ROM

• Active Assistive Exercise


  Exercise performed by a person with manual or mechanical assistance
• Active Exercise


  Exercise performed by a person by active muscle contraction
• Passive Exercise


  Exercise performed on a person by manual or mechanical means; no voluntary muscle contraction occurs
• Capsular Pattern


  A characteristic pattern for a given joint that limits joint motion and indicates that a problem exists within that joint
• Contraction


  A drawing together or shortening or shrinking (e.g., a muscle contracts)
• Dorsal


  Directed toward or situated on the back surface
• Concentric Contraction


  An overall shortening of a muscle as it develops tension and contracts; positive work is performed or movement is accelerated
• Eccentric Contraction


  An overall lengthening of a muscle as it develops tension and contracts to control motion performed by an outside force; negative work is performed or movement is decelerated
• End Feel


  The quality of the movement that a person senses when pressure is applied passively to a joint at the end of its available range of motion
• Hypertrophy


  An increase in the cross-sectional size of a fiber or cell
• Joint Play


  The laxity or elasticity of a joint capsule that allows movement of the joint surfaces within the capsule
• End Feels


  • Normal
  • Abnormal
  • Soft - Elbow Flexion
  • Firm - Hip Rotation
  • Hard - Elbow Extension
  • Empty - Acute pain
  • Springy
  • Boggy
  • Extended
• Hard End Feel


  Abrupt halt to movement when two hard surfaces meet
• Hard End Feel


  • Elbow extension, HO, malunion fx
• Firm End Feel


  Leathery, firm resistance when range is limited by joint capsule
• Firm End Feel


  • Shoulder rotation, Adhesive Capsulitis
• Soft End Feel


  Gradual onset of resistance when soft tissue approximation, or when range is limited by muscle length
• Soft End Feel


  • Knee flexion, Cervical sidebending
• Empty End Feel


  Movement is stopped by the person before tester feels resistance
• Empty End Feel


  • Any movement stopped by the subject because of pain
• Springy Block End Feel


  Rebound felt and seen at end range of motion
• Springy Block End Feel


  • Loose bodies or displaced meniscus
• Boggy End Feel


  Resistance by fluid
• Boggy End Feel


  • Knee joint effusion
• Extended End Feel


  No resistance felt w/in normal range expected for a particular joint
• Extended End Feel


  • Joint instability or hypermobility
• Why use ROM exercises?
• Why use ROM exercises?


  • Basic technique for movement examination
  • Technique used for initiating or incorporating movement into a therapeutic intervention program
• Types of ROM Exercises


  • Passive range-of-motion exercises (PROM)
  • Active range-of-motion exercises (AROM)
  • Active-Assistive range-of-motion exercises (AAROM)
• Passive ROM Exercises (PROM)


  Movement produced by an external force within the unrestricted range of motion of a segment; little to or no muscle contraction elicited
• External Forces for PROM


  • Therapist or another person
  • Another part of the individual's own body
  • Gravity
  • Machine
• Goals of PROM


  • Maintain joint and connective tissue mobility
  • Minimize the effects of the formation of contractures
  • Maintain mechanical elasticity of muscles
  • Assist circulation
  • Enhance synovial movement along joints
  • Decrease pain
  • Assist with healing process after injury or surgery
  • Maintain patient's awareness of movement
  • Prevent complications of immobilization
• Indications for PROM


  • Acute or inflamed tissue where active motion may disrupt the normal healing process
  • Patients who are unable to move or are not allowed to move such as when comatose, paralyzed, or on complete bed rest
  • For assessment purposes
  • When teaching a patient movement
  • To prepare a patient for stretching
• Limitations of PROM


  • Will not prevent atrophy
  • Will not increase strength or endurance
  • Will not assist in circulation to the extent that active, voluntary muscle contraction does
• Precautions and Contraindications of ROM Exercises


  • Should not disrupt the healing process
  • Excessive movement/wrong performance of movement leads to increased pain and inflammation
  • Cautiously done if patient's condition is life-threatening (eg. MI)
• Principles & Procedures for Applying ROM Techniques


  • Examination, Evaluation, and Treatment Planning
  • Patient preparation
  • Application of techniques
  • Application of PROM
  • Application of AROM
• Examination, Evaluation, and Treatment Planning


  • Examine and evaluate the impairments and level of function
  • Determine any precautions and prognosis, and plan of intervention
  • Determine the ability to participate in the ROM activity
  • Note what type of ROM exercise to meet goals
  • Decide on the patterns of movement
  • Anatomic plane vs Functional patterns
  • Monitor the general condition and response during and after the examination and intervention
  • Take vital signs, presence of pain, quality of movement, change in ROM
  • Document and communicate findings and intervention
  • Re-evaluate and modify the intervention as needed
• Patient Preparation


  • Communicate with the patient the plan and the method of intervention to be used
  • Remove all restrictive clothing, linen, splint, and dressings; drape appropriately
  • Position the patient comfortably maintaining proper alignment and stabilization while allowing movement along the available ROM
  • Maintain proper biomechanics (therapist)
• Application of Techniques


  • Grasp the extremity around the joints providing support needed for control
  • Support areas of poor structural integrity
  • Move the segment throughout its pain-free range to point of tissue resistance
  • Perform the movements smoothly and rhythmically 5 to 10 reps
• Application of Passive ROM


  Movement is being provided by an external force; no active resistance or assistance is provided by the muscles that cross the joint; motion is performed within the available or free ROM; there should be no pain or forced motion elicited