passive movement.pdf

Dr Rehab Saleh Passive movement Range of motion: The amount of movement that occurs at a joint is the ROM of the joint. Tissue flexibility refers to the ability of tissue (ex, a muscle or tendon….) to lengthen to allow normal joint motion Bones move with respect to each other at the connecting...

Dr Rehab Saleh Passive movement Range of motion: The amount of movement that occurs at a joint is the ROM of the joint. Tissue flexibility refers to the ability of tissue (ex, a muscle or tendon….) to lengthen to allow normal joint motion Bones move with respect to each other at the connecting joints. The structure of the joints, as well as the integrity and flexibility of the soft tissues that pass over the joints, affects the amount of motion that can occur between any two bones. The full motion possible is called the range of motion (ROM). When moving a segment through its ROM, all structures in the region are affected: muscles, joint surfaces, capsules, ligaments, fasciae, vessels, and nerves. To maintain normal ROM, the segments must be moved through their available ranges periodically. It is recognized that many factors can lead to decreased ROM, diseases, surgical or trauma; or simply inactivity or immobilization for any reason. Therapeutically, ROM activities are administered to maintain joint and soft tissue mobility to minimize loss of tissue flexibility and contracture formation. Joints are structured so that motion is limited by the capsule, ligaments, and tendons, or by the bony configuration. Some motions are limited by soft tissue bulk of the segments. For instance, elbow flexion is usually limited by the muscle bulk of the arm against the forearm. Soft tissues such as ligaments, tendons and capsules are dense, regular connective tissue with inherent elastic properties, they may become tight or loose and affect the motion available at joints. Muscles associated with the joints may become stretched or/contracted thereby affecting the joint motion. The shape of the joint surfaces is designed to allow motion in particular directions. These surfaces may be altered by such factors as disease, or trauma to allow more or less motion than normal at a joint. Hypermobility (exceed the normal range) or hypomobility( less than normal range of motion) of joints affects a patient's function in activities of daily living.  Range of motion ex: 1-passive movement Types of passive movement : Relaxed passive movement : (is used to maintain unrestricted joint range) passive movement for stretch ( is used to increase the restricted joint range to full range) passive movement for mobilizing (is used to break down adhesions and increase range of motion) Relaxed Passive ROM. Passive ROM (PROM) is movement of an segment within the unrestricted ROM that is produced entirely by an external force; there is no voluntary muscle contraction. The external force may be from gravity, a machine, another individual, or another part of the individual’s own body. no voluntary muscle contraction Performed within the available range applied by an external force No pain Character of relaxed passive movement: Slowly Rhythmic Regular Through the available range of motion Goals for PROM : Maintain joint and connective tissue mobility, Maintain unristricted range of motion Minimize the effects of the formation of contractures, adhesion formation Maintain mechanical elasticity of muscle Note: Elasticity: ability to return to original length and shape after contraction Assist circulation and vascular dynamics Enhance cartilage nutrition and stimulate movement of synovial fluid Decrease or inhibit pain Assist with the healing process after injury or surgery Help maintain the patient’s awareness of movement passive movement exert mechanical pressure on and cause stretching of thin walled vessels (passing over the joint) which assist in venous and lymphatic return, and therefore reduce edema Indications for PROM In the region where there is acute, inflamed tissue, passive motion is beneficial; active motion would be detrimental to the healing process (Inflammation after injury or surgery usually lasts 2 to 6 days). coma Paralysis complete bed rest Muscle red-education Other Uses for PROM used in examination (PROM is used to determine limitations of motion, to determine joint stability, and to determine muscle and other soft tissue elasticity (assessment purpose ) -When a therapist is teaching an active exercise program (PROM is used to demonstrate the desired motion). - Maintain the available range of motion and the extensibility of the muscles and therefore prevent occurrence of adaptive shortening or the formation of adhesions in the tissues which may result due to some painful condition, swelling or muscle spasm in case of injury or disease Note :Extensibility: ability to stretch ability without being damaged adaptively shortened muscle: Muscles will change their functional resting length to adapt to the length at which they are habitually used or positioned - Paralysis : preserve memory of movement pattern by stimulating the kinesthetic receptors so that at return of muscle strength, the patient will be able to use the affected body parts at his own. - In conditions When a patient is not able actively move a segment(s) of the body Note complete immobility leads to adhesion and contracture formation, sluggish circulation, and a prolonged recovery time. Limitations of Passive Motion Passive motion does not: Prevent muscle atrophy. Increase strength or endurance. Assist circulation to the extent that active, voluntary muscle contraction does Notes: Muscular strength: The maximal amount of tension or force that a muscle or muscle group can voluntarily exert in one maximal effort Muscular Endurance: The ability of a muscle or a muscle group to perform repeated contractions, against resistance, or maintain the isometric contraction for a period of time Contraindications to passive range of Motion Exercises immediately after acute tears, fractures, and surgery (Recent injury ) (ROM should not be done when motion is disruptive to the healing process). Fever Acute inflammation Increase blood pressure Deep venous thrombosis Open wound Sever pain Precautions recent evidence support that early, continuous PROMwithin the limits of pain-free motion during early phases of healing has been shown to benefit healing and early recovery of many soft tissue and joint lesions. Because of the benefits of controlled motion have demonstrated decreased pain and an increased rate of recovery. so Carefully early controlled motion within the limits of pain-free motion during early phases of healing is used so long as the patient’s tolerance is monitored. Signs of too much or the wrong motion include increased pain and increased inflammation (greater swelling, heat, and redness) ,If these signs occur stop motion. Principles and Procedures for Applying PROM the therapist must have a sound knowledge of anatomy (including joint motions, normal rom for every joint ,muscle origin and insertion, and muscle function) explain purpose of movement ,method of intervention Position the patient in well supported ,comfortable position with proper body alignment but that also allows you to move the segment through the available ROM. Free the region from restrictive clothing or allow the patient to wear clothes not restrict joint motion Position yourself so proper body mechanics can be used The body part to be moved should be well supported and grasped comfortably ,near the joint to be moved to localize the movement to the specific joint (Good stabilization of segment) The therapist will need to use both hands to support the segment by grasping above and below it Grasp should be firm but not harmful or painful traction: To the distal segment to facilitate the movement by reducing friction of articular surfaces specially for distal joints (wrist, ankle) 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. The motion is carried out within the free ROM—that is, the range that is available without forced motion or pain (unrestricted range of motion) Move the segment through its complete pain-free range to the point of tissue resistance (not pain). Do not force beyond the available range. If you force motion, it becomes a stretching technique. The direction of passive movements in the same as that of active movements Relaxed passive movement given slowly and rhythmically, with 5 to 10 repetitions. The number of repetitions depends on the patient’s condition and response to the treatment.  Passive movement for hip flexion Passive movement for shoulder abduction Passive movement for hip abduction Passive movement for hip internal and external rotation  Passive movement for hip internal and external rotation Passive movement for ankle dorsiflexion Passive movement for shoulder flexion by another part Passive movement for ankle planterflexion of the body Continuous Passive Movement motion performed by a mechanical device that moves the joint slowly, rhythmically and continuously through a controlled range of motion. Continuous motion devices for knee Continuous motion devices for shoulder CPM has been reported to be effective in improving the recovery rate after a variety of surgical procedures