ROM, PROM, and Goniometry
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What is ROM and what are the types of ROM?
RANGE OF MOTION - the amount of movement that occurs at a joint
ACTIVE RANGE OF MOTION - the amount of movement the patient voluntarily moves the body part through without any external assistance.
PASSIVE RANGE OF MOTION - the amount of movement that an external force (therapist) moves the body part through without any assistance from the patient
What does the assessment of AROM include?
The client performs AROM at affected joint & joints proximal and distal.
The therapist observes all joints separately, bilaterally and symmetrically
What does the assessment of AROM provide
- Patient’s willingness to move the joint.
- Level of consciousness.
- Attention span.
- Joint ROM.
- Movements that cause or increase pain.
- Muscle strength.
- Ability to follow instructions.
- Ability to perform functional activities.
What are reasons for decreased AROM?
- Muscle weakness.
- Inability to follow instructions.
- Unwillingness to move.
What does assessment of PROM determine?
Amount of movement at join.
Greater than AROM due to elastic stretch of muscle tissue and decreased bulk
Why is PROM performed?
- Establish joints ROM.
- Determine quality of movement throughout ROM & end feel.
- Determine whether a capsule or non-capsular pattern is present.
- Presence of pain.
What is End Feel?
The sensation transmitted to the therapist’s hands at the extreme end of the passive ROM indicates the structures that limit the joint movement - may be normal (physiological) or abnormal (pathological)
1. Normal End Feel - when full Rom & normal anatomy of joint stops movement
2. Abnormal End Feel - decrease or increase in the ROM or normal ROM exists but other structures other than the normal anatomy stop joint movement
What is Passive Insufficiency?
- ROM is limited by length of muscle e.g. Hamstrings.
What are some normal limiting factors and end-feels?
Unique anatomical structure of a joint determines the direction & magnitude of the joints ROM
- 1. Stretching of soft tissue
- 2. Stretching of ligaments or joint capsule
- 3. Apposition of soft tissue
- 3. Bone contacting bone
What is HARD abnormal (pathological) End Feels?
- An abrupt hard stop to movement when bone contacts bone, or a bony grating
- sensation, when rough articular surfaces pass over each other. Loose bodies, degenerative joint disease, dislocations, or a fracture.
What is SOFT abnormal (pathological) End Feels?
Boggy sensation that indicates the presence of synovitis or soft tissue edema.
Synovitis - inflammation of a synovial membrane, usually painful, particularly on motion, and characterized by fluctuating swelling, due to effusion in a synovial sac. It may be caused by rheumatic fever, rheumatoid arthritis, tuberculosis, trauma, gout, or other conditions.
What is FIRM abnormal (pathological) End Feels?
A springy sensation or a hard arrest to movements with some give, indicating muscular, capsular or ligamentous shortening.
What is SPRINGY BLOCK abnormal (pathological) End Feels?
A rebound is seen or felt and indicates the presences of an internal derangement. e.g. knee with a torn meniscus.
What is EMPTY abnormal (pathological) End Feels?
- No sensation (end feel) before the end of passive ROM due to pain. This may be caused by:
- ◦Extra-articular abscess
- ◦a neoplasm (abnormal growth of tissue)
- ◦acute bursitis (inflammation of a bursa, esp one in the shoulder joint)
- ◦joint inflammation
What is SPASM abnormal (pathological) End Feels?
A hard sudden stop to passive movement that is often accompanied by pain is indicative of an acute or subacute arthritis, the presence of a severe active lesion or fracture.
Definition of JOINTS?
- Junctions, or pivot points between two or more bones in the body.
- Movement of the body is mostly due to the motion of the joints.
- There are seven basic types of joints.
What are the 7 types of Joints?
- 1. Hinge Joint
- 2. Pivot Joint
- 3. Ellipsoid Joint
- 4. Ball and Socket Joint
- 5. Plane Joint
- 6. Saddle Joint
- 7. Condyloid Joint
What is an example of a Condyloid Joint?
What is an example of a saddle joint?
What is an example of a Plane Joint?
What is an example of a Ball and Socket Joint?
What is an example of an Ellipsoid Joint?
What is an example of a Hinge Joint?
What is an example of a pivot joint?
What is Motion?
What are the 2 types of Motion?
- Motion – Either active or passive
- ◦Active is the patients movement of his or her arm
- ◦Passive is the examiners movement of the patient’s arm
What is Extension?
Extension – Natural movement opposite to flexion at the zero position.
What is Hyperextension?
Hyperextension – Unnatural motion opposite to flexion at the zero position.
What are the two types of angles?
Relative Angle and Absolute Angle.
What is Relative Angle?
Anatomical reference position
Angle at a joint formed between the longitudinal axes of adjacent body segments
The convention used for measuring relative joint angles is that in anatomical reference position, all joint angles are at 00.
Relative angles should consistently be measured on the same side of a given joint.
What is Absolute Angle?
Horizontal reference and vertical reference
Angular orientation of a body segment with respect to a fixed line of reference.
Absolute angles should consistently be measured in the same direction form a single reference – either horizontal or vertical
What is Instant Center of Rotation?
Quantification of joint angles is complicated by the fact that joint motion is often accompanied by displacement of one bone with respect to the articulating bone at the joint. As a result, the location of the exact center of rotation at a given joint angle, or at a given instant it time during a dynamic movement, is called the instant center.
