Download PT 153: Therapeutic Exercise II Range-of

PT 153: Therapeutic Exercise II
Range-of-motion Exercises
Aila Nica J. Bandong, PTRP
Instructor
Department of Physical Therapy
UP- College of Allied Medical Professions
Learning Objectives
At the end of the lecture, the students
should be able to:

Differentiate the types of range-of-motion
(ROM) exercises in terms of
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Goals of treatment
Indications
Treatment variables
Limitations
Contraindications
Identify the appropriate type of ROM exercise
to employ given a condition
 Perform ROM exercises properly (lab)

Why use ROM exercises?

Basic technique for movement
examination

Technique used for initiating or
incorporating movement into a
therapeutic intervention program
◦ Full ROM vs Functional ROM
TYPES OF ROM EXERCISES

Passive range-of-motion exercises
◦ PROM

Active range-of-motion exercises
◦ AROM

Active-Assistive range-of-motion
exercises
◦ AAROM
PASSIVE ROM EXERCISES

Movement produced by an
external force within the
unrestricted range of motion
of a segment
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
Gravity
Machine
Therapist or another person
Another part of the individual’s
own body
Little to or no muscle
contraction elicited
G ! Minimize ill-effects of immobilization
O
A
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L
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S
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Maintain joint and connective tissue mobility
Minimize the effects of the formation of
contractures
Maintain mechanical elasticity of muscles
Assist circulation
Enhance synovial movement along joints
Decrease pain
Assist with healing process after injury or
surgery
Maintain patient’s awareness of movement
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Acute or inflamed tissue where active
motion may disrupt the normal healing
process
 Patients who are unable to move or are
not allowed to move such as when
comatose, paralyzed, or on complete bed
rest
 For assessment purposes
 When teaching a patient movement
 To prepare a patient for stretching
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Passive ROM exercise WILL NOT:
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prevent atrophy
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increase strength or endurance
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assist in circulation to the extent that
active, voluntary muscle contraction does
Evidence in Practice
Clinical Question:
Is there evidence to suggest the
effectiveness of continuous passive
motion following total knee arthroplasty?
Evidence in Practice
Key articles:
 Grella, RJ (2008) Continuous passive motion
following total knee arthroplasty: a useful
adjunct to early mobilisation? A systematic
review
 Brosseau L, et al (2004) Efficacy of
continuous passive motion following total
knee arthroplasty: A meta analysis
 Lenssen AF, et al (2003) Continuous passive
motion following primary total knee
arthroplasty: Short- and long-term effects on
range of motion
Evidence in Practice
Results/conclusion:
 Conflicting evidence on the effectiveness
of continuous passive motion following
total knee arthroplasty
 Potential benefits may need to be
weighed against additional cost and
inconvenience
 There is need for further trials to
ascertain the effects of using continuous
passive motion post-total knee
arthroplasty
ACTIVE ROM EXERCISES

Movement produced on a
segment upon active
contraction of the muscles
crossing the joint within the
unrestricted range of motion.
ACTIVE-ASSISTIVE ROM
EXERCISES

Assistance is provided by
an outside force (manual or
mechanical), as the prime
mover muscles is unable to
complete the motion.
G
O
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L
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Maintain elasticity and contractility of
muscles
 Provide sensory feedback from the
contracting muscles
 Provide a stimulus for bone and joint
tissue integrity
 Increase circulation and prevent
thrombus formation
 Develop coordination and motor skills
for functional activities
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N
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C
A
T
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When a patient is able to actively
contract the muscles and move the
segment with or without assistance
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Muscle weakness and inability to move
segment completely against gravity

Aerobic conditioning programs
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During periods of immobilization, AROM
is used in joints above and below the
immobilized segment
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Active ROM exercise WILL NOT:
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maintain or increase strength of already
strong muscles
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develop skill or coordination except in
the movement patterns used
PRECAUTIONS AND
CONTRAINDICATIONS OF ROM
EXERCISES

Should not disrupt the healing process
◦ Excessive movement/wrong performance of
movement leads to increased pain and
inflammation

Should not be done if response will be
life-threatening to the patient
PRINCIPLES OF ROM TECHNIQUES

Examination, Evaluation, and Treatment
Planning

Patient preparation

Application of techniques
◦ Application of PROM
◦ Application of AROM
Examination, Evaluation, and
Treatment Planning

Examine and evaluate the impairments and
level of function.
◦ Determine any precautions and prognosis, and
plan of intervention
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Determine the ability to participate in the
ROM activity
◦ Note what type of ROM exercise to meet goals

