Midterm L1 TheraEx ROM Exercises PDF

ROM EXERCISES DEFINITIONS PRECAUTIONS AND CONTRAINDICATIONS ROM: Basic technique used for the examination Should not disrupt the healing process of movement. If response will b...

ROM EXERCISES DEFINITIONS PRECAUTIONS AND CONTRAINDICATIONS ROM: Basic technique used for the examination Should not disrupt the healing process of movement. If response will be life-threatening the patient Range of Motion Exercise (ROMEx): Initiating PRINCIPLES OF ROM TECHNIQUES movement into a program of therapeutic intervention Functional excursion: The distance a muscle is EXAMINATION, EVALUATION, AND capable of shortening after it has been TREATMENT PLANNING elongated to its maximum. Examine and evaluate the impairments and level of Immobility: Physical restriction or limitation of function. body movements as a result of certain disease ○ Determine any precautions and prognosis, or treatment procedures. May result in different and plan of intervention. adverse effects on the different system of the Determine the ability to participate in the ROM body, including tightness and contractures. activity PASSIVE VS. ACTIVE INSUFFICIENCY ○ Note what type of ROM will achieve goals Decide on the patterns of movement Active insufficiency occurs when a multi-joint muscle ○ Anatomic plane vs muscle range of shortens across all joints simultaneously, reducing its elongation vs combined patterns vs ability to generate optimal tension and force. functional patterns Monitor the general condition and response during During full shoulder flexion, elbow flexion will and after the examination and intervention be limited (because the biceps brachii assists ○ Take vital signs, presence of pain, quality of with shoulder flexion, it cannot shorten during movement,change in ROM elbow flexion as much) Document and communicate findings and During hip flexion, knee extension will be intervention limited (because the rectus femoris does hip Re-evaluate and modify the intervention as needed flexion, it cannot shorten as much when you extend your knee) During full knee flexion, hip extension will be PATIENT PREPARATION limited. Communicate with the patient the plan of intervention Passive insufficiency occurs when a multi-joint muscle Remove all restrictive clothing; drape appropriately lengthens at all the joints it crosses. This limits the Position the patient comfortably maintaining proper range of motion at each joint as a muscle is typically not alignment and stabilization long enough to allow full range of motion Maintain proper biomechanics (therapist) simultaneously at each joint it crosses. APPLICATION Finger extension is limited when elbow is Stabilize and support appropriate areas of the joint. extended Move through pain-free ROM up to tissue resistance Hip flexion is limited when the knee is Perform smoothly and rhythmically from 5-15 reps extended (adjust as needed) Knee flexion is limited when the hip joint is extended  PASSIVE RANGE OF MOTION (PROM) EVIDENCE IN PRACTICE Movement of a segment within the unrestricted Is there evidence to suggest the effectiveness of ROM that is produced entirely by an external continuous passive motion following total knee force: there is little to or no voluntary muscle arthroplasty? contraction. KEY ARTICLES APPLICATIONS Grella, RJ (2008) Continuous passive motion Movement is being provided by an external force following total knee arthroplasty: a useful No active resistance or assistance is provided by the adjunct to early mobilization? A systematic muscles that cross the joint. review Performed within the available free ROM Brosseau L, et al (2004) Efficacy of continuous passive motion following total knee INDICATIONS arthroplasty: A meta analysis Lenssen AF, et al (2003) Continuous passive Acute or inflamed tissue where active motion motion following primary total knee may disrupt the normal healing process (usually arthroplasty: Short- and long term effects on lasts 2-6 days) range of motion When a patient is not able to or not supposed to actively move a segment or segments of the RESULTS/CONCLUSION body. Conflicting evidence on the effectiveness of Assessment purposes continuous passive motion following total knee Teaching a patient arthroplasty Preparation for stretching Potential benefits may need to be weighed against additional cost and inconvenience LIMITATIONS There is need for further trials to ascertain the True passive, relaxed ROM may be difficult to effects of using continuous passive motion obtain when muscle is innervated; and the post-total knee arthroplasty. patient is conscious. PROM does not: ○ Prevent muscle atrophy ACTIVE-ASSISTIVE RANGE OF MOTION (AAROM) ○ Increase strength or endurance ○ Assist circulation to the extent that Assistance is provided by an outside force (manual or active, voluntary muscle contraction mechanical), as the prime mover muscles is unable to does complete the motion GOALS Decrease the complications that would occur with immobilization, such as cartilage degeneration, adhesion and contracture formation, and sluggish circulation  ACTIVE RANGE OF MOTION (AROM) CONTINUOUS PASSIVE MOTION (CPM) Movement produced on a segment upon active Refers to passive motion performed by a mechanical contraction of the muscles crossing the joint device that moves a joint slowly and continuously within the unrestricted range of motion. through a controlled ROM The mechanical devices that exist for nearly every APPLICATIONS joint in the body were developed as a result of the Demonstrate the desired motion through PROM research by Robert Salter, who demonstrated that Ask the patient to perform the movement continuous passive motion has beneficial healing independently effects on diseased or injured joint structures and ○ Be ready to provide assistance or guidance soft tissues in animal and clinical studies when necessary Perform the motion within the available range BENEFITS Prevents development of adhesions and INDICATIONS contractures and thus joint stiffness When a patient is able to actively contract the Provides a stimulating effect on the healing of muscles and move the segment with or without tendons and ligaments assistance. Enhances healing of incisions over the moving joint Muscle weakness and inability to move segment Increases synovial fluid lubrication of the joint and completely against gravity. thus increases the rate of intra-articular cartilage Aerobic conditioning program healing and regeneration During periods of immobilization, AROM is used Prevents the degrading effects of immobilization in joints above and below the immobilized Provides a quicker return of ROM segment. Decreases postoperative pain LIMITATIONS AROM will not: ○ Maintain or increase strength of already strong muscles – only weight-bearing exercises will. ○ Develop skill or coordination except in the movement patterns used. GOALS Maintain elasticity and contractility of 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