal limits” and “within functional limits” should be done cautiously and in adherence with clinical guidelines of the specific facility.

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