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basic technique used for the examination of movement
and for initiating movement into a program of
therapeutic intervention
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The structure of the joints, as well as the integrity and
flexibility of the soft tissues that pass over the joints,
affects the amount of motion that can occur between
any two bones.
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all structures are affected by ROM
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To describe joint range  flex. Ext. …
◦ measured with a goniometer and recorded in degrees.
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Muscle range  functional excursion of muscles.
◦ the distance a muscle is capable of shortening after it has been elongated
to its maximum.
◦ directly influenced