What is functional excursion
The distance a muscle is capable of shortening after it has been maximally elongated
What is active insufficiency
The point where a muscle can shorten no more
What is passive insufficiency
The point where a muscle can no longer be lengthened
What are precautions with ROM exercises
PROM - within pain free range can be beneficial to acute injuries but can be detrimental if done improperly
PROM can be introduced to major joints, AROM to ankles and feet to prevent thrombus formation
AROM to upper extremities and limited, supervised walking are beneficial after heart attacks and heart surgery
What are CIs to ROM exercises
- pain
- when motion is detrimental to the healing process
- when motion of Pt. Response is life threatening (DVT, spinal)
How should you prepare a patient for ROM exercises
- communicate the plan and method of intervention
- fee the region of obstructive clothing or splints and drape as necessary
- position the client comfortably, with adequate support and proper body alignment
- use proper body mechanics
What is the application of techniques
- control the segment and stabilize the proximate segment. Modify your grip if it is painful for the pt.
- support areas of decreased structural integrity, hypermobility, recent fracture or paralyzed limb segment
- move the segment through the Pain free range until you feel tissue resistance
- repeat the motion 5-10 times, depending on the tx goals and the pt.s response to tx
What are PROM goals
- Maintain tissue health
- Decrease effects of immobilization
- decrease pain
- increase proprioception
- assessment of inert structures
- demonstration of exercises
- precede passive stretching
Where is pain usually with active ROM
Pain usually in tendon and muscle problems
Where is pain usually with PROM
Usually pain in ligaments and capsule
What does resisted testing test
The strength of the muscle
When is PROM used
- in the acute stage
- inflamed tissues
- where AROM would be detrimental
- paralyzation
- comatose
What are CPM machines
Passive motion performed slowly and continuously by a device that takes the segments through a prescribed ROM
Research is still being performed to determine appropriate application parameters
What are CPM benefits
- decrease adhesions
- decrease contractures
- stimulates healing of tendon and ligament enhances scar healing (over the Jr)
- increases synovial lubrication of it
- increase intra-articular cartilage regeneration / healing prevents degrading effects of immobilization enables quick return of ROM
- decrease post operative Pain
What are PROM limitations
- conscious clients with intact innervation
- difficult with spastic segments
Does not:
- increase strength or endurance
- prevent atrophy
- assist circulation (negligible)
What are goals or AAROM, SA-AROM, AROM
- increase tissue health (elasticity/contractility) of muscles
- provide sensory feedback
- stimulate bone and increase joint integrity
- prevent thrombus formation
- maintain circulation
- develop coordination
- prepare for function activities
What is A-AROM
Performed by therapist - manual or mechanical assistance applied to achieve end range due to prime mover insufficiency
When is A-AROM used
When a pt. Has weak musculature and cannot complete ROM against gravity
The pt. Has little control over movements in a segment (neurological)
What is Self assisted ROM
Using the unaffected limb, or equipment to move the affected segments through ROM
Equipment used: towels, dowels (wand), pulleys, wall, power (skate) boards, stationary bikes, ergometers, elliptical
Used as soon as the patient is able to understand both instructions and the safe parameters of the motions, when there is unilateral weakness
No therapist involvement, this is for homecare
Used when AAROM is indicated with the same goals and limitations
When is AROM used
When the pt is able to contract the muscles of a segment without assistance
During prolonged immobilization, segments above and below can be moved through ranges to maintain tissue and prepare for future movements (walking/crutches)
AROM can be used for aerobic conditioning exercises
AROM is used Above and below immobilizations to maintain tissue health and prepare for activities like walking with crutches
What are limitations of SAROM and AAROM
Does not maintain or improve strength
Does not develop skill and coordination outside of movement patterns
What are functional patterns
1st. Determine what the desired functional movement pattern
2nd. Move the segments involved through the pattern using assistance if required (manual, mechanical, self assistance where appropriate )
What are upper extremity functional patterns
Grasping an eating utensil (finger extension, flex ion)
Eating (hand to mouth: shoulder: flex, abd, lat rot. Elbow: flex, sup)
Reaching shelves
Brushing hair
Holding a phone to ear
Dressing
Reaching out of a car window (drivethru)
What are lower extremity functional patterns
Sitting up (laying supine to sitting) on edge of bed
Standing from sitting
Sitting from standing
Walking
Dressing
Shoe tying
