Active Assisted ROM PDF

Active assisted range of motion By Dr. Marwa Mostafa Definition: Active assisted ROM exercises is a type of active ROM in which assistance is provided manually or mechanically by an outside force because the prime movers muscles need assistance to complete the motion....

Active assisted range of motion By Dr. Marwa Mostafa Definition: Active assisted ROM exercises is a type of active ROM in which assistance is provided manually or mechanically by an outside force because the prime movers muscles need assistance to complete the motion. Indication of AAROM When the patient has a weak musculature and is unable to move the joint through the desired range against gravity. AAROM exercises is used to provide enough assistance to the muscle in carefully controlled manner so the muscle can function at its maximum level and be progressively strengthened. Once the patients gain control of their ROM they are progressed to manual or mechanical resistance exercises to improve muscle performance for return to functional activities. Indications of AAROM: - Weak but not paralyzed muscles: Less than grade 3 >>> AAROM - To increase ROM - To assist functional activities of ADL - After removal of plaster cast - During sub-acute stage of tissue healing AAROM can be started with cautious. - As a method of muscle re-education; - After tendon or muscle transplantation Specific goals: - 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. - Prevent DVTs. - Develop coordination and motor skills for functional activities. - Maintain joint and connective tissue mobility. _ Maintain the patient’s awareness of movement. _ Maintain mechanical elasticity of muscle. _ Assist circulation. _ healing process after injury or surgery. _ Enhance synovial movement for cartilage nutrition. _ the formation of contractures. _ or inhibit pain. Limitations - For strong muscles, active ROM does not maintain or increase strength. - It does not develop skill or coordination except in the movement patterns used (specificity). Contraindication and Precautions: Contraindications - DVT. - Recent trauma / fracture). Precautions - During early phases of healing: Carefully controlled motion within the limits of pain- free motion has been shown to benefit healing and early recovery. - ROM exercises proximal and distal to the injured and or immobilized joint: to minimize venous stasis and thrombus formation. - After major surgeries: as cardiac surgeries patient response to AROM of upper extremity and early walking should be carefully monitored. Types of assistance 1. Manual assistance: when the assistance is provided by a. The P.T. b. the sound limb of the patient( self assisted) 2. Mechanical assistance: when the assistance is applied by mechanical tools as a. Slings b. Pulleys c. Wheels, etc Application of Techniques: Demonstrate the motion desired using PROM, then ask the patient to perform the motion. Have your hands in position to assist or guide the patient if needed. Provide the assistance only as needed for smooth motion. When there is weakness assistance may be required only at the beginning or the end of ROM or when the effect of gravity has the greatest torque. The motion is performed within the available ROM. Rules and principles of application 1. Starting position: complete stability and comfort must be provided to the body to ensure complete patient attention, concentration and maximum effort required for performance. 2. Fixation: The proximal part& joint of the exercised limb should be adequately fixed by the physiotherapist to improve the efficiency of the agonist muscles. 3. Support: Full support must be given to the exercised part of the limb by means of: -Pillows -Boards -Sings -Manually Support eliminates any force or load on the weak muscles by eliminating effect of gravity. 4. Characteristics of active assistive exercise: a. The assistance should be sufficient to give adequate help to the working muscles, it must be allowed to exceed this level or a passive movement will result. b. As the muscle power increases, the given assistance must be decreased proportionally. 5. Direction: The assistance or external force employed is applied in the direction of muscle action. 6. Repetition: Repetitions depend on the level of muscle fatigue. So the cause and the extent of weakness must be known and understood. 7. Understanding the pattern of movements: Clear information must be given and understood by the patient about what is expected from him to perform. This may be taught to him by: a. Applying passive movement to the affected side or b. Active movement of the contralateral sound side. 8. Patient co-operation: - Full patient cooperation is essential during application of AAROM. - Encouragement, concentration and coordination are essential to achieve controlled active assisted movement. - i.e. use a mirror, palpate his/ her muscle as they contract will encourage him/her. I. Manual assistance 1. Self assistance When a patient has a unilateral weakness or paresis, he can be taught to use his normal extremity to move the affected limb through ROM. Examples of movements: I. Shoulder flexion & extension II. Shoulder horizontal abduction& adduction III. Shoulder rotation IV. Elbow flexion& extension V. Forearm supination& pronation VI. Wrist flexion& extension VII. Radial & ulnar deviation VIII. Finger flexion& extension IX. Thumb flexion with opposition& extension with reposition X. Hip and knee flexion & extension XI. Hip abduction & adduction XII. Ankle& toes movements. 2. Therapist assistance: All the previous movements in addition to other movements could not be done by the patient are done by the therapist assistance, but not by the therapist completely. II. Mechanical assistive exercises: 1. Wand exercises: a wooden stick, cane or similar objects may be used. a. Shoulder flexion & extension b. Shoulder hyper extension c. Shoulder horizontal abduction& adduction d. Shoulder internal& external rotation e. Elbow flexion& extension 2. Finger ladder exercises: with wall climbing to assist shoulder and hand movements a. Shoulder flexion b. Shoulder abduction Precaution: The patient must be taught the proper motions& not allowed to side bending, toe raising or scapular elevation 3. Cord& pulley or weight& pulley circuit: Over head pulleys provide assistance for shoulder, elbow& wrist ROM. Pulleys set up: 1. Two pulleys are attached to an overhead bar or to the ceiling approximately shoulder-width apart. 2. A rope is passed over both pulleys, and a handle is attached to each end of the rope. 3. The patient may be supine, sitting or standing with the shoulders aligned under the pullyes. Pulleys exercises: 1. Shoulder flexion& abduction 2. Shoulder internal& external rotation. 3. Elbow flexion& extension 4. Shoulder wheel: Set-up: 1. A shoulder wheel is permanently attached to a wall. 2. Usually it can be adjusted to various heights& arm length. Shoulder wheel exercises: 1. Shoulder abduction& adduction 2. Shoulder flexion& extension 3. Shoulder internal& external rotation