Decide on the patterns of movement
o
Anatomic plane vs muscle range of elongation vs
combined patterns vs functional patterns
Examination, Evaluation, and
Treatment Planning

Monitor the general condition and
response during and after the
examination and intervention
◦ Take vital signs, presence of pain, quality of
movement, change in ROM
Document and communicate findings and
intervention
 Re-evaluate and modify the intervention
as needed

Patient Preparation
Communicate with the patient that plan
of intervention and the method to be
used
 Remove all restrictive clothing, linen,
splint, and dressings; drape appropriately
 Position the patient comfortably
maintaining proper alignment and
stabilization while allowing movement
along the available ROM
 Maintain proper biomechanics (therapist)

Application of Techniques
Grasp the extremity around the joints
providing support needed for control
 Support areas of poor structural integrity
 Move the segment throughout its painfree range to point of tissue resistance
 Perform the movements smoothly and
rhythmically 5 to 10 reps

◦ Depends on the objectives of the program
and patient’s general condition and response
to the exercise
Application of Passive ROM
Movement is being provided by an
external force
 No active resistance or assistance is
provided by the muscles that cross the
joint.
 Motion is performed within the available
or free ROM

◦ There should be no pain or forced motion
elicited
Application of Active ROM


Demonstrate the desired motion through
PROM
Ask the patient to perform the movement
independently
◦ Be ready to provide assistance or guidance when
necessary
 To complete movement smoothly
 In the presence of weakness (may provide at the
beginning or end of ROM, or when torque is greatest)

Perform the motion within the available
range
EXERCISE PRESCRIPTION

Identify the appropriate ROM exercise for
the case with due consideration to the ff:
◦ baseline function of the patient
◦ available resources
Note the joint segments that are involved,
therefore, require mobilization
 Identify joint motions required
 State the number of repetitions, sets, and
the frequency (how often in a day) that
the exercise is to be performed

SAMPLE CASE 1
You are a physical therapist working in an aged
care facility. A 67-year old female diagnosed
with cerebrovascular accident was referred
to you for management. She presents with
weakness of both the right upper and lower
extremity muscles. Result of which, she has
difficulty moving her involved extremities to
full range. One of your goals is to maintain
joint flexibility. You deem that a regular ROM
exercise may be beneficial.
What does the case tell you?

Patient has inability to move both upper
and lower extremities to full range due to
weakness of muscles

There’s a need for an ROM exercise that
will maintain joint flexibility
What does evidence say?
Tseng et al, in 2007, reported that a simple
range-of-motion exercise can generate
positive effects in physical function of older
people with stroke.
* randomized controlled trial
* statistically significant improvements in
joint angles, activity function, and perception
of pain and depressive symptoms
What ROM ex is appropriate?
AROM?
 AAROM?
 PROM?
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WHY?
Exercise prescription
AAROM exercise of the right upper and
lower extremities, all planes x 10
repetitions x 1 set, 3 times daily
References
Brosseau, L., Milne, S., Wells, G., Tugwell, P., Robinson,V., Casimiro, L., Pelland, L.,
Noel, M.J., Davis, J., and Drouin, H. (2004) Efficacy of continuous passive
motion following total knee arthroplasty: a metaanalysis. The Journal of
Rheumatology. 31(11): 2251-2264.
Encabo, M. (2004). Lecture notes on PT 153: Therapeutic exercises II, range of
motion exercise and stretching. UP-College of Allied Medical Professions
Grella, R. J. (2008) Continuous passive motion following total knee
arthroplasty: a useful adjunct to early mobilisation? Physical Therapy Reviews.
3(4): 269-279.
Kisner, C., Colby, L. (2007). Therapeutic exercise: Foundations and techniques
(4th ed). Philadelphia: F. A. Davis Company.
Lenssen, A. F., Koke, A., de Bie, R. A., and Geesink, R. (2003). Continuous
passive motion following primary total knee arthroplasty: short- and longterm effects on range of motion. Physical Therapy Reviews. 8(3):113-121.
Rothstein, J., Roy, S., and Wolf, S. (2005). The rehabilitation specialist’s
handbook (3rd ed). Philadelphia: F. A. Davis Company.
Tseng, C. N., Chen, C. C., Wu, S. C. & Lin, L. C. (2007). Effects of a range of
motion exercise programme. Journal of Advanced Nursing. 57(2): 181-191.