ROM

Question 1

Cardinal Planes of Motion

Answer 1

• Sagittal: flexion and extension
• Frontal: abduction and adduction, lateral flexion of the spine, wrist ulnar and radial deviation
• Transverse: internal and external rotation, spinal rotation, forearm supination and pronation
• Triplanar: foot inversion and eversion

Question 2

ROM vs stretching

Answer 2

Stretching moves into overpressure, ROM does not.

Question 3

We measure ROM in non diagonal ROM, but ____ we do.

Answer 3

functionally

Example:
UE: Reaching for something in the fridge
LE: Kicking, putting on pants, getting in a car

Question 4

Joint vs Muscle Range

Answer 4

If a muscle crosses more than one joint,
* Lengthen over both joints simultaneously to assess muscle range.
* Slacken over one joint to assess joint range.

• In Picture on Left, hip joint flexion is limited by tightness of the hamstrings.
  In Picture on Right, the flexed knee puts the hamstrings on slack and allows the hip joint to reach full flexion.

Question 5

Active Assisted ROM

Answer 5

requires external force through part of the range

Question 6

Benefits of ROM - PROM and AROM

Answer 6

PROM
* Stimulates tissue healing
* Prevents adhesions and joint stiffness

AROM
* Helps maintain health, integrity, and elasticity of tissues
* Increases sensory input
* Promotes tissue alignment
* “Skeletal muscle pump” enhances local circulation

Question 7

PROM Indications

Answer 7

• When the patient’s own muscle force cannot produce safe, effective motion at the joint
• When active muscle contraction would be harmful
• As an assessment technique (Joint mob, joint stability)
• As an intervention (contracture risk, AROM would damage tissue)

Question 8

PROM - Precautions

Answer 8

• When it temporarily increases patient’s pain
• When it elicits undesired muscle tone

Question 9

PROM Contraindications

Answer 9

• When motion will interfere with tissue healing
• In the presence of extreme muscle guarding
• When strong muscle guarding is accompanied by increased pain

Question 10

PROM Dosage

Answer 10

To promote early tissue healing
* Low Intensity (without resistance)
* High Frequency (20-30 reps)

Orthopedic conditions:
* Generally, 5 to 12 repetitions
* Approximately 5 to 10 seconds per cycle (peforming the full range in this time for a rep)
* Generally, 3 to 5 times/week

Some neurological conditions (e.g., cerebral palsy)
* Repetitions tend to be slower, with a sustained hold of 20 to 60 seconds at end range (not overpressure).If you went faster may activate spasticity (counterproductive to ROM)

Question 11

AROM indications

Answer 11

• As an assessment technique
• As an intervention
• Preferbale when the patient is able to perform the movement safely, effectively, and without pain (AMAP/ANAP)
• Provides more stimulation to the bone, cartilage, and other tissues than PROM

Question 12

AROM Precautions

Answer 12

• PROM precautions
• Generates undesired movements
• Physiological demands increase patient risk

Question 13

AROM Contraindications

Answer 13

• PROM contraindications
• Pain throughout motion and/or persisting after the activity
• Development of dysfunctional muscle tone
• Cardiac distress
• Other adverse exercise responses (inflammation, effusion, etc.)

Question 14

AROM Dosage

Answer 14

• Determined by patient responses
• Watch for:
  – Fatigue
  – Pain
  – Changes in quality or accuracy of movement
  – Changes in vital signs

Number of reps can vary from exercise to exercise based on their response/ability

Question 15

How do you chose a plan of motion?

Answer 15

Straight plane
* More specific and thorough
* Allows isolation of movements
* Appropriate for examination and treatment
* Can combine straight planemotions of 2 or more joints (hip and knee flexion)

Diagonals
* Closer to daily functional movement patterns
* Do not allow for isolation and therefore not appropriate for examination
* Three components, one from each cardinal plane

Question 16

In order to get from 60-120 degrees of shoulder flexion utilization of the ____ is necessary.

Answer 16

Scapula.

If you don’t get it moving can cause an impingement with the acromion.

Question 17

Body Mechanics during ROM

Answer 17

1. Have the patient close to you.
2. Stand with a wide base of support (BoS), generally facing in the direction of movement
3. If supervising AROM, position yourself to allow full AROM while still able to monitor the activity and guard as needed.

Question 18

ROM Procedure

Answer 18

• Stabilize the proximal joint.
• Use a lumbrical grip.
• Control passive movements centrally (CCDD).
• Direct active movements distally (CCDD).
• AMAP/ANAP (as much as possible, as naturally as possible)
• Use a systematic approach
• Proximal to distal OR Distal to Proximal

Question 19

PROM Procedure

Answer 19

• Move patient through range slowly and with brief hold at end range (but not beyond).
• Monitor the patient’s response to activity

Question 20

AAROM Procedure

Answer 20

• Have patient start movement as able
• Have your hands / body in ready position to assist as needed
• Assist patient through parts / whole ROM as needed
  – May be that patient is weak throughout range, so needs support throughout
  – May be that patient is weak only at certain points in the range and needs intermittent support
• Monitor patient response / compensatory movements

Example: Use a towel on a slideboard to decrease friction, using a gait belt, little wheels, bz board.

Question 21

AROM Procedure

Answer 21

• Instruct patient in movement
• Watch for movement form and quality
• Be ready to provide support / guidance as needed
• Monitor patient’s response to activity

Question 22

Codman’s Pendulum Exercise

Answer 22

• Example of shoulder passive or very early active-assisted ROM
• Patient (prone or standing) allows the arm to hang down and initiates very small shoulder movements, assisted by gravity and lower body movement.

Move lower body to get upper body moving. People with high tone can put a weight in the hand so get them sto straighten out then move into circles.

Question 23

Observations and Findings

Answer 23

• Quantity of movement
• Quality of movement
• Patterns of movement
• End Feel
• Pain
• Msucle tone, spasms, guarding
• Audible sounds