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Range of Motion - Lecture Slides | PT 220, Study notes of Physiotherapy

Material Type: Notes; Class: Therapeutic Exercise I; Subject: Physical Therapy; University: California State University - Sacramento; Term: Unknown 1989;

Typology: Study notes

2009/2010

Uploaded on 03/28/2010

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Range of Motion
PT220
LoisBoulgarides,PT,DPT,MS
Types of ROM Exercises
Passive
Active
ActiveAssisted
Manual
•SelfExercise
Mechanical(CPMmachine)
Assistivetools(recip pulley,wand,skateboard)
Indications and Goals for ROM
PassiveROM
IndicationsforPROM
•AROMisnotpossibleoriscontraindicated
Severeinflamedinjury
–GoalsforPROM
Minimizecontractures/maintainelasticity/mobility
Assisthealing
Assistcirculation
•Improvesynovialmovement/nutritionofcartilage
•Decreasepain
Maintainpatientawareness
–OtherusesforPROM
•Examination
•Patientteaching
•Preparationforstretch
Indications and Goals for ROM
ActiveandactiveassistiveROM
IndicationsforAROM
•Patientstrongenough:UseAROM
Weakness:UseAAROM
•Aerobicconditioning
•Aboveandbelowareaofinjuryduringhealing
GoalsforAROM
Maintainelasticityandstrength
•Sensoryfeedback
Stimulatesofttissueandboneintegrity
•Improvecirculation/preventthrombusformation
Coordinationandmotorskilldevelopment
Limitations of ROM Exercises
Limitations of passive motion
Does not prevent atrophy or increase strength
Limited improvement in circulation
Limitations of active ROM
Does not increase strength of STRONG muscles
Principles and Procedures for
Applying ROM Techniques
Examination, evaluation, and treatment planning
Patient preparation
Application of techniques
Application of PROM
Application of AROM
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Range of Motion

PT 220

Lois Boulgarides, PT, DPT, MS

Types of ROM Exercises

  • Passive
  • Active
  • Active Assisted
  • Manual
  • Self‐Exercise
  • Mechanical (CPM machine)
  • Assistive tools (recip pulley, wand, skateboard)

Indications and Goals for ROM

• Passive ROM

  • Indications for PROM
    • AROM is not possible or is contraindicated
    • Severe inflamed injury
  • Goals for PROM
    • Minimize contractures/maintain elasticity/mobility
    • Assist healing
    • Assist circulation
    • Improve synovial movement/ nutrition of cartilage
    • Decrease pain
    • Maintain patient awareness
  • Other uses for PROM
    • Examination
    • Patient teaching
    • Preparation for stretch

Indications and Goals for ROM

  • Active and active‐assistive ROM
    • Indications for AROM
      • Patient strong enough: Use AROM
      • Weakness: Use AAROM
      • Aerobic conditioning
      • Above and below area of injury during healing
    • Goals for AROM
      • Maintain elasticity and strength
      • Sensory feedback
      • Stimulate soft tissue and bone integrity
      • Improve circulation/prevent thrombus formation
      • Coordination and motor skill development

Limitations of ROM Exercises

• Limitations of passive motion

  • Does not prevent atrophy or increase strength
  • Limited improvement in circulation

• Limitations of active ROM

  • Does not increase strength of STRONG muscles

Principles and Procedures for

Applying ROM Techniques

• Examination, evaluation, and treatment planning

• Patient preparation

• Application of techniques

• Application of PROM

• Application of AROM

Application of ROM Techniques

  • Clothing
  • Support
  • Hands
  • Body mechanics
    • Select appropriate treatment (motion, vigor and method)
    • Patient CLOSE (when appropriate)
    • Support proximal segments
    • Use legs
    • Back straight
    • Shoulders relaxed
    • Smooth / Rhythmic
    • Usually 5 ‐ 10 repetitions
    • Within normal joint ROM
    • (Sometimes) slight hold at the end of the range

Upper Extremity ROM

Techniques

  • Shoulder: flexion and

extension

  • Hand placement and

procedure

  • Shoulder: extension (hyperextension) - Alternate positions - Shoulder Abduction

Upper Extremity ROM

Techniques (cont.)

  • Shoulder: internal (medial) and external (lateral) rotation - Shoulder: horizontal abduction (extension) and adduction (flexion)
  • Scapula:

elevation/depression,

protraction/retraction,

and upward/downward

rotation

  • Elbow: flexion and extension
    • Hand placement and procedure

Elongation of the two‐joint rectus femoris muscle

  • WHEN STRETCHING
    • Stabilize pelvis
      • Prone with opposite leg hanging down foot on floor
      • Supine with opposite knee hugged to chest
      • Sidelying with opposite knee hugged to chest
    • Extend hip
    • Flex knee
  • WHEN GOING THROUGH RANGE OF MOTION WITHOUT STRETCH: Pelvic stabilization is less important 1. In prone position, stabilize pelvis with hand 2. Hip is already extended (increase with pad under thigh) 3. Flex knee

Lower Extremity ROM

Techniques (cont.)

  • Hip: abduction and adduction - Hip: internal (medial) and external (lateral) rotation

Lower Extremity ROM

Techniques (cont.)

  • Ankle: dorsiflexion
  • Ankle: plantarflexion
  • Subtalar (lower ankle) joint: inversion and eversion

Lower Extremity ROM

Techniques (cont.)

  • Transverse tarsal joint
  • Joints of the toes: flexion and extension and

abduction and adduction (metatarsophalangeal and

interphalangeal joints)

Cervical Spine ROM Techniques

  • Flexion
  • (Extension)
  • Lateral flexion
  • Rotation
  • Precautions
    • VBA
    • UC Ligamentous laxity

Lumbar Spine ROM Techniques

  • Flexion • Rotation

Self-Assisted ROM

  • Self‐assistance
  • Wand (T‐bar) exercises
  • Wall climbing

Self-Assisted ROM (cont.)

  • Overhead pulleys
    • Shoulder ROM
  • Skate board/powder board
  • Reciprocal exercise unit (bicycle/UE cycle)
  • Continuous passive motion
    • Benefits of CPM
    • General guidelines for CPM