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Questions and Answers
What is the primary purpose of starting position in assisted exercise?
What is the primary purpose of starting position in assisted exercise?
Which technique can enhance the efficiency of prime movers during assisted exercise?
Which technique can enhance the efficiency of prime movers during assisted exercise?
Why is it important to support the moved part during assisted exercise?
Why is it important to support the moved part during assisted exercise?
What does preliminary stretching of weak muscles in assisted exercise stimulate?
What does preliminary stretching of weak muscles in assisted exercise stimulate?
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In what way should the assistance force be applied during assisted movement?
In what way should the assistance force be applied during assisted movement?
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What is implied by AROM (Active Range of Motion) exercises?
What is implied by AROM (Active Range of Motion) exercises?
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Which benefit is NOT typically associated with AROM exercises?
Which benefit is NOT typically associated with AROM exercises?
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What is the primary purpose of range of motion (ROM) exercises?
What is the primary purpose of range of motion (ROM) exercises?
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Which of the following is NOT an intrinsic factor that affects joint range of motion?
Which of the following is NOT an intrinsic factor that affects joint range of motion?
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What is Passive Range of Motion (PROM)?
What is Passive Range of Motion (PROM)?
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Which external force is NOT typically associated with promoting Passive Range of Motion?
Which external force is NOT typically associated with promoting Passive Range of Motion?
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When might Passive Range of Motion exercises be indicated?
When might Passive Range of Motion exercises be indicated?
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Which of the following describes an effect of aging on joint range of motion?
Which of the following describes an effect of aging on joint range of motion?
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What is the role of passive movement for mobilization?
What is the role of passive movement for mobilization?
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Which method can be classified as an external force applied during passive range of motion exercises?
Which method can be classified as an external force applied during passive range of motion exercises?
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What is the main goal of passive range of motion (PROM) exercises?
What is the main goal of passive range of motion (PROM) exercises?
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Which outcome is NOT a specific goal of PROM?
Which outcome is NOT a specific goal of PROM?
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Which of the following conditions would contraindicate the use of PROM exercises?
Which of the following conditions would contraindicate the use of PROM exercises?
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Which of these is a limitation of passive motion?
Which of these is a limitation of passive motion?
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What aspect should be documented during the application of ROM techniques?
What aspect should be documented during the application of ROM techniques?
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When should re-evaluation of the intervention occur in ROM techniques?
When should re-evaluation of the intervention occur in ROM techniques?
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Which of the following best describes active assistive ROM (AAROM)?
Which of the following best describes active assistive ROM (AAROM)?
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What effect does PROM have on pain levels?
What effect does PROM have on pain levels?
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In which patient scenario is PROM most appropriate?
In which patient scenario is PROM most appropriate?
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What is a primary consideration before applying PROM?
What is a primary consideration before applying PROM?
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What should the magnitude of the assisting force be during active assisted exercises?
What should the magnitude of the assisting force be during active assisted exercises?
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Which of the following is not an effect of active assisted range of motion (AAROM) exercises?
Which of the following is not an effect of active assisted range of motion (AAROM) exercises?
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Which type of assistance involves the patient’s sound limb?
Which type of assistance involves the patient’s sound limb?
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What is a contraindication for performing AAROM exercises?
What is a contraindication for performing AAROM exercises?
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How does AAROM contribute to neuromuscular re-education?
How does AAROM contribute to neuromuscular re-education?
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Which of these is a benefit of regular exercise mentioned in the content?
Which of these is a benefit of regular exercise mentioned in the content?
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What is a recommended precaution during AAROM exercises?
What is a recommended precaution during AAROM exercises?
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Which type of assistance may involve specialized equipment like pulleys or a T-bar?
Which type of assistance may involve specialized equipment like pulleys or a T-bar?
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What should be decreased as muscular power increases during assisted exercises?
What should be decreased as muscular power increases during assisted exercises?
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Which of the following is an indication for AAROM exercises?
Which of the following is an indication for AAROM exercises?
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What is the first step in patient preparation before treatment?
What is the first step in patient preparation before treatment?
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What is the purpose of supporting areas of poor structural integrity during movement techniques?
What is the purpose of supporting areas of poor structural integrity during movement techniques?
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What characterizes relaxed passive movement according to the content?
What characterizes relaxed passive movement according to the content?
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Which of the following is NOT a benefit of continuous passive motion (CPM)?
Which of the following is NOT a benefit of continuous passive motion (CPM)?
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What defines Active Assisted Range of Motion (AAROM)?
What defines Active Assisted Range of Motion (AAROM)?
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How many repetitions of motion are generally recommended for treatment techniques?
How many repetitions of motion are generally recommended for treatment techniques?
