Introductory Physiotherapy Heal 1000

Informed consent

 is a person's voluntary decision about heath care that is made with knowledge and understanding of the benefits and risks involved

Where does movement occur?

Movement occurs at the joint

What is required to achieve a joint movement

• Passive structures

• Muscles

• Nerves and circulation

• spinal cord

• Brain areas

Types of movement

Passive movement

 

Active - assisted movement

 

Active movement

 

Active-resisted movement

Passive movement

Movement of a joint without muscle activity from the patient (produced by the therapist/mechanical device)

Active assisted movement

movement produced by the patient with help from the therapist. (Patient is unable to complete the movement without assistance)

active movement

Movement produced by the patient’s own muscle. (assistance not required to produce joint movement)

Active-resisted movement

Movement where a patient actively moves a limb against resistance provided by a therapist to improve strength, coordination, and range of motion.

When might physiotherapist use P.Ms

When patients have a restriction in a key element needed for joint movement:

• Muscle activation

• Muscle length

• nerves

• spinal cord

• brain area

• conciousness

Indications for passive movements

• paralysis

• unconcious patients

• pain and swelling

• Patients who have to be immobilised

Consequences of loss of R.O.M

• functional limitations

• poor cosmetics

• poor hygiene

Aims of P.Ms treatment

management of:

• Joint R.O.M

• Muscle length/soft tissue extensibility

• circulation

Restoration of:

• joint R.O.M

• Muscle length/soft tissue extensibility

Assesment of:

• joint R.O.M

• muscle tone

• Pain

Common use of PMs following surgery

• used early to decrease pain and increase recovery rate

• Movement within patient’s tolerance

• Likely to increase confidence

Potential affects of PMs

• decrease or inhibit pain

• maintain/improve joint mobility

• improve confidence in movement

• Reactivate brain or CNS circuits

Key principles of passive movement

Key Principles - REMEMBER THESE!

• Expose the joint and drape appropriately

• Stabilise proximal segment, support distal segment

• Perform slowly, smoothly & rhythmically

• Isolate movement to single joint and plane

• Each movement repeated several times (3+)

• Take the joint through full range of movement for that patient (may be pain limited) and overpress at end of range (except shoulder)

• Monitor for pain or discomfort throughout

Therapists position

• Position should provide eye contact

• Balanced posture that allows movement

• Feet in line with direction of movement

• Allows weight transference

• Close to the patient

Therapist handling

Patient position

Shoulder flexion and extension

plane - sagittal
axis - coronal

Appox ROM - 180 F / 60 E

Shoulder Abduction and adduction

plane - coronal
axis - sagittal

Appox ROM - 180 Abd / 30 Add

Shoulder internal and external rotation

plane - Transverse
axis - longitudinal

Appox ROM - 70 IR / 90 ER

Shoulder horizontal abduction and adduction

plane - Transverse
axis - longitudinal

Appox ROM - 100 H ABD / 50 H Add

Elbow Flexion and extension

plane - Sagittal
axis - coronal

Appox ROM - 150 F / 0-10 E

Forearm Supination and pronation

plane - Transverse
axis - Longitudinal

Appox ROM - 80 P / 90 S

Wrist Flexion and extension

plane - Sagittal
axis - Coronal

Appox ROM - 80 F/ 70 E

Wrist Radial Deviation and ulna deviation

plane - Coronal
axis - sagittal

Appox ROM - 20 RD / 30 US

Patient centred care

This means ensuring that health services are:
- Tailored to people’s needs and
- Provided in partnership with them, rather than simply given to them

MCP (metacarpophalangeal) joints

Flexion and extension
Sagittal plane
Coronal axis
90 F/45 E

IP (interphalangeal) joints

Flexion and extension

Sagittal plane
coronal axis

80-100F/ 0E