Exam 1 Study Materials on Functional Range of Motion (ROM) and Edema in Medical Practice

What can be observed through a functional motion assessment?

-performance difficulties

-movement patterns

-limited ROM

-limited strength

T or F: You need ROM and strength to sustain endurance over time.

true

Can you see someones endurance ability during their performance of functional occupations?

yes

AROM (active ROM)

-ROM performed independently by the muscle

-the client uses their own strength to take the limb through range of motion

-clients muscles acting on the joint

PROM (passive ROM)

-ROM by an outside force

-outside forces acting on the joint

AAROM (active-assistive ROM)

client moves partial way but then requires outside assistance to complete ROM

What is the purpose of a ROM screening and assessment?

1) determine limitations interfering w/ function

2) determine additional range needed to fulfill activity (restore, modify)

3) keep record of progression/regression

4) measure objectively

5) determine appropriate tx goals

6) select tx modalities, positioning techniques (AG, GM)

7) determine need for splints + assistance devices

How can we screen for ROM?

functional performance

-have pt groom hair or put on a sweater

directed screening

-"lift arms, make a stop sign, look at your nails, hands behind head" etc.

T or F: It is a joint issue (or other deeper issue) when PROM = AROM.

true

WNL

pt able to move through complete ROM

ex: pt able to do 180/180 of shoulder flexion

WFL

amount of motion needed to perform ADL without adaptive equipment

ex: pt able to do 160/180 of shoulder flexion

-this is fxnl bc still able to perform tasks like reaching for a cup in the cabinet

When is ROM contraindicated?

-joint dislocation

-unhealed fractures

-recent surgery

-myositis ossificans

When is ROM a precaution?

-inflammation or infection

-pain meds or muscle relaxers

-osteoporosis

-hypermobility or subluxation

-newly united fracture

-prolonged immobilization

-ankylosis is suspected

-bone carcinoma

-fragile bone condition

-acute injury to soft tissue

-hematoma

T or F: If PROM is greater than AROM, then it is muscle weakness.

true

-we work on strengthening and/or pain relief

What is stretching? What are the 2 types?

-point of maximal stretch, move a few degrees beyond the point of discomfort and hold for about 20 seconds

-therapeutic maneuver designed to increase mobility of soft tissues and subsequently improve ROM by elongating (lengthening) structures that have adaptively shortened and have become hypomobile over time

types

-active stretch

-passive stretch (more effective)

Is an active or passive stretch more effective?

passive stretch more effective

-because the OT controls the motion and can push the pt pass the point of discomfort for therapeutic benefits

in active stretch, the pt controls the force, speed, extent, and direction and will typically not go past the point of discomfort bc of pain

What is an active stretch?

-client uses the force of the agonist muscle to increase the length of the antagonist muscle

-requires good (4/5) to normal (5/5) strength of the agonist muscle to complete

-requires strength in certain muscles while other, opposing muscles are being stretched

patient does the stretch!!!

Sawing is an example of what type of stretch?

active stretch

-forceful contraction of triceps with an accompanied stretch of biceps

Lying on your back on the floor and lifting a straight leg to the ceiling until you feel your hamstring stretch. What type of stretch is this?

active stretch

-holding that position without a strap requires active work from your hip flexors and core to keep your leg in the air, while your hamstrings — the muscles on the opposite side of the hip joint — are statically stretching

What is a passive stretch?

-uses other forces to stretch your muscles, rather than your own ability

-during passive stretching, your body is loose and relaxed and an external force — like a partner, towel or fitness strap — does the work

-you apply a gentle, firm, prolonged stretch (~45 seconds)and should feel no pain!!

-used only when loss of joint ROM is evidenced to the other side

Lying on your back on the floor and lifting a straight leg to the ceiling with a stretch strap wrapped around your foot until you feel your hamstring stretch. What type of stretch is this?

passive stretch

-the stretch strap is the external force that is helping apply the stretch deeper

Stretch of the wrist flexors during a block printing activity is an example of what type of stretch?

passive stretch

When is stretching contraindicated?

inflammation

When is stretching a precaution?

sensory loss

steroids

prolonged immobilization

When creating activities to increase ROM, the OT should focus on desired movements that are repetitive and gradable. How can this be achieved?

-providing gentle, active stretch

-slow, repetitive isotonic contractions (one of the best ways to strengthen)

-increase ROM beyond limitation

-ROM routine as part of an HEP

-adapt activities

Lengthening handles to facilitate active stretching, decreasing padding in handles, and placing objects at higher heights are examples of ________

ways to grade and adapt activities to increase ROM

During the initial evaluation, you note that your client is unable to flex his elbow against gravity/ When you place his elbow in a gravity-minimized position, you observe that he can actively move his elbow through his full ROM and can resist against minimal force. What grade do you assign to his elbow flexors?

2+/5

What is edema?

abnormal swelling due to the accumulation of interstitial fluid within tissues

What is pitting edema?

When finger pressure applied on the swollen extremity leaves an indentation mark on the skin.

How can we evaluate edema?

volumetrics and circumferential

What is volumetrics

-measures hand volume of interstitial fluid for patients with edema

-displacement of water to get a measurement of edema

-increased volume/displacement of H2O = presence of edema

What is circumferential measurement for edema?

measurement of affected extremity in centimeters

How is edema treated in OT?

1) positioning/elevation

-positioning extremity above heart to help drain fluid

2) AROM

3) retrograde massage

4) compression

-coban wrapping

-compression gloves

-compression/pneumatic pump

5) contrast baths

-vasodilation (warm water) and vasoconstriction (cold water)

When is massaging contradindicated?

-damaged blood vessels

-poor venous system

-metastasis

-open wounds or fragile skin

-infection