PT Fundamentals Week 10 - Lower Quarter Range of Motion Testing (Transcripts)

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What primarily determines the sensation of an end-feel during passive range of motion testing?

The patient's psychological state

The unique structure of the joint being assessed (correct)

The strength of the muscles around the joint

The therapist's technique and experience

What indicates a hypomobile joint during passive range of motion assessment?

A firm end-feel when approaching the limit

End-feel occurring sooner than the expected normative (correct)

End-feel occurring later in the range of motion

No sensation felt during movement

During passive range of motion assessment, what can pain primarily indicate?

The patient’s active engagement level

Stretching of contractile tissues only

Muscle fatigue from previous activity

Movement or pinching of non-contractile tissues (correct)

What characterizes an abnormal end-feel?

The absence of resistance, termed an empty end-feel Signup and view all the answers

Which of the following statements about passive range of motion is correct?

Passive range can help assess the integrity of joint surfaces. Signup and view all the answers

Which factor is commonly associated with increased hypermobility in individuals?

Age Signup and view all the answers

What is an important consideration when comparing range of motion findings?

Contralateral extremity Signup and view all the answers

What is a critical precaution to consider during range of motion testing?

Presence of pain Signup and view all the answers

What should be measured in centimeters rather than degrees during range of motion assessments?

Spinal movement Signup and view all the answers

What is indicated by a likely increase in active range of motion when compared to passive range of motion?

Muscle tightness Signup and view all the answers

What is the significance of the 'neutral zero method' in measuring range of motion?

It provides a universal scale ranging from 0 to 180 degrees. Signup and view all the answers

How does the position of a patient affect the measurement of active range of motion?

The anatomical position is always the starting point for measurement. Signup and view all the answers

What role does the goniometer play in assessing range of motion?

It measures angles created by bones at the joints. Signup and view all the answers

Which component of the goniometer is crucial for ensuring accurate measurements?

The axis of rotation must align with the joint axis. Signup and view all the answers

When measuring shoulder flexion in a prone position, what should be considered?

Movement from 0 to 90 degrees is assisted by gravity. Signup and view all the answers

What does active range of motion (AROM) primarily indicate about the individual being assessed?

The range of motion available in the joints without assistance. Signup and view all the answers

Which factor might suggest that additional testing is necessary after assessing active range of motion?

The occurrence of pain during the active range of motion. Signup and view all the answers

What is the primary purpose of assessing passive range of motion after active range of motion shows limitations?

To clarify the nature of the problem when active movement is painful. Signup and view all the answers

What characterizes active-assistive range of motion (AAROM)?

External assistance facilitates some of the muscle's motion. Signup and view all the answers

Which of the following best describes what may cause pain during active range of motion?

Pinching of muscles and tendons connecting to bones. Signup and view all the answers

Study Notes

Range of Motion Testing - Precautions and Contraindications

Precautions are factors that may modify the way range of motion is assessed, but do not entirely prevent it.
- Pain: May influence the order of assessment or postpone the procedure to a later visit.
- Suspected or Confirmed Joint Dislocation: Requires careful consideration and may necessitate modifications to the procedure.
- Joint Subluxation: Similar to dislocation, requires cautious handling and potential adaptations to the assessment.
- Unstable Bony Fracture: The presence of an unstable fracture necessitates more conservative assessment.
- Rupture of a Tendon or Ligament: Demands careful consideration and may be postponed until the tissue has stabilized.
- Infectious or Acute Inflammatory Process: Testing may be contraindicated due to the risk of spreading infection or exacerbating inflammation.
- Severe Osteoporosis: The risk of fractures during the assessment requires careful consideration and possibly a modification of procedure.
Contraindications are absolute limitations, meaning range of motion testing should not be performed.
- Healing Fracture Site: Avoid testing to prevent disruption of healing and potential fracture displacement.
- Healing Surgical Site: Testing should be avoided until the surgical site has adequately healed to minimise risk of disruption and infection.
- Severe and Acute Soft Tissue Trauma: Testing may be contraindicated due to the risk of further damage and exacerbation of the injury.
- Life Threatening Condition: Range of motion testing is not a priority when a patient's life is at risk, and should be postponed.
- Immobilized Joint: Range of motion testing is not possible with an immobilized joint.

Performing Range of Motion Testing

There are three main components to the process of performing ROM testing:
- Prepare for testing: Review medical record, determine precautions and contraindications, and select joints to assess.
- Explain procedure to the patient and gain consent: This ensures patient understands the procedure and agrees to participate.
- Testing procedure: This involves a series of steps which will be detailed later in the lecture.

Preparing for Goniometry Assessment

Gather specific movement limitations/pain points from the systems review during patient evaluation.
Structure the testing sequence by body position: Aim for grouping tests in sitting, supine, prone and side-lying positions, minimizing patient movement.
Prepare necessary equipment and supplies:
- A goniometer for measurement.
- A towel for certain joints and movements.
- Documentation tools (laptop, pen, paper).
Explain the procedure to the patient:
- Clearly state the purpose of the testing (e.g., "I want to measure the range of motion at your elbow").
- Explain the equipment being used (e.g., "This instrument is called a goniometer").
- Explain the process and what to expect during the assessment, including potential for exposure (e.g., "To find these landmarks, you may need to remove your shirt").
- Gain patient consent for the procedure.

Goniometry Testing Procedure

12 individual steps
Step 1: Positioning the patient in the recommended testing position, close to the edge of the bed or plinth. The therapist should position themselves close to the body part being tested, maximizing their body mechanics.
Step 2: Stabilizing the proximal joint segment to isolate motion of the joint being tested and prevent excessive compensatory movements from adjacent joints. Stabilization is achieved through patient position and manual therapist intervention.
Step 3: Passively moving the distal joint segment from the zero-degree starting position to the end of the available passive range of motion. This should be done slowly, assessing for end-feel and pain.
Step 4: Gaining a visual estimate of the available range of motion, within at least ten degrees of accuracy.
Step 5: Returning the patient back to the starting position.
Step 6: Palpating the bony anatomical landmarks needed for goniometer alignment, including the axis of rotation and the positions for the proximal stationary arm and the moving distal arm. (This step is only performed if needed.)
Step 7: Aligning the goniometer based on anatomical landmarks (only performed if the patient was unable to reach a zero starting position).
Step 8: Measuring the starting position and removing the goniometer.
Step 9: Stabilizing the proximal joint segment.
Step 10: Moving the distal segment through the full range of motion actively or passively.
Step 11: Realigning the goniometer and palpating the anatomical landmarks at end-range.
Step 12: Measuring the difference from the starting position (if impaired) to the end position and recording the findings.

Clinical Pearls for Accurate Goniometry

Use an appropriate goniometer size: Select a goniometer with an arm length comparable to the segment being measured.
Ensure correct goniometer reading: Practice reading the goniometer and ensure it’s turning the right way, with clear visibility of the numbers. Read from the correct side of the goniometer.
Make initial visual estimations: Before placing the goniometer, perform visual estimations of range of motion to avoid significant measurement discrepancies.
Maintain eye level: Keep the goniometer at eye level to prevent parallax effects and ensure accuracy.
Be aware of stationary and moving arms: Understand the functionality of stationary and moving arms on the 180-degree goniometer.
Recognize clinically meaningful change: Understand that an improvement of greater than 5 degrees is clinically meaningful and signifies real change.

Clinical Applications of Goniometry

Objectively measure joint impairments: Helps determine the presence, absence or changes in impairments.
Establish diagnosis: Assists in establishing a diagnosis.
Develop prognosis and treatment goals: Provides a framework for developing prognosis and creating treatment goals.
Evaluate progress: Allows for measuring the effectiveness of interventions and tracking progress.
Determine need for treatment modification: Identifies whether treatment approaches need adjustment based on lack of improvement.
Enhance patient motivation: Shares objective data with patients, motivating them to engage with physical therapy and home exercise programs.
Track treatment effectiveness: Used to track the effectiveness of various treatments.
Fabrication of orthotics and adaptive equipment: Provides data to guide the fabrication of orthotics and adaptive equipment for patients.

Essential Knowledge for Goniometry Assessment

Understand the entire goniometry process: preparation, patient explanation, consent and the 12 testing steps.
Know the normal end-feel for each joint.
Know the normative AAOS values for each joint and movement.

References

Ensure you provide the specific references used for the provided goniometry information.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers important precautions and contraindications for conducting range of motion testing. Learn about factors that could modify the assessment process, such as pain, joint dislocation, and other conditions that may necessitate careful handling. Understanding these precautions will enhance your clinical practice and patient safety.