1401AHS End of Tri Exam - ROM, Movement & ICF

ROM and movements for end of tri exam. + ICF

Clinical Measurement

A way of understanding, evaluating, & differentiating characteristics of a patient’s presentation

Why do physiotherapists need to use clinical measurements?

1. identify the problem → diagnosis

2. compare with normal ranges

3. assist in planning intervention

4. evaluate intervention

5. effective documentation

6. effective communication (patient and colleagues)

7. Research

What makes a good clinical measure?

• Valid

• Reliable

• Practical

• Objective

Validity in clinical measurements

Extent to which an instrument measures what it is intended to measure

• i.e. how well a test measures what it claims to measures

• ✅Swelling

• ❌ pain

Reliability in clinical measurements

The degree to which the result of a measurement can be depended on to be accurate

• the variation in the measurement when taken on repeated occasions

• the variation in the measurement when taken by two different individuals

Measurements can be reliable but NOT VALID

• Measuring device reliable if it is consistent!

• HOWEVER, if it consistently overestimates → it may be reliable but not valid!!!

Intra-examiner Reliability

the ability of a single examiner/tester to obtain identical measurement during separate performances

Inter-Examiner Reliability

The ability of 2x or more examiners to obtain identical measurement during separate performances

Measurement Error

• Difference between a measured quantity and it’s true value

Systemic Error (bias)

caused by an issue with equipment that affects all measures

Random Error

Deviation from the true measure is a result of chance

How do we enhance reliability?

Standardization:

• using a standardized testing procedure

• training in testing procedure

• using standardized instructions

• using specific landmarks

• standardizing equipment

Practicality

capable of, or suitable to, being used or put effort into effect

Objectivity

findings are reported without distortion by personal opinion or feelings

Physiological Movement

• joint movement can be produced voluntarily by person

• active and passive

• e.g. flexion, extension, rotation

Accessory Movements

• joint movement that can not be produced in isolation by a person by themselves

• Important part of normal physiological movement

• e.g. gliding, rolling, spinning, translation

Active ROM

• Patient contracts muscles to voluntarily move body part through the ROM i.e. nil assistance

• Reflects functional ability

• most unable to perform movement their full available ROM

• May be affected by:

  • Willingness to move

  • restricted joint mobility

  • muscle weakness

  • pain

  • swelling

Passive ROM

• Therapist or another force the body part through the ROM i.e therapist assists

• Reflects amount of movement possible at joint

• Typically slightly more than AROM

• Provides information about factors limiting movement:

  • soft tissue

  • ligaments

  • joint capsule

  • bone

What does AROM vs PROM tell us?

• AX of AROM and PROM can assist with diagnosis and management

• contractile (muscle/tendon) vs non-contractile tissues (ligament/joint)

Contraindication of AROM and PROM

• immediately after injury/surgery where movement is likely to disrupt healing

• fracture, dislocation, or subluxation is suspected

• Myositis ossificans or ectopic calcification is suspected or present

Precautions of AROM and PROM

• painful conditions

• inflammatory process in/around joint

• osteoporosis or marked bone fragility

• Hypermobile joints

• Patients with hemophilia

• recently healed fractures

• presence of a hematoma

Factors Affecting ROM

• age

• gender

• cultures

• genetics (hypo/hyper)

• occupation/hobbies

• impairments

• position of joint being measured

• Muscle length - 2 joints muscles

Abnormal limitations of ROM

• destruction of bone and cartilage

• bone fracture foreign body in joint

• Tearing or displacement of intrascapular structures

• adhesions or scar tissue

• muscle atrophy or hypertrophy, tear or rupture

• pain

• oedema

• neurological impairment

Function of the Hip Joint

• supports body weight/ loads

• movement/locomotion

• movement in 3 planes

Anatomical Variations of the Femoral Neck

Angle of inclination:

• Normal: 120-135°

• Coxa vara: < 120°

• Coxa valga: >135°

Femoral Version:

• normal: ~ 12-15°

• Anteversion: > 12-15 °(“toe-in gait)

• Retroversion: < 12-15 °(“toe-out gait)

