ROM

range of motion (ROM) definition

• basic techniques used for the examination of movement and for initiating movement into a program of therapeutic intervention

  • it is not synonymous with stretching

movement

• necessary to perform functional activities and desired tasks can be viewed, as muscles or external forces moving bones in various patterns or ranges of motion

ROM

-structured of joints, integrity and flexibility affect the amount of motion between two bones

full motion possible is the ROM

types of ROM - passive

• movement of a segment within the unrestricted ROM that is produced entirely by an external force

• little to no voluntary muscle contraction

types of ROM - passive indications

• acute/inflamed tissue (inflammation lasts approx. 2-6 days)

• patient not able to move

• patient not supposed to actively move

• after surgical repair on contractile tissue

types of ROM - passive goals

• maintain mobility and elasticity of muscle

• minimize contractures

• assist circulation

• synovial movement

• assist healing process

• maintain awareness of movement

types of ROM - passive other uses

• determine limitations

• to demonstrate desire motion

• used before passive stretching techniques

types of ROM - passive limitations

• does not prevent atrophy

• does not increase strength or endurance

• does not assist in circulation as muscle contraction does

types of ROM - active

movement of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing that joint.

types of ROM - active-assistive

which assistance is provided manually or mechanically by an outside force. prime mover muscles need assistance to complete the motion

types of ROM - AROM/AAROM indications

• patient has weak musculature

• use on the regions above and below the immobilized segment

• for aerobic conditioning programs

types of ROM - AROM/AAROM goals

• maintain physiological elasticity and contractility of muscles

• provide sensory feedback from muscles

• provide a stimulus for bone and tissue

• increase circulation and prevent thrombus formation

• develop coordination and motor skills for functional activities

types of ROM - AROM/AAROM limitations

does not

• maintain or increase strength

• develop skill or coordination

precautions and contraindications for ROM

• should not be done when disruptive to the healing process.

• motion within the limits of pain-free motion in early phases of healing (helps healing)

• too much or wrong motion increases pain and inflammation

precautions and contraindications for ROM: after MI,CABG, PTCA

• upper extremity AROM usually tolerated with monitoring

• ankle and feet AROM minimize venous stasis and thrombus formation

applying techniques

• control movement

• provided necessary support for control

• support hypermobile joints, recent fracture sites or paralyzed limbs

• move segment through complete pain-free range until tissue resistance

• motions smoothly and rhythmically

• number of repititions depends on objectives and patient’s response

application of PROM

• Force of movement is external (by the therapist or mechanical)

• motion within the free ROM

application of AROM

• demonstrate motion using PROM

• assistance as need fro smooth motion

• motion within available ROM

self-assisted ROM (patient self-care) - forms

• manual

• equipment

• wand or t-bar

• finger ladder

• pulleys

• more…

self-assisted ROM (patient self-care) - guidelines

• educate and teach patient

• observe and correct patient performance

• HEP: provide drawings, repetitions, and frequency

• modify or progress exercise program

continuous passive motion (CPM)

• performed by mechanical device

• prevents adhesions and contractures

• stimulating effects on healing of tendons and ligaments

• healing of incisions

• synovial joints lubrication

• prevents effects of immobilization

• quicker return to ROM

• decrease postoperative pain

functional ROM activities

• determine pattern of movement desired

• move extremity thru pattern with assistance

• help patient recognized importance of ROM exercises for function

functional ROM activities - examples

• grasping utensil to eat

• reaching for shelf

• brushing hair

• donning shirt

• supine to sit

• standing up

• putting on socks