OTS 362-week 4 cpt (ROM and strength)

What is range of motion (ROM)?

the available amount of movement that a joint has

What are the types of ROM?

active range of motion (AROM), passive (PROM), and assistive active (AAROM)

Active range of motion (AROM)

how far a person can move a joint on their own

-using their own internal forces (strength)

Passive Range of Motion (PROM)

how far someone else can move your joint, without you engaging the muscles normally used to perform the motion

-no active muscle control by the person

Assistive Active Range of Motion (AAROM)

skilled procedure where the client moves the joint the the limbs of their ability and the health care professional moves the joint the rest of the way

WNL

within normal limits: the normal range of motion is what a typical person has at that joint when there is no condition affecting the joint mobility

-must be measured with a goniometer to use this term

WFL

within functional limits: range of motion that is observed in a functional screen or during participation in an occupation

impaired

if a person does not have ROM that is WFL or WNL, then you must document as

What is the first step when assessing ROM and strength ?

perform a functional screen of AROM and make a decision for further assessment needs as appropriate (WFL or impaired)

When do you document as WFL?

If the client has UE AROM that is WFL as observed with a functional AROM screen, then no further assessment is needed for AROM and document as WFL

(however, you may assess strength using manual resistance with MMT if AROM is WFL and there are no other contraindications)

When to document as impaired?

when a patient has a deficit in their AROM, observed with functional tasks or with the AROM functional screen then assess PROM

What should you do if you notice a deficit with AROM, but not PROM?

use a goniometer to measure the deficit with AROM (be sure to document that PROM is WFL)

What should you do if you notice a deficit with PROM?

use a goniometer to measure the deficit with PROM (you can document both impairments (AROM and PROM, but PROM impairment documentation is prioritized

How do you document WNL?

ONLY if you use standardized assessment (goniometer or MMT) and compare to normative data

When to document WNL?

if a patient scored within a normal range when measured using a goniometer and compared against normal range of motion scores

What is the MMT scale?

looks at strength in terms of against gravity AROM or gravity reduced (AAROM)

What are the muscle grade categories?

against gravity and gravity-reduced

What are the against gravity scores?

5 to 3-

What are gravity-reduced MMT scores?

2+, 2, 2-, 1, 0

3+ muscle grade for MMT means:

part moves through full ROM against gravity with slight resistance.

3 muscle grade for MMT means:

part moves through full ROM against gravity, no resistance

3- muscle grade for MMT means:

part moves through less than full ROM against gravity (but approximately half range of motion against gravity)

2+ muscle grade for MMT means:

part moves through full ROM with gravity eliminate and minimal resistance

2 muscle grade for MMT means:

part moves through less than full ROM with gravity eliminated

2- muscle grade for MMT means:

part moves through less than full ROM with gravity eliminated

1 muscle grade for MMT means:

contraction seen or felt, but no movement

0 muscle grade for MMT means:

no muscle contraction seen or felt

When making decisions for ROM & strength, if the joint has AROM observed as WFL then

this means the person has enough strength to move their limb against gravity, and next you must apply resistance to continue assessing their strength

What is the next step in assessing ROM if AROM is impaired?

then manually assess PROM first