Anatomical Variations of Acetabulum

Center-edge Angle:

• 35° in the coronal/frontal plane

Anteversion Angel:

• normal - 20°

• anteversion - inclines more anteriorly

• Retroversion - inclines more pstero-laterally

Hip Flexion Range

120 ° (at the hip)

Hip Extension Range

30° (at the hip)

Hip Abduction Range

45° (at the hip)

Hip Adduction Range

30 ° (at the hip)

Hip Internal Rotation Range

45° (at the hip, rotation)

Hip External Rotation Range

45 ° (at the hip, rotation)

Function of the Knee Joint

• Support body weight

• transmit/absorbs forces

• sustains large mechanical loads

Knee Flexion Range

140 ° (at the knee joint)

Knee Extension Range

0° (at the knee)

Joint Position → Closed packed position

• Position with most joint congruency

• capsule and surrounding ligaments maximally tight

• minimal accessory joint movement

• Maximally compressed and difficult to distract

Joint position → Open/Loose Packed Position

• Any position of joint other than closed packed position

• “resting position” → least joint congruency and greatest laxity of capsule and ligaments

Closed & Open Packed Positions of the Hip

Closed Packed = Full extension, IR and abduction

Open Packed = 30° flexion, 30° abduction and slight ER

Closed & Open Packed position for knee (tibiofemoral joint)

closed packed = full extension & ER

open packed = flexion ~ 25°

Closed and open packed position for ankle (Talocrual Joint)

Closed packed = Maximal DF

Open packed = 10° PF

Q - Angle

angle formed by the line of pull of the quadriceps and the line representing patellar tendon

females: 15-17°

males: 10 - 14 °

Anatomical Variation of Knee joint alignment

• Neutral alignment/normal

• Genu Varus (knees out)

• Genu Valgus (knock knees)

Valgus Forces

outwards/lateral angulation of the distal segment of bone or joint

Varus Forces

Inward/medial angulation of the distal segment of a bone or joint

Open kinetic chain movements

• movement of one joint is independent of other joint

• distal segment of chain moves freely in space

Closed chain kinetic movements

• movement of one joint causes other joints to move

• distal segment of chain is fixed

Arthrokinematics → Knee Flexion

• ER of the femur by the popliteus muscle (unlocking the knee)

• Patella shifts laterally

• posterior rolling and anterior femur translation/slide (fixed tibia)

• posterior motion of minisci

Arthrokinematics → Knee Extension

• ER rotation of the tibia in last 20° of extension (screw-home mechanism)

• Superior glide of patella

• Anterior rolling and posterior translation/slide of femur (fixed tibia)

• anterior motion of menisci

Arthrokinematics → screw home mechanism

• “knee locking”

• rotation during the last 20° extension

• Causes external tibial rotation

• Point at which the medial and lateral condyles are locked to form the lose pack position of the knee

Function of the Shoulder

• link between the upper extremity and the trunk

• most dynamic and mobile joint in the body → yet can sustain incredible forces & speeds

• complex and intricate movements

• important for hand positioning

• Disparity in size between the ball (humeral head) and socket (glenoid) that make up the joint

• Range of motion at the expense of stability (large ROM, not stable)

  • Absent bony constraints

  • stability from soft tissue

Stability and Mobility of the Shoulder

• interplay between the rotator cuff muscle and the static structures

• coordinated movement of the scapular enables the power movers of the shoulder to function

• mobility derived from 4 joints

  • Sternoclavicular Joint

  • Acromioclavicular Joint

  • Glenohumeral Joint

  • Scapulothoracic Joint/articulation

• Movement further augmented by movement of the spine

Scapulohumeral Rhythm

Describes the timing of movement at the glenohumeral and scapulothoracic joints during shoulder elevation

• it preserves the length-tension relationships of the glenohumeral muscles

• it prevents impingement between the humerus and the acromion

Elbow Flexion Range

140-160° (at the elbow)

Elbow Extension Range

0° (at the elbow)

Forearm Supination Range

80-90° (at the forearm)

