Range of Motion (ROM)
Refers to the range through which the joint moves.
Active Range of Motion
The range through which a patient can move a joint using his own muscle power. It identifies both the degrees of range of motion and muscle power.
Passive Range of Motion
The range which is available in a joint when it is moved by an outside force such as a therapist (PROM).
Evaluation of ROM
- The instrument used to evaluate ROM is called a goniometer. Every goniometer has a protractor, an axis and two arms.
- The stationary arm extends from the protractor on which degrees are marked. The other arm is called the movable arm and has a center line or pointer to indicate the degrees of the angle being measured. The axis is the point where the two arms are riveted together.
- The axis is placed by the joint being measured and the two arms are placed parallel to the bones correspond to the joint that is being measured. The stationary arm is placed proximal to the joint and the movable arm is placed distal to the joint.
Full Circle Goniometer
(0-360o) used to measure the shoulder, elbow, hip and knee.
Half Circle Goniometer
(0-180o) used to measure the forearm, wrist, hand and ankle.
Finger Goniometer
alternate goniometer used for the fingers.
Goniometer Info
The full circle measures from 0-180o in both directions. When using the half circle goniometer it is necessary to position the protractor opposite to the direction of motion for the indicator to remain on the face of the protractor. A finger goniometer has a short movable arm and a flat arm surface that fits comfortably over the finger joints.
Measuring
When measuring ROM the stationary arm is positioned parallel to the longitudinal axis of the part proximal to the joint. The movable arm is positioned parallel to the longitudinal axis of the part distal to the joint.
Important Considerations
- Have the joint uncovered when possible for maximum accuracy
- Support proximally and distally to the joint leaving the joint free to move
- The patient should be comfortable and relaxed
- Explain what you are going to do and why
- Respect pain watching for facial expressions or verbalizations. Remember to move the extremity slowly when both lifting and lowering when doing PROM
- Evaluation and reevaluation is more accurate and reliable when done by the same therapist (intrarater reliability)
Recording Range of Motion
- WNL = within normal limits
- WFL = within functional limits, denotes a limitation but it does not interfere with function
- MEASUREMENT IS CRITICAL FOR DEVELOPING A BASELINE AND PROGRESS
- IF YOU TREAT IT – MEASURE IT
Example ROM Recordings
Elbow extension-flexion (norm 0-150o) 0 -150o = no limitation/WNL 20 -150 o = a limitation in extension 0-30 o = a limitation in flexion 20-120 o = a limitation in extension and flexion
Example ROM Recordings
Wrist flexion (norm 0-80o) 0-80 = no limitation/WNL 20-80 = a limitation in extension 0-30 = a limitation in flexion 20-50 = a limitation in extension and flexion
Case: A patient has wrist flexion of 20-50 o, what is the recording for wrist extension?
x
Interpretation of ROM Results
- The terms slight, moderate or severe can be used to clarify the degree of limitation present.
- ROM limitations may be caused as a result of injury, joint disease, edema, pain, wounds, skin tightness, joint stiffness, shortening, muscle weakness and spasticity.
Slight
limitation is present but the patient is able to function fairly well
Moderate
limitation is present and interferes with function – the patient tends to be able to overcome the limitation with adaptive equipment
Severe
limitation is present and severely limits function. Contractures are present. Difficult for the patient to function even with adaptive equipment – lacks half or more of the normal range usually available at a joint.
