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Therapeutic Exercise I Chapter 3

Therapeutic Exercise I Chapter 3. Range of Motion (ROM). What is ROM?. It is therapeutic intervention and examination of movement, it is described as joint range and muscle range ( functional excursion) , it is measured with the use of a goniometer and recorded in degrees

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Therapeutic Exercise I Chapter 3

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  1. Therapeutic Exercise IChapter 3 Range of Motion (ROM)

  2. What is ROM? It is therapeutic intervention and examination of movement, it is described as joint range and muscle range (functional excursion), it is measured with the use of a goniometer and recorded in degrees Muscles and external forces cause ROM

  3. Muscle/External force • ROM can be affected by structures of the joints, the integrity of the soft tissue and the flexibility of the soft tissues over the joints • These structures can be: muscles, joint surfaces, ligaments, fasciae, vessels, and nerves

  4. Active An active muscle that can no longer be shortened Example: wrist flexion with finger flexion, prone HS curls Passive To fully elongate a muscle Example: Passive wrist and finger flexion, passive elbow extension Active versus Passive Insufficiency

  5. Types of ROM • PROM – not passive stretching • AAROM • AROM The usual progression of ROM is: PROM-AAROM-AROM-Resisted Strengthening….however, you must understand the MD orders and if there are any specific restrictions to follow or specific program guidelines to follow Neither PROM/AAROM/AROM should be performed if it is disruptive to the healing process You must be aware of the patient’s normal ROM

  6. Purposes of ROM • Maintain joint and soft tissue mobility • Minimize loss of tissue flexibility • Minimize contracture formation

  7. PROM • To be done after injury or surgery during the inflammation period when a patient can not perform and AROM • PROM: decreases complications from immobilization, maintains joint/connective tissue mobility, minimizes contractures, maintains muscle elasticity, assists circulation/vascular dynamics, enhances synovial movement, decreases/inhibits pain, assists healing, and maintains patient’s awareness • It also serves as a guide for the PT/PTA to determine limitations to the joint and muscle/tendons • Can be done preceding passive stretching techniques

  8. AAROM/AROM • To be initiated when a patient can contract a muscle, if weak-AAROM • Working towards full available functional ROM and then progress towards strengthening (covered in chap. 6) • To maintain muscle elasticity/contractility of muscles, provide feedback (muscles) and stimulus (bones/joint); to increase circulation, and develop coordination/motor skills

  9. BENEFITS Improve mobility at a faster rate Improve recovery rate/healing of incisions Increase synovial fluid lubrication, allowing increase rate of intra-articular cartilage healing and regeneration Decrease post-operative pain Continuous Passive Motion (CPM)

  10. General Guidelines for CPM • Applied immediately after surgery • Often started 20-30 degrees & progressed 10-15 degrees daily (Pt tolerance & available ROM) • Amount of time applied will vary but ranges from continuous (24 hours) to 1 hour 3x/day. • Rate of motion is determined – 1 cycle 45 sec or 2 min

  11. General Guidelines CPM (continued) • P.T. is initiated when pt not in CPM (AAROM & muscle setting exercises) • Duration usually < 1 week or when ROM is achieved • CPM is adjustable, controllable, portable

  12. Application of Techniques • ALWAYS MAKE SURE YOU REVIEW THE PATIENT”S CHART/POC AND DISCUSS THE PATIENT WITH THE SUPERVISING THERAPIST • Control the movement with a grasp of the extremity around the joint (make sure the patient is comfortable) • Support areas of weakness of poor structural integrity (hyper-mobile joint, fracture site paralyzed limb) • Move through pain-free ROM (if you force ROM beyond, it then becomes a passive stretching-to be covered in Chap. 4) • The optimal # of repetition is between 5-10 reps, but it does depend on the objectives and how the patient is responding to the treatment….the movement should be done slowly, smoothly, and controlled

  13. Things to Remember • Always introduce yourself as a student physical therapist assistant • Always educate your patient on the purpose of the exercise/activity • Always demonstrate the exercise/activity you are asking of the patient • Remember to use good body mechanics for both you and your patient • Remember to always communicate with your supervising PT and with all others Health Care providers who are involved directly with the patient’s care • Always practice within your standards of practice and ethics • Always be timely with documentation and be thorough as required by state laws and the facility

  14. Break for Lab with Lecture on UE’s and LE’s • PROM • AAROM • AROM • CPM

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