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What is an important consideration when positioning the patient during treatment?
What is an important consideration when positioning the patient during treatment?
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What should you avoid when moving a segment through its range of motion?
What should you avoid when moving a segment through its range of motion?
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In what situation would AAROM be primarily utilized?
In what situation would AAROM be primarily utilized?
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Which statement about continuous passive motion (CPM) is true?
Which statement about continuous passive motion (CPM) is true?
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Study Notes
Range of Motion Exercises
- Range of motion (ROM) is the amount of movement at joints in certain directions or the range a body part can move around a joint.
- It's a basic technique used for:
- Examining movement (Goniometry)
- Starting a therapeutic intervention program.
Physical and Physiologic Considerations Related to Joint ROM
-
Intrinsic Factors:
- Shape and congruency of articulating bony surfaces
- Pliability of joint capsule, ligaments, and collagenous tissues
- Strength and flexibility of musculature acting on or crossing the joint
-
Extrinsic Factors:
- Aging decreases joint ROM
- Body segment size is related to muscle and adipose bulk within the segment
- Disease, injury, overuse, and immobilization affect joint tissues and ROM.
Types of ROM Exercises
- Passive ROM (PROM)
- Active ROM (AROM)
- Active-Assistive ROM (A-AROM)
Passive ROM (PROM)
- Definition: Movement of a segment within the unrestricted ROM produced entirely by an external force, without voluntary muscle contraction by the patient.
-
Sources of external force:
- Gravity
- Machine (Continuous Passive Motion)
- Another individual
- Another part of the individual's body.
Types of External Forces
-
Manual:
- Therapist
- Patient (unaffected body part)
- Gravity
-
Mechanical:
- Continuous Passive Motion (CPM)
Uses of Passive Range of Motion (PROM)
- Relaxed Passive Movement: Maintain full range of motion without restriction.
- Passive Movement for Mobilization: Breakdown adhesions, increase range of motion.
- Passive Movement for Stretching: Lengthen pathologically shortened soft tissue structures to increase joint range.
Indications of Passive Range of Motion (PROM)
- Coma
- Paralysis
- Immobilized joint
- Muscle re-education (teaching desired movement)
- Used before passive stretching
- Examination
Goals for PROM
- Main goal: Decrease complications of immobilization (cartilage degeneration, adhesion, contracture formation, sluggish circulation).
-
Specific goals:
- Maintain joint and connective tissue mobility
- Minimize effects of contracture formation
- Maintain mechanical elasticity of muscle
- Assist circulation and vascular dynamics
- Enhance synovial movement for cartilage nutrition
- Decrease or inhibit pain
- Assist in healing after injury or surgery
- Maintain patient's awareness of movement
Limitations of PROM
- Does not prevent muscle atrophy
- Does not increase strength or endurance
- Does not assist circulation as effectively as active voluntary muscle contraction
Precautions and Contraindications to PROM Exercises
- When the motion is disruptive to healing (unhealed fracture, open wound at the fracture site)
- When too much or wrong motion increases pain and inflammation
- At the site of effusion and swelling
- Immediately after ligament or tendon tear
- Uncontrolled high blood pressure
Principles and Procedures for Applying ROM Techniques
-
Examination, Evaluation, and Treatment Planning:
- History taking (patient report, relative report)
- General examination (Active ROM, Passive ROM, muscle strength)
- Select appropriate technique (AROM, PROM, AAROM)
- Monitoring the patient (response to exercise, vital signs, pain, ROM quality, warmth & color)
- Document and communicate findings & interventions
- Re-evaluation of the intervention as necessary
Patient Preparation
- Communicate with the patient
- Free region from restrictive clothing, linen, splints, dressings
- Cover other parts
- Position patient comfortably with proper body alignment & stability, allowing movement through available ROM
- Position yourself for proper body mechanics.
Application of Techniques
- To control movement, grasp extremity proximal and distal to target joint; grasp should be firm but not harmful.
- Support areas of poor structural integrity (hypermobile joint, recent fracture, paralyzed limb) so patient feels confident and relaxed.
- Move segment through complete pain-free range to tissue resistance; do not force beyond range (forces motion becomes stretching).
- Perform motions smoothly and rhythmically with 5-10 repetitions.
Characteristics of Relaxed Passive Movement
- Slowly
- Rhythmically
- Regular
- Through full range of motion (available)
Continuous Passive Motion (CPM)
- Continuous passive motion (CPM) refers to passive motion performed by a mechanical device that moves a joint slowly and continuously through a controlled ROM.
