Range of Motion

1. Range of Motion Chapter 3

2. Range of Motion • Basic technique used for examination of movement and for initiating movement into a purposeful therapeutic intervention • Range of motion (ROM) • Functional excursion • Active insufficiency • Passive insufficiency

3. Types of Range of Motion (ROM) Exercises • Passive ROM (PROM) • Motion produced by an external force, manual or mechanical • Active ROM (AROM) • Motion produced by active contraction of the muscles • Active-Assistive ROM (A-AROM) • Motion produced by a combination of external force and active muscle contraction (type of AROM)

4. Indications, Goals, and Limitations of ROM • Passive ROM (PROM) • Indications for PROM • Goals for PROM • Other Uses for PROM

5. Indications, Goals, and Limitations of ROM (cont'd) • Active and Active-Assistive ROM (AROM and A-AROM) • Indications for AROM • Goals for AROM • Limitations of A-AROM

6. Precautions and Contraindications to ROM Exercises • ROM should not be done when motion is disruptive to the healing process • Follow specific precautions during early phases of healing • ROM should not be done when the patient’s response or condition is life threatening • Follow specific precautions when the patient’s condition is critical or severe

7. Principles and Procedures for Applying ROM Techniques • Examination, Evaluation, and Treatment Planning • Determine appropriate level of ROM • Determine safe amount of motion • Decide the pattern of motion to best meet goals • Monitor patient response to ROM intervention • Document and communicate findings • Re-evaluate and modify as appropriate

8. Principles and Procedures for Applying ROM Techniques (cont'd) • Patient Preparation • Describe the intervention to meet set goals • Free the area from restriction • Drape the patient • Position the patient for alignment and stabilization • Position yourself for proper body mechanics

9. Principles and Procedures for Applying ROM Techniques (cont'd) • Application of Techniques • Control movement grasping around the joint • Support areas of poor structural integrity • Move the segment through pain-free range to the point of resistance • Perform motions smoothly and slowly • Repetitions are determined in the plan of care

10. Principles and Procedures for Applying ROM Techniques (cont'd) • Application of PROM • Movement of the segment by a therapist, PTA ,or mechanical device • No active muscle contraction • Motion only through the pain-free ROM without tissue resistance

11. Principles and Procedures for Applying ROM Techniques (cont'd) • Application of AROM • Demonstrate the motion using PROM • Ask the patient to perform the motion • Provide assistance for smooth motion, weakness, at the beginning or end of range only as needed • Motion within available pain-free ROM

12. ROM Techniques • Upper Extremity • Lower Extremity • Cervical Spine • Lumbar Spine

13. Self-Assisted ROM • Self-Assistance • Equipment • Wand (T-bar) • Wall climbing, finger ladder • Ball rolling • Overhead pulleys • Skate board/powder board • Reciprocal exercise unit

14. Continuous Passive Motion (CPM) • Passive motion that is performed by a mechanical device that moves a joint slowly and continuously through a pre-set, controlled range of motion

15. Benefits of CPM • Prevents development of adhesions, contractures • Stimulates healing of tendons, ligaments • Enhances healing of incisions • Increases synovial fluid lubrication • Prevents degrading effects of immobilization • Quicker return of ROM • Decreases postoperative pain

16. General Guidelines for CPM • Device is applied immediately after surgery • Arc of motion is adjustable and determined • Rate of motion is adjustable and determined • Duration on the machine is determined • Physical therapy is included during off periods • Devices are often portable and battery operated to allow patients to be functionally active

17. ROM Through Functional Patterns • Assists in teaching ADLs and IADLs • Helps patient realize purpose and value of ROM exercises • Assists in developing motor patterns

18. Independent Learning Activities • Critical Thinking and Discussion • Laboratory Practice