Introduction to ROM

goal of ROM assessment

quantify a ROM or measure the angles created at a joint

measuring a joint angle → may tell me about ROM, strength(how much can they actively move) and/or flexibility of the muscle(how it limits the ROM)

ROMmeasurement with interview and exam leads to

presence or absence of impairment

setting a goal

establish a diagnosis

develop POC

evaluate progress

modify treatment

motivate client(have a clear target to reach)

research

lead other treatment interventions

ROM osteokinematic Assessment tools

standard goniometer

bubble goniometer/inclinometer(need 2 for accuracy)

tape measure(distance)

digital tools(HALO)

apps

eyeball - subjective

standard goniometer

center of body on AXIS bony landmark

stationary arm

moving arm - points to distal bony arm

eyeball the motion with an idea of the measure then read the goniometer

keep same scale from start to finish

reading goniometry measurement

START AT 0 (neutral zero method)

percentages(0-100%)

WNL

WFL - not to full range but no limitations to patient

Goiometry performance -AROM

Observe to set the bar/pt’s limit, contractility of the tissue, sees the ability(coordination, strength, joint) and willingness to move

Goniometry PROM(PT does it)

total joint motion available(usually greater than active)

helps gauge strength testing(used for AROM)

pattern - direction joint tells to go instead of plane you want

end feel - normal and abnormal for each joint

Normal & Abnormal end feel

Soft(tissue approximation) - Soft(edema)

Springy(musculotendinous) - Firm(tone)(stroke spasticity)

Firm(capsular, ligamentous) - Hard(OA)

Hard(boney) - Empty(pain for pt but PT doesn’t feel anything)

Pattern of motion(limitation)

capsular, non-capsular, hypermobility, hypomobility, pain during ROM(contractile or not), pain at end ROM(contractile or not)

capsular

pattern of restriction for joint involving capsule

fixed proportion of motion loss of one direction to another

each joint has a predicted capsular pattern

non-capsular

limitation in joint ROM that is not proportioned similar to capsular pattern

intra-articular problem, muscle involvement

hypermobility

increase in PROM that exceeds normal values

can be fine if they’re strong around it/work on it

hypermobility scale(9 point scoring system) - > 4 = hypermobility

hypomobility

decrease in PROM less than normal

how to compare AROM to PROM

Selective tissue tension testing

Contractile Pattern of motion

AROM - pain in direction of movement of tissue

PROM - pain opposite of action of tissue(the direction that will stretch it)

Non-contractile Pattern of motion

AROM - pain in direction of movement of tissue

PROM - pain in direction of tissue

factors affecting ROM

extremity dominance, background(change depending on stress), age, gender, passive insufficiency, active sufficiency

passive insufficiency

inability to stretch muscle at both joints simultaneously

inability for a 2+ joint muscle to lengthen and allow full ROM at all of the joints the muscle crosses

cannot stretch it at both ends and have full ROM of both joints

extending elbow, wrist, fingers

Active insufficiency

inability to contract muscle at both joints simultaneously

inability for a 2+ joint muscle to shorten any further thus limiting ROM and/or torque production of the joint it crosses

you cannot perform both actions of a 2+ joint muscle and get max performance at both joint

bending, elbow, wrist and fingers

Performing Goniometry

explain procedure(don’t get too wordy)

Positioning - standard position for each joint

identify landmarks - need to see skin

AROM rep

stabilization(may need to be done before AROM rep)

perform and measure with appropriate goni, 2+ trials, visual first, measure 2nd with neutral zero method

document

AROM assessment

explain procedure

demonstrate pattern

observe client for quality of motion(pace, effort, deviations, limitations) and quantity of motion(goniometer)

measure

assessment

document

PROM Assessment

explain procedure

client positioning(accessible, stable)

PT body mechanics

quality (end feel, tone(resistance))

quantity of motion(goniometer)

assessment

document

documentation

start to finish values with 0 starting position

end value

percentages

WNL and WFL

side - motion - active/passive - 0-?? - Tool used

ex. Right AROM knee extension to flexion: 5-0-140 with standard goni

started at 5 degree ext. and 140 deg flexion

stationary arm

is connected to body of goniometer

moving arm

is attached to goni’s axis

ROM validity

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

ROM Reliability

amount of consistency between successive measurement of the same subject under the same conditions

good to excellent

+5 degrees

UE > LE > Spine

intra-rater > inter-rater