Range Of Motion PDF

Range of Motion PRESENTED BY: DR: HEND HAMDY AHMED ROM: is the maximum amount of movement available at a joint in one of the three planes of the body. The three planes of the body: 1-Sagital pane. 2- Frontal plane. 3- Transverse plane. Types of joint movement: Angular Movements: Angular motio...

Range of Motion PRESENTED BY: DR: HEND HAMDY AHMED ROM: is the maximum amount of movement available at a joint in one of the three planes of the body. The three planes of the body: 1-Sagital pane. 2- Frontal plane. 3- Transverse plane. Types of joint movement: Angular Movements: Angular motions refer to movements that produce an increase or decrease in the angle between the adjacent bones and include: Flexion, extension, abduction, and adduction. Rotation Movements: These movements generally occurs around a longitudinal or vertical axis: - Internal (medial, inward) rotation. - External (lateral, outward) rotation. - Neck or trunk rotation. - Scapular rotation. - supination-pronation. Types of ROM: Active ROM(AROM): the range of movement through which a person can voluntarily move a joint without assistance from another body parts, person or device. Limitation of this range may be due to: Restricted joint mobility)immobilization). Muscle weakness. Pain. Passive ROM(PROM): amount of motion at a given joint when the joint is moved by an external force or therapist. PROM is greater than AROM because the slight elastic stretch of soft tissues surrounding joint. A passive range of motion test gives the examiner information about the integrity of the joint, but provides no information about the capabilities of contractile tissue. PHYSIOLOGICAL FACTORS AFFECTING RANGE OF MOTION : Age. Gender. Joint structures(mobility or stability). Dominance. Purpose of joint range of motion evaluation: 1. To establish the existing range of motion available in a joint and to compare it to the normal range for that subject. This information is used to develop goals and a treatment plan. 2. To aid in diagnosing and determining the patient's joint function. It provide information regarding limitations if joint disease is suspected. Hypermobility or hypomobility of joints affects a patient's function in activities of daily living. Hypermobility - laxity in the joint or structures- surrounding the joint allows motion to exceed the normal range. Hypomobility is joint tightness or a less than normal range of motion. 3. To reassess the patient's status after treatment and compare it to that at the time of the initial evaluation. Goniometric measurements are used to evaluate the effectiveness of treatment programs. 4. Modifying treatment -If the range of motion is not increasing, the treatment program may need to be changed in order to obtain effective clinical results. Instruments: The instruments practitioners use for measuring joint range of motion are called goniometers or arthometers. The tools, although varying in size, shape, and appearance, all possess the capabilities to provide specific information regarding joint motion. The goniometer is basically a protractor with two long arms. One arm is considered movable and the other stationary, and both are attached to the body of the protractor by a rivet or tension knob. Contraindication: Both active and passive ROM assessment techniques are contraindicated: 1) In the region of a dislocation or unhealed fracture. 2) Immediately following surgical procedures to tendons, ligaments, muscle, joint capsule or skin. 3) In the presence of myositis ossificans. Precaution : The therapist must take extra care when performing active and passive ROM assessment where motion to the part might aggravate the condition such as: 1. In the presence of an infections or inflammatory process in a joint or the region around a joint. 2. In patients on medication for pain or muscle relaxants. 3. In the region of marked osteoporosis. (Extreme care or not at all). 4. In assessing a hyper mobile or subluxed joint. 5. In painful conditions where the assessment technique might reinforce the severity of symptoms. 6. In patient with hemophilia. 7. In the region of hematoma, most notably at the elbow, hip or knee. 8. In assessing joints it bony ankylosis is suspected. 9. Immediately after an injury where there has been a disruption of soft tissue (i.e. tendon, muscle, ligament). Assessment of active range of motion: - The patient performs all of the active movements that normally occur at the affected joint(s) and at the joints immediately proximal and distal to the affected joints. The therapist observes as the patient performs each active movement one at a time, and if possible bilaterally and symmetrically. The active ROM provides the therapist with information about the patient's willingness to move, co- ordination: - Active range of motion may be decreased due to restricted joint mobility, muscle weakness, pain, an inability to follow instructions, and, or an unwillingness to move on the part of the patient. Observation of active ROM is followed by an assessment of passive ROM. Assessment of Passive Range of Motion: Passive range of motion is assessed to determine the amount of movement possible at the joint. The therapist takes the body segments through a passive ROM to estimate each joints range of motion, determine the quality of the movement throughout the ROM and the end feel, determine whether a capsular on non-capsular pattern of movement is present, and note the presence of pain. The therapist repeats the passive ROM and measures and records the range of motion using a goniometer. The end feel: is the sensation transmitted to the therapist hands at the extreme of the passive ROM and indicates the structures that limit the joint movement. A normal end feel exists when there is full ROM at the joint and the normal anatomy of the joint stops movement. An abnormal end feel exists when there is either a decreased or increased joint ROM or when there is a normal ROM but structures other than the normal anatomy stop joint movement. The end feel may be normal (Physiologic) or abnormal (pathologic ).  NORMAL (PHYSIOLOGIC) AND FEELS: End feel Description Hard An abrupt, hard stop to movement when bone contacts bone; for ex.: passive elbow (Bony) extension. The olecranon process contacts the olecranon fossa. Soft When two body surfaces come together a soft compression of tissue is felt, for ex.: in (soft tissue passive knee flexion, the posterior aspects of the calf and thigh come together. opposition) Firm A firm or springy sensation that has some give when muscle is stretched for ex.: passive (soft tissue ankle dorsi flexion performed with the knee in extension is stopped due to tension in the stretch) gastrocnemius muscle. A hard arrest to movement with some give when the joint capsule or ligaments are (Capsular stretch) stretched. The feel is similar to stretching a piece of leather, for ex.: passive shoulder external rotation. ABNORMAL (PATHOLOGIC )END FEEL: End feel Description An abrupt hard stop to movement, when bone contacts bone, or a bony grating sensation, Hard when rough articular surfaces move past one another, for ex.: in a joint that contains loose bodies, degenerative joint disease, dislocation, or a fracture. Soft A boggy sensation that indicates the presence of synovitis or soft tissue edema. A springy sensation or a hard arrest to movement with so me give, indicating muscular, Firm capsular, or ligamentous shortening. Springy A rebound is seen or felt and indicates the presence of an internal derangement, for Ex. the block knee with a tom meniscus. If considerable pain is present there is no sensation felt before the extreme of passive ROM as Empty the patient requests the movement be stopped. This indicates pathology such as an extra articular abscess, a neoplasm, acute bursitis, joint inflammation, or a fracture. A hard sudden stop to passive movement that is often accompanied by pain, is indicative of an acute or subacute arthritis, the presence of a sever active lesion or fracture. If pain is Spasm absent a spasm end feel may indicate a lesion of the control nervous system with resultant increased muscular tonus. NORMAL (PHYSIOLOGIC) AND FEELS: HARD (PATHOLOGIC )END FEEL: SOFT PATHOLOGICAL END FIRM PATHOLOGICAL ENDFEEL SPRINGY BLOCK