Download Therapeutic exercise foundation and techniques

Therapeutic Exercise
Foundations and Techniques
Part II
Applied Science of Exercise and Techniques
Chapter 3
Range of Motion
Range of Motion
The full motion possible is called the range of
motion (ROM).
• Muscle range is related to
the functional excursion of
muscles
• Functional excursion is the
distance a muscle is capable
of shortening after it has
been elongated to its
maximum
Range of Motion
• In some cases the
functional excursion, or
range of a muscle, is
directly influenced by
the joint it crosses.
• For example, the range
for the brachialis
muscle is limited by the
range available at the
elbow joint.
Range of Motion
• For two-joint or multi joint
muscles ,their range goes
beyond the limits of any
one joint they cross
• Example of a two joint
muscle functioning at the
elbow is the biceps brachii
muscle
• This point is known as
active insufficiency, where
it can shorten no more
Range of Motion
• The muscle is lengthened full range by
extending the elbow, pronating the forearm,
and simultaneously extending the shoulder.
When fully elongated it is in a position known
as passive insufficiency
Leading Factors to decreased ROM
•
•
•
•
•
Systemic joint
Neurological
Muscular diseases
Surgical or traumatic insults
Inactivity or immobilization
for any reason.
Range of Motion
Therapeutically, ROM activities are administered
• To maintain joint and soft tissue mobility
• To minimize loss of tissue flexibility and
contracture formation
TYPES OF ROM EXERCISES
• Passive ROM
• Active ROM
• Active-Assistive ROM
Passive ROM
• PROM is movement of a segment within the unrestricted ROM
that is produced entirely by an external force; there is little to or
no voluntary muscle contraction.
Types external forces
• Gravity
• A machine
• Another individual
• Another part of the
individual’s own body.
Passive ROM
Indications for PROM
• In acute, inflamed tissue, passive motion is
beneficial; active motion would be detrimental to
the healing process. Inflammation after injury or
surgery usually lasts 2 to 6 days.
• When a patient is not able to or not supposed to
actively move a segment or segments of the
body, as when comatose, paralyzed, or on
complete bed rest
Passive ROM
• Goals for PROM
Primary Goal is to decrease the
complications of immobilization, such
as
• Cartilage
• Degeneration
• Adhesion
• Contracture formation
• Sluggish circulation
Passive ROM
Specific Goals
• Maintain joint and connective tissue mobility
• Minimize the effects of the formation of contractures
• Maintain mechanical elasticity of muscle
• Assist circulation and vascular dynamics
• Enhance synovial movement for cartilage nutrition and
diffusion of materials in the joint
• Decrease or inhibit pain
• Assist with the healing process after injury or surgery
• Help maintain the patient’s awareness
Passive ROM
Other Uses for PROM
• When a therapist is examining inert structures, PROM is
used to determine limitations of motion, to determine
joint stability, and to determine muscle and other soft tissue
elasticity.
• When a therapist is teaching an active exercise program,
PROM is used to demonstrate the desired motion.
• When a therapist is preparing a patient for stretching,
PROM is often used preceding the passive stretching
techniques.
Active ROM (AROM)
• AROM is movement of a segment within the unrestricted
ROM that is produced by active contraction of the muscles
crossing that joint
Active-Assistive ROM (AAROM)
AAROM is a type of AROM in which assistance is provided manually or
mechanically by an outside force because the prime mover muscles
need assistance to complete the motion.
(AROM)& (AAROM)
 Indications for AROM& AAROM
• Whenever a patient is able to
contract the muscles
actively and move a segment with or
without assistance,
AROM is used.
• When a patient has weak
musculature and is unable to
move a joint through the desired
range (usually against
gravity), A-AROM is used.
(AAROM)
• AROM can be used for aerobic
conditioning programs.
When a segment of the body is
immobilized for a period of time,
AROM is used on the regions
above and below the immobilized
segment to maintain the areas in
as normal a condition as possible
and to prepare for new activities,
such as walking with crutches
(AROM)
 Goals for AROM
• If there is no inflammation or contraindication to active
motion, the same goals of PROM can be met with AROM.
In addition, there are physiological benefits that result from
active muscle contraction and motor learning from voluntary
muscle control.
 Specific goals
•
•
•
•
•
Maintain physiological elasticity and contractility of the
participating 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
Limitations of ROM exercises
 Limitations of Passive Motion
PROM does not:
1.
2.
3.
Prevent muscle atrophy
Increase strength or endurance
Assist circulation to the extent that active,
voluntary muscle contraction does
 Limitations of Active ROM
• Active ROM does not maintain or
increase strength.
• It also does not develop skill or
coordination
Precautions and contraindications to ROM exercises
• ROM should not be done when motion is disruptive to
the healing process
• Carefully controlled motion within the limits of pain-free
motion during early phases of healing has been shown to
benefit healing and early recovery.
• Signs of too much or the wrong motion include
increased pain and inflammation.
PRINCIPLES AND PROCEDURES
FOR APPLYING ROM TECHNIQUES
 Examination, Evaluation, and
Treatment Planning
1. Examine and evaluate the
patient’s impairments and level of
function
2. Determine the ability of the
patient
3. Determine the amount of motion
PRINCIPLES AND PROCEDURES
FOR APPLYING ROM TECHNIQUES
4.Decide what patterns can best meet the
goals
•
Anatomic planes of motion
•
Muscle range of elongation
•
Combined patterns
•
Functional patterns
5.Monitor the patient’s general condition and
responses
6.Document and communicate findings and
intervention
7.Re-evaluate and modify the intervention as
necessary
PRINCIPLES AND PROCEDURES
FOR APPLYING ROM TECHNIQUES
 Patient Preparation
1. Communicate with the patient. Describe the plan
and
method of intervention to meet the goals.
2. Free the region from restrictive clothing, linen,
splints,
and dressings. Drape the patient as necessary.
3. Position the patient in a comfortable position with
proper body alignment and stabilization but that
also allows you to move the segment through the
available ROM.
4. Position yourself so proper body mechanics can be
used.
PRINCIPLES AND PROCEDURES
FOR APPLYING ROM TECHNIQUES
 Application of PROM
1.During PROM the force for movement is external, being
provided by a therapist or mechanical device. When
appropriate, a patient may provide the force and be
taught to move the part with a normal extremity
2. No active resistance or assistance is given by the
patient’s muscles that cross the joint. If the muscles
contract, it becomes an active exercise.
3. The motion is carried out within the free ROM, that is,
the range that is available without forced motion or pain.
PRINCIPLES AND PROCEDURES
FOR APPLYING ROM TECHNIQUES
 Application of AROM
1. Demonstrate the motion desired using
PROM; then ask the patient to perform
the motion. Have your hands in position
to assist or guide the patient if needed.
2. Provide assistance only as needed for
smooth motion.
3.The motion is performed within the
available ROM