ROM Exercise PDF

ROM exercise Dr. Meeyoung Kim Therapeutic Exercise Physiotherapy Dept. University of Sharjah  Contents Types of ROM Exercises Indications, Goals, and Limitations of ROM Exercises Precautions and Contraindications to ROM Exercises Princi...

ROM exercise Dr. Meeyoung Kim Therapeutic Exercise Physiotherapy Dept. University of Sharjah  Contents Types of ROM Exercises Indications, Goals, and Limitations of ROM Exercises Precautions and Contraindications to ROM Exercises Principles and Procedures for Applying ROM Techniques ROM Techniques Continuous Passive Motion  Range of motion is a basic technique used for the examination of movement and for initiating movement into a program of therapeutic intervention. The structure of the joints, integrity and flexibility of the soft tissues affects the amount of motion. The full motion possible is called ROM.  ROM activities are most easily described in terms of joint range and muscle range. To describe joint range, terms such as flexion, extension, abduction, adduction, and rotation are used. measured with a goniometer and recorded in degrees.  Jt range: flexion, extension… Ms range: functional excursion of muscle. It is the distance a muscle is capable of shortening after it has been elongated to its maximum. Directly influenced by jt it crosses One jt ms Vs 2 jt ms.  When a ms crosses 2 or more jts, it performs simultaneous actions at all the involved jts. Ms is unable to produce effective tension at all jts = active insufficiency = inability to shorten  ROM is limited by length of ms = Passive insufficiency = inability to lengthen  Types of ROM Exercises Passive ROM. (PROM) is movement of a segment within the unrestricted ROM that is produced entirely by an external force; no voluntary muscle contraction. PROM and passive stretching are not synonymous. Active ROM. (AROM) is movement of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing that joint. Active-Assistive ROM. (A-AROM) is a type of AROM in which assistance is provided by an outside force. Indications, Goals, and Limitations of ROM  Indications, Goals, and Limitations of ROM Passive ROM Indications acute, inflamed tissue When a patient is not able to or not supposed to actively move. comatose, paralyzed, or on complete bed rest.  Indications, Goals, and Limitations of ROM Goals for PROM To decrease the complications that would occur with immobilization Maintain joint and connective tissue mobility. Minimize the effects of the formation of contractures. Maintain mechanical elasticity of muscle. Assist circulation and vascular dynamics. Enhance synovial movt for cartilage nutrition and diffusion of materials in jt. Decrease or inhibit pain. Assist with the healing process after injury or surgery. Help maintain the patient’s awareness of movement.  Indications, Goals, and Limitations of ROM Other uses of PROM When a therapist is examining inert structures, PROM is used to determine limitations of motion, joint stability, muscle flexibility and other soft tissue elasticity. When a therapist is teaching an active exercise program, PROM is used to demonstrate the desired motion. When a therapist is preparing a patient for stretching, PROM is often used preceding the passive stretching techniques. You could find out end-feels of range of motion (Search activity: end feels range of motion in physiopedia)  Indications, Goals, and Limitations of ROM Limitations of PROM True passive, relaxed ROM may be difficult to obtain when muscle is innervated, and the patient is conscious. Passive motion does not: Prevent muscle atrophy. Increase strength or endurance. Assist circulation to the extent that active, voluntary muscle contraction does.  Indications, Goals, and Limitations of ROM AROM (and AAROM) Indications When a patient can contract the muscles actively and move a segment with or without assistance AROM can be used for aerobic conditioning programs and is used to relieve stress from sustained postures.  Weak musculature and unable to move through the desired range (usually against gravity), AAROM is used. Progressed to resistance exercises to improve muscle performance. When a segment of the body is immobilized for a period, AROM is used on the regions above and below the immobilized segment to maintain the areas in as normal a condition as possible and to prepare for new activities.  Indications, Goals, and Limitations of ROM Goals for AROM If there is no inflammation or contraindication to active motion, the same goals of PROM can be met with AROM. In addition, Maintain physiological elasticity and contractility of the participating muscles. Provide sensory feedback from the contracting muscles. Provide a stimulus for bone and joint tissue integrity. Increase circulation and prevent thrombus formation. Develop coordination and motor skills for functional activities.  Indications, Goals, and Limitations of ROM Limitations of AROM For strong muscles, active ROM does not maintain or increase strength. It also does not develop skill or coordination except in the movement patterns used.  Precautions and Contraindications to ROM Exercises contraindicated immediately after acute tears, fractures, and surgery; but early controlled motion is used so long as the patient’s tolerance is monitored.  Self-Assisted ROM Patient involvement in self-care should begin as soon as the individual is able to understand and learn what to do! After surgery or traumatic injury, self-assisted ROM (S-AROM) is used to protect the healing tissues when more intensive muscle contraction is contraindicated. Could be a part of the home exercise program  Self-Assisted ROM Unilateral weakness or paralysis or during early stages of recovery after trauma or surgery, the patient can be taught to use the uninvolved extremity to move the involved limb. Relationship btw Gravity-Agonist (prime mover: concentric control)-Antagonist (eccentric control): depends on direction of mvmt and pt’s positioning  Self-Assisted ROM ROM Using Equipment Wand (T-Bar) Exercises Wall Climbing/ Finger ladder Overhead Pulleys Skate Board/Powder Board Reciprocal Exercise Unit  Continuous passive motion (CPM) refers to passive motion performed by a Continuous mechanical device that moves a joint slowly and continuously through a Passive Motion controlled ROM. More to look: https://www.youtube.com/watch?v=UC2 QPlL7hn8  CPM