Benefits of CPM
- Prevents adhesions and contractures, thus preventing joint stiffness
- Stimulates healing of tendons and ligaments
- Enhances healing of incisions over the moving joint
- Increases synovial fluid lubrication, increasing intra-articular cartilage healing and regeneration
- Prevents the degrading effects of immobilization
- Provides a quicker return of ROM
- Decreases postoperative pain.
Definition of Active-Assistive ROM (AAROM)
- Movement performed within unrestricted ROM controlled by voluntary muscle contraction, with assistance from outside force (manual or mechanical) when muscle strength is inadequate to complete the motion.
- Muscle strength is less than grade 3 by manual muscle testing.
- Once patients gain ROM control, they progress to AROM.
The principles of active assisted exercises
- When voluntary muscle contraction is insufficient to produce movement.
- An external force may be added to complete the range
- Force is applied in the direction of muscle action.
- The assisting force magnitude is only sufficient to augment, not substitute, muscular action
- As muscular power increases, assistance decreases proportionally.
Types of Assistance
- Manual: Provided by therapist or patient
- Mechanical: Uses equipment (wand, T-bar, finger ladder, wall climbing, ball rolling, pulleys, skate board/powder board, reciprocal exercise devices)
Effects and uses of AAROM
- When patient has weakness (poor to fair minus muscle test grade)
- Maintain physiologic elasticity and contractility of participating muscles
- Provide sensory feedback for early neuromuscular re-education
- Provide stimulus for bone and joint tissue integrity
- Develop coordination and motor skills for functional activities
- Build patient confidence and cooperation
- Prevent Deep Vein Thrombosis (DVT)
Indications of AAROM
- Muscle weakness (disuse, after plaster cast)
- Muscle re-education
- Inability to do Activities of Daily Living (ADL)
- To increase ROM
- Following tendon or muscle transplantation
Contraindications of AAROM
- Swelling, fever and redness
- Immediately following myocardial infarction
- If active assisted exercises induce severe pain during movement
- Cardiopulmonary dysfunction
- Unhealed or unprotected recent fracture or recent surgical site
- In cases of deep vein thrombosis (DVT)
Precautions for ROM Exercises
- Avoid proximity and distally to the injured or immobilized joint to minimize venous and thrombus formation.
Technique of Assisted Exercise
- Starting position: Ensure patient's concentration on movement pattern and effort required
- Pattern of movement: Explain by performing it passively or actively on sound limb.
- Fixation: Fix proximal part of prime movers to improve efficiency; avoid trick movements
- Support: Support moved part to reduce load on muscles (pillows, boards, slings, manual support), countering gravity effect
- Traction: Preliminary stretching of weak muscle provides a powerful stimulus to the contraction (myotatic reflex) initiating movement.
- Antagonistic muscle: Select starting position to reduce tension in antagonistic muscles
- Assistance force: Apply force in direction of movement by therapist's hands
- Movement character: Smooth
- Repetitions: Depends on patient condition
- Patient cooperation: Encourage maximum effort
Active Free Exercise (AROM)
- Performed by patient's own muscular efforts within the unrestricted ROM.
- No assistance or resistance other than gravity.
AROM Classification
- Localized: strengthening specific muscle groups
- Generalized: using numerous muscles of the body.
Uses of AROM
- Relaxation: Induced by rhythmic or pendulum exercises
- Joint mobility: Maintains normal range of motion in the full range of movement
- Power and Endurance enhancement in working muscles
Goals for AROM
- Maintain participating muscle's physiologic elasticity and contractility.
- Provide sensory feedback from contracting muscles.
- Stimulate bone and joint integrity
- Increase circulation and prevent thrombus formation
- Develop coordination.
Technique of Active Free Exercise
- Starting position: Select and teach to maximize postural efficiency. Give instructions to gain interest & cooperation
- Speed: Depends on required effects
- Duration: Depends on patient capacity without reaching fatigue.
- Demonstration: Demonstrate the desired motion with PROM, and then guide the patient
Effects of Immobilization
- Fractures, surgery, paralysis, muscle spasticity, arthritis, and pain can result in extended periods of immobilization
Effects of Immobilization (details)
- Loss of bone density: Lack of muscle contraction & weight bearing leads to regional osteoporosis, delayed or incomplete recovery
- Articular cartilage: Reduces thickness & stiffness, impairing absorption and dissipation of joint forces
- Collagenous tissue: Fibrosis and adhesion caused by excessive collagen fiber cross-links
- Muscle tissue: Atrophy (reduction in muscle size & contractile force), especially in slow-twitch fibers.
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Description
This quiz explores the fundamental concepts of range of motion (ROM) exercises, including intrinsic and extrinsic factors affecting joint mobility. Learn about the different types of ROM exercises like passive, active, and active-assistive ROM. Understand how these exercises are essential for therapeutic interventions.