Forearm Pronation Range

80-90° (at the forearm)

Elbow joint closed packed positions → ulnohumeral

Extension (at the elbow)

Elbow joint open packed positions → ulnohumeral

70° flexion, 10 ° supination (at the elbow)

Elbow joint closed packed position → Radiohumeral

90° flexion + 5° supination

Elbow joint open packed position → radiohumeral

full extension, full supination (at the elbow)

Elbow Joint closed packed position → Superior Radioulnar

5° supination (at the elbow)

Elbow joint open packed position → Superior Radioulnar

70° flexion, 35° supination (at the elbow)

Dorsiflexion Range

15-20° (at the ankle)

Plantarflexion Range

40-50°

Inversion (ST joint) Range

5 ° (at the ankle)

Eversion (ST joint Range)

5 ° (at the ankle)

Total/whole foot inversion (includes fore foot) range

30-35° (at the ankle and foot)

Total/whole foot Eversion (includes fore foot) Range

15-20° (at the ankle and foot)

Hallux Flexion range

45° (at the big toe)

Hallux Extension Range

70° (at the big toe)

Pronation of Ankle

Abed:

• abduction

• eversion

• dorsiflexion

• unlocks midtarsal joint

• flatter

• longer

• wider

• flexible

• mobile

Supination of Ankle Joint

Adip:

• adduction

• inversion

• Plantarflexion

• locks midtarsal joint

• higher

• shorter

• narrower

• stiff

• rigid

Windlass Mechanism

Phenomenon in which the plantar fascia becomes taut as the 1st MTP join is extended passively, causing a rise in the medial longitudinal arch without direct muscle action.

Function:

1. supports medial and lateral arch during WB

2. Assists in re-supination of foot during propulsion

3. absorbs and release mechanical energy

4. increases forward propulsion force

Shoulder Flexion Range

170-180° (at the shoulder)

Shoulder Extension Range

60° (at the shoulder)

Shoulder Abduction range

170-180° (at the shoulder)

Shoulder Horizontal Adduction Range

135° (at the shoulder)

Shoulder Horizontal Abduction Range

45° (at the shoulder)

Shoulder Internal Rotation (in 90° abduction) range

70° (at the shoulder)

Shoulder External Rotation (in 90° Abduction) Range

90° (at the shoulder)

Wrist Flexion Range

80-90° (at the wrist)

Wrist Extension Range

70-90° (at the wrist)

Ulnar deviation range

30° (at ulna)

Radial Deviation Range

20° (at radius)

Metacarpophalangeal Flexion Range

100° (at metacarpal joints)

Metacarpophalangeal Extension Range

45° (at metacarpal joints)

Proximal interphalangeal Flexion Range

100° (phalanges)

Proximal Interphalangeal Extension Range

0° (phalanges)

Distal Interphalangeal Flexion Range

90° (phalanges)

Distal interphalangeal Extension Range

20° (phalanges)

What are the Social Determinants of Health

Gender, Ethnicity, Religion, Minority Group Membership, Food Security, Access to Health Care, Community Resources, Education, Living Situation, Income, Employment, Social Support

What is the ICF

Dual Function:

• A classification System for describing health (the broader definition which includes participation and quality of life)

• A common framework and language — the biopsychosocial model — integration of the ‘medical’ and ‘social’ models of disability and health

ICF Body Functions Definition

The physiological functions of body systems (including psychological functions).

ICF Body Structures Definition

Anatomical parts of the body, such as organs, limbs and their components

ICF Impairments Definitions

Problems in body function and structure, such as significant deviation or loss

ICF Activity Definition

the execution of a task or action by an individual

ICF Activity Limitations Definitions

the difficulties an individual may have in performing activities

ICF Participation Definition

is the involvement in a life situation

ICF Participation restrictions definition

the problems an individual may experience in involvement in life situations

Definitions of Contextual Factors

How the world around you impacts your experience

• Environmental Factors

• Personal Factors

ICF Environmental Factors Definition

The physical, social and attitudinal environment in which people live and conduct their lives; these are either barriers to or facilitators of the person’s functioning