ROM, MMT, and JPA

osteokinematic

is ROM an osteokinematic or arthrokinematic assessment?

AROM

willingness to move, ROM, coordination, muscle strength, pain

contractile

pain during AROM is likely due to ____ structures

PROM

further investigates source of pain and restrictions in motion (tissue type)

ligaments; fascia

pain during PROM is likely due to structures like ____, bursa, capsule, ___, and skin

PROM

which is usually greater: AROM or PROM?

hypomobility causes

abnormalities of joint surfaces

passive shortening of joint capsules, ligaments, muscles, fascia, and skin

inflammation of structures

OA, RA, adhesive capsulitis, and spinal disorders

immobilization and scar development

stroke, head trauma, cerebral palsy, and CRPS

diabetes

hypermobility causes

-laxity of soft tissue structures (ligaments, capsules, muscles)

-CT diseases: ehlers-danlos, marfan syndrome, rheumatic diseases, osteogenesis imperfecta

-down syndrome

- repeated ankle sprain

contraindications to ROM

joint dislocation (unless non-traumatically dislocated)

joint subluxation

unstable bone fracture

rupture of tendon or ligament

infectious or acute inflammatory process (clinical judgement)

severe osteoporosis (AROM is safe)

immobilization or external fixation device

pain (pt. may not let you)

movement would disrupt healing process

interrater reliability

same values between 2 people

intrarater reliability

The consistency or equivalence of repeated measurements made by the same person over time

empty

an ___ end feel is never normal (pt. claims they are in pain, you don't feel resistance)

stop

during PROM if pain is occuring before resistance you should ___

proceed with caution

during PROM is pain is occuring synchronously with resistance you should ____

strong

during PROM pain occuring after resistance is a lesion suitable for ____ stretching

ROM

what test is used for one-joint muscles?

muscle length

what test is used for two-joint muscles?

passive insuffiency

the inability of a muscle to lengthen and allow full ROM at all the joints the muscle crosses

contraindications to MMT

early post op tendon repair or nerve repair

MD order for no strengthening

regional recent unstable fracture

when contraindicated by MD or condition (pulmonary embolism, easy post op cardiac surgery, TBI)

spasticity (DEPENDS, rigid-not helpful, can move through full ROM w/ a few catches-fine)

precautions to MMT

concerns related to valsalva maneuver and impact on BP

- uncontrolled HTN

- surgical incisions (abdominal peripheral, intervertebral disc, eye surgery)

unstable cardiac arryhthmias

osteoporosis

recent injury such as dislocation, muscle strain, muscle contusion, TBI

stabilization

the firmness or stability of the body or body part

necessary to insure an accurate test of a muscle/muscle group

break test

manual resistance applied at the end of available range or test position for an isometric contraction

necessary to grade above 3/5

make test

resistance applied throughout the ROM

PT ramps up resistance to match patient's force

found to produce less force than break test

proximally

during an MMT you should stabilize ___

weaker

MMTs are most valid for ___ grades

arthrokinematic

is JPA an osteokinematic or arthrokinematic assessement?

contraindications to JPA

premature stressing of surgical sutures

infection

over recent/ unheald fracture

unstable spondylosthesis

bone pathology

vertebral artery insufficiency

spinal cord instability

malignancies

excessive pain

total joint replacement (DEPENDS)

CT pathology causing weakness (ehlers-danlos)

excessive JPA causes

hypermobility

instability

normal for patient

restricted JPA causes

glide: joint surface and periarticular structure

distraction: CT

- if pain decreases: joint surface

- if pain increases: tear of CT (joint capsule)

- compression reverse: pain may be loose body or joint surface; relief, joint capsule