Instant center: Precisely located center of rotation at a joint at a given instant in time. The exact location of the instant center for a given joint may be determined through measurements taken from roentgenograms (x rays), which are usually taken at 100 intervals throughout the range of motion at the joint. An Instrumented spatial linkage involving intracortical pin fixation has been used to quantify relative linear and angular movements at the knee.
Pivot Point – The point that the joints rotate about. The fundamental movements are roll, slide, and spin.
What are the tools for Measuring Body Angles?
- 1. Goniometer
- 2. Electrogoniometer (elgon)
- 3. Inclinometer
How to use a goniometer?
Goniometers are commonly used by clinicians for direct measurement of relative joint angles on a live human subject.
- Goniometer: is essentially a protractor with two long arms attaches.
- • One arm is fixed so that it extends from the protractor at angle of 00.
- • The other arm extends from the center of the protractor and is free to rotate.
- • The center of the protractor is aligned over the joint center, and the two arms are aligned over the longitudinal axes of the two body segments that connect at the joint.
- • Accuracy depends positioning of goniometer
- • Place marks on the skin
What is an Electrogoniometer?
a goniometer with an electrical potentiometer at its vertex
What is an Inclinometer?
- devices used for direct assessment of human body segment angles
- • Usually gravitationally based
What are the procedures for measuring Passive Joint Range of Movement?
- Passive Joint Range of Movement:
- 1. Expose the area
- 2. Explanation and instruction – explain verbally or demonstrate by passively moving patient’s limb through test movement.
- 3. Assessment of the normal ROM –uninvolved side first –involved side
- * if uninvolved side can’t be used - rely on past experience taking into account age, sex, dominance & occupation
- 4. Measurement procedure:
- –patient position
- –trick movements or substitute
What is a universal Goniometer?
- Most common device used to measure joint angles or ROM.
- 180-360 degree protractor
- One axis which joins two arms
- One stationary arm ◦One moveable arm Size of goniometer is determined by size of the joint being assessed
What is the measurement procedure for using a universal goniometer?
Goniometer placement: The goniometer should be placed lateral to the joint, just off the surface of the limb .
- Axis: The axis of the goniometer should be placed over the axis of movement of the joint
- ◦Eg. Bony prominance
- ◦Anatomical landmark
How is the stationary arm placed on the goniometer?
Stationary arm: lies parallel to the longitudinal axis of the fixed proximal joint segment and/or points toward a distant bony prominence
How is the movable arm placed on the goniometer?
It lies parallel to the to the longitudinal axis of the moving distal joint segment and/or points toward a distant bony prominence
What are the types of Motion?
- Two types
- ◦Translational –Center of Mass
- – A ball being thrown
- ◦Rotational –Limbs
- –A gate swinging open.
The focus for Range of motion testing is rotational motion
What is ROM - Range of Motion testing?
- ROM is a measure of joint flexibility by observing the number of degrees a joint can move through from a set neutral position. Goniometers are the measuring devices ◦Goniometer pin is placed over the joint and two arms are aligned with the limbs connected to the
- A proficiency in anatomical landmark location aids in more accurate measurements.
Why perfume ROM test?
- A limited range of motion can be caused by several things.
- ◦Muscle weakness
- ◦Trauma/Injury ◦Nerve damage
- ◦Spine damage
This test is a basis for finding greater ailments.
Tests serve as a baseline for documentation of interventions, and responses.
What are the types of Joint Movements - ROM?
- RANGE OF MOTION ◦the amount of movement that occurs at a joint
- ACTIVE RANGE OF MOTION ◦the amount of movement the patient voluntarily moves the body part through without any external assistance.
- PASSIVE RANGE OF MOTION ◦the amount of movement that an external force (therapist) moves the body part through without any assistance from the patient
What are some contraindications and precautions when performing Active and Passive ROM?
In a region where there is a recent dislocation or unhealed fracture.
Immediately following surgery to tendons, ligaments, muscles, joint capsules or skin. }
When myositis ossificans is present (is an unusual condition that often occurs in athletes who sustain a blunt injury that causes deep tissue bleeding).
Additional Precautions AROM and PROM
- 1. Infectious or inflammatory process in a joint
- 2. Patient is on medication for pain or muscle relaxants
- 3. Osteoporosis or fragile bones is a factor 4. In assessing hyper mobile or subluxed joints
- 5. Painful conditions
- 6. Hemophilia
- 7. Hematoma in the region especially in the elbow, hip or knee
- 8. If bony ankylosis is suspected (stiffness or fixation of a joint by disease or surgery)
- 9. After an injury disrupting soft tissue (tendons, muscles or ligaments)
- 10. In the region of a newly united fracture 11. After prolonged immobilization of a part
How is AROM assessed?
Client performs AROM at affected joint & joints proximal and distal.
Therapist observes all joints separately, bilaterally and symmetrically
What information does AROM provide?
- Patient’s willingness to move the joint.
- } Coordination.
- } Level of consciousness.
- } Attention span.
- } Joint ROM.
- } Movements that cause or increase pain.
- } Muscle strength.
- } Ability to follow instructions.
- } Ability to perform functional activities.
What are some reasons AROM maybe decreased?
- } Restricted joint mobility.
- } Muscle weakness.
- } Pain.
- } Inability to follow instructions.
- } Unwillingness to move.
What does PROM determine?
- 1. amount of movement at joint
- 2. greater than AROM due to elastic stretch of muscle tissue and decreased bulk
Why is PROM performed?
- 1. establish joints ROM
- 2. determine quality of movement throughout ROM & end feel
- 3. determine whether a capsule or noncapsular pattern is present
- 4. presence of pain
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