week 2 tues

Definition of Range of Motion (ROM)
- The amount of available motion at a joint.
- Involves flexibility of physical structures around the joint.

ROM can impact any occupation.
Not necessarily a direct indicator of mental health.
- A client with 20% loss of ROM may need significant assistance versus another with 10% loss who can manage independently.

Definition: Motion performed by the occupational therapist; no muscle activation by the client.
- Focus on the flexibility of the joint's physical structures.
- Example: A hand can passively move a leg for external rotation.
Considerations:
- Structures Involved: Joint capsule, bone-to-bone motion, and surrounding soft tissue.
- If skin cannot stretch, it limits ROM (e.g., making a fist).

Definition: Motion that is initiated and executed by the client themselves.
- Requires brain function to facilitate muscle activation and contraction.
Example Scenario: If a patient attempts to elbow flex but can only achieve limited movement, understanding their ability and fatigue is key.

Definition: A combination of active and passive movements where the client activates muscles with some assistance.
Example: Assisting a weak patient by providing help while they perform a movement (e.g., moving an elbow).

Definition: The slight movements between the two bones at a joint that allow for additional passive range of motion.
Significance: Typically there is more passive range available due to joint play compared to active range, but this does not apply universally.
- For example, elbow extension may show no difference in passive and active.

Client Cooperation: Check if the client is willing to participate.
Safety Considerations: Confirm if it is safe to assess.
Contraindications vs. Precautions:
- Contraindications: Conditions where ROM assessment should not be done (e.g. dislocated joints, unhealed fractures).
- Precautions: Situations requiring caution (e.g. joint inflammation, osteoporosis).

Conduct a quick scan of ROM, typically starting with functional tasks and observing movements.
If deficits are noted, proceed with active assessments first unless contraindicated.
Follow up with passive assessment and document findings carefully, capturing not just numbers but also client feedback.

Different ways to document extension and flexion measurements:
- Extension: Positive numbers for normal, negative for lack of motion to zero, and plus signs for hyperextension.
- Functional Limits: "Within Normal Limits" (WNL) and "Within Functional Limits" (WFL).

Normal Range: Based on standard measurements, generally accepted in literature and textbooks.
Functional Limit: Good enough to perform tasks relevant to the client’s daily life.
- Different professions or activities demand different ROM levels.

Goniometer: For precise angle measurement during active and passive assessments.
Visual Observation: Use of naked eye to monitor muscle control, compensatory movements, and overall symmetry.
End Feels: Assessing the resistance felt at the end of a ROM movement, including:
- Hard (bone-to-bone contact)
- Firm (muscle or ligament pulling)
- Soft (swelling/fluid in soft tissue)
- Springy (like stretching a rubber band)
- Empty (movement halted due to pain or discomfort)

Different tasks may require varying degrees of ROM to be considered functional.
Assessment must take into account specific activities relevant to the client's lifestyle or occupation.

Reliability of Measurements: Intrarater reliability is higher than inter-rater reliability, meaning the same therapist can provide consistent measurements over time.
Documentation Importance: Always specify if measurements are Active (A), Passive (P), or Active-Assisted (AA) to avoid misinterpretation.

Understanding and documenting range of motion assessment accurately supports client-centered occupational therapy by correlating physical capabilities to functional performance.