Benefits of CPM Effective in lessening the negative effects of joint immobilization Also, improves the recovery rate and ROM after a variety of surgical procedures. Prevents development of adhesions, contractures -> joint stiffness Provides a stimulating effect on the healing of tendons and ligaments Enhances healing of incisions over the joint Increases synovial fluid lubrication of the joint ->increases the rate of intra-articular cartilage healing and regeneration Prevents the degrading effects of immobilization Provides a quicker return of ROM Decreases postoperative pain  CPM General Guidelines for CPM The device may be applied to the involved extremity immediately after surgery while the patient is still under anesthesia or as soon as possible if bulky dressings prevent early motion. The arc of motion: Often a low arc of 20˚ to 30˚ is used initially and progressed 10˚ to 15˚ per day as tolerated. The portion of the range used initially is based on the range available and patient tolerance. The rate of motion: usually 1 cycle/45 sec or 2 min is well tolerated.  CPM The amount of time: varies for different protocols from continuous for 24 hours to for 1 hour three times a day. The duration minimum for CPM: less than 1 week or when a satisfactory range of motion is reached. home use is possible. CPM machines are designed to be adjustable, easily controlled, versatile, and portable.  Indications › Pain relief for patients with chronic low back pain (LBP) › Extensive joint contracture › CPM may be used to maintain or improve ROM following: Joint reconstructive surgery or arthroplasty –Knee arthroplasty –Anterior cruciate ligament (ACL) reconstruction –Rotator cuff repair –Elbow Surgical procedures involving articular cartilage that require non-weight-bearing  CPM Contraindications Unstable fracture Uncontrolled/untreated infection Spastic paralysis Deep vein thrombosis (DVT) Poor patient compliance  CPM Precautions Significant bleeding Sensory impairments Compromised joint soft tissue constraints Skin irritation May elicit pain of the involved extremity Principles and Procedures for Applying ROM Techniques  Principles & Procedures for applying ROM Examination, Evaluation, and Treatment Planning 1. Examine and evaluate the patient’s impairments and level of function 2. Determine the ability of the patient to participate in the ROM activity and whether PROM, A-AROM, or AROM 3. Determine the amount of motion that can be applied safely 4. Decide what patterns. a. Anatomic planes of motion: frontal, sagittal, transverse b. Muscle range of elongation: antagonistic to the line of pull of the muscle c. Combined patterns: diagonal motions or movements that incorporate several planes of motion d. Functional patterns: motions used in activities of daily living (ADL) 5. Monitor the patient’s general condition and responses 6. Document and communicate findings and intervention. 7. Re-evaluate and modify the intervention as necessary.  Principles & Procedures for applying ROM Patient Preparation 1. Communicate with the patient. Describe the plan and method of intervention to meet the goals. 2. Free the region from restrictive clothing, linen, splints, and dressings. Drape the patient as necessary. 3. Position the patient in a comfortable position with proper body alignment and stabilization but that also allows you to move the segment through the available ROM. 4. Position yourself so proper body mechanics can be used.  Principles & Procedures for applying ROM Application of Techniques 1. Grasp the extremity around the joints. If the joints are painful, modify the grip. 2. Support areas of poor structural integrity, such as a hypermobile joint, recent fracture, or paralyzed. 3. Move the segment through its complete pain-free range to the point of tissue resistance. Do not force beyond the available range. If you force motion, it becomes a stretching technique. 4. Perform the motions smoothly and rhythmically, with 5 to 10 repetitions. The number of repetitions depends on the objectives of the program and the patient’s condition and response to the treatment.  Principles & Procedures for applying ROM Application of PROM 1. During PROM the force for movement is external. When appropriate, a patient may provide the force and be taught to move the part with a normal extremity. 2. No active resistance or assistance is given by the patient’s muscles that cross the joint. If the muscles contract, it becomes an active exercise. 3. The motion is carried out within the free ROM—that is, the range that is available without forced motion or pain.  Principles & Procedures for applying ROM Application of AROM 1. Demonstrate the motion desired using PROM; then ask the patient to perform the motion. 2. Provide assistance only as needed for smooth motion. When there is weakness, assistance may be required only at the beginning or the end of the ROM, or when the effect of gravity has the greatest moment arm (torque). 3. The motion is performed within the available ROM.  ROM Techniques When making the transition from PROM to AROM, gravity has a significant impact CLINICAL TIP especially in individuals with weak musculature. When transitioning from PROM to AROM, vary patient position in order to use Consider the gravity!! gravity to either assist or resist the motion. When moving parallel to the ground (gravity eliminated or gravity neutral) Functional activities that are antigravity When the part moves downward, muscles will require assistance when muscles are less antagonist to the motion become active and than 3/5 in strength. controlling the descent of the part. The therapist must be aware of these effects and modify the patient’s position if needed  ROM technique The following descriptions are with the patient in the supine position. Alternate positions are possible. For efficiency, perform all motions possible in one position; then change the patient’s position and perform all appropriate motions in that position, progressing the treatment with minimal turning of the patient. Individual body types or environmental limitations might necessitate variations of the suggested hand placements. Use of good body mechanics by the therapist while applying proper stabilization and motion to the patient to accomplish the goals and avoid injury to weakened structures is the primary consideration. Any questions?