Range of Motion

Range of Motion (ROM)

arc of motion through which a joint moves

Passive Range of Motion (PROM)

movement by an external force

tested first!

looks at the joint structure itself

flexibility

Active Range of Motion (AROM)

movement by muscles and surrounding the joint

influenced by tendon integrity and may supplement MMT for more specific muscle grading

Functional Range of Motion 

amount of joint range necessary to perform essential ADLs and IADLs without equipment 

Rationale for Assessment of ROM

determine a limitation that is interfering with occupation

identify specific areas needing intervention (ROM, strength, assistive devices)

document changes/effectiveness of intervention

if you treat it, measure it!: you need a baseline!

“Normal” Determinants

normal ranges varies across the population

structure of the joints: mechanics

stretch of joint capsule and ligament

muscle tone and tendons: bulkiness of muscles

dominance: which hand is stronger/flexible

temperature/climate: warmer or cooler

circadian rhythms: daily cycle variations

ROM Limitations

skin contracture due to adhesions or scar tissues 

soft tissue contraries such as tendon, muscle, or ligament shortening 

diseases of the joint 

fractures - bony obstruction or destruction 

burns 

hand trauma 

displacement of fibrocartilage or presence of other firing bodies in the joint 

generally speaking: spasticity, muscle weakness, pain, edema, immobility 

Measurement Expectations

general knowledge of typical ranges

end feel

specific knowledge regarding how client’s condition may affect ROM

looks for patterns of limitation

End Feel

feeling tat is elicited when the joint is brought through the entire available ROM

normal resistance to further joint motion because of stretching of soft tissue, stretching of ligaments and joint capsule, approximation of soft tissue, and bone contacting bone

abnormal: when movement is stopped by body structures other than normal anatomy

soft, hard, firm

Hard

bone on bone

olecranon process/fossa with elbow extension

Soft

soft tissue opposition of the biceps/supinator and radial wrist flexors

Firm 

firm or springy sensation that has some give, as in shoulder flexion 

Measurement Tools

goniometers in various sizes

ROM documentation form 

Measurement Procedures

assess less involved side first

assess proximal to distal 

ask the client to move and observe (perform functional PROM scan): compensation, posture, skin color changes, creases → after deicide which joints require precise ROM measurement

therapist passively moves part to its limit of motion if limitations observed during functional AROM scan): stabilize proximally and watch for pain!

if no passive limitation: problem is AROM = muscle strength (may measure AROM)

if limitation is present: palpate and place goniometer 

goniometer: place at starting alignment then reexamine at ending alignment 

document

Palpate

to find bony landmarks

with index and middle finger, sometimes thumb

fingernails should not contact 

gentle but firm pressure to detect underlying muscle, tendons or bony structures 

Axis

has protractor: measuring device 

gets placed over the axis of motion 

Stationary Arm

stationary level/bone

line on the goniometer

Moveable Arm

moveable lever/bone

ruler of on the goniometer

Neutral Zero Method (180 Degree System)

all joint motions begin at 0 degree and increase toward 180 degrees

joints in which ending position of one joint motion is starting position of opposite motion: one set of measurements (one set of measurements)

joints in which starting position of both joint motions is the same = neutral/zero (two sets of measurements)

Interpretation of ROM Evaluation 

what is normal?: ranges from person to person

factors that might influence joint ROM?: age, sex, body structure, occupation, postural habits

what is functional ROM?: refers to that joint range that is essential to the normal performance of ADL without the use of assistive equipment 

Establishing Treatment Priorities

ranges that fall below the accepted functional ranges are those that the OT should deal with first 

is loss of ROM causing pain?

is there a consistent/progressive loss of ROM in the same joints?

is loss of ROM interfering with the use of normal muscles? 

Reporting ROM to Others 

be concise, accurate and as meaningful as possible 

proceed in a sequential way: report proximal to distal 

if several joint ranges have similar measurements, group them together 

is it necessary to report on bilateral extremities or are there enough similarities that you can pain a big picture of both?

address ROM and relate to function

using the words: slight, moderate, severe 

Slight

limitations are present, but client is able to function fairly well

Moderate

limitations are present, interfere with intron but client can overcome with use of assistive equipment

Severe

limitations severely limit function, contractures present, difficult for client to function even with assistive equipment

lacks hald or more of normal range is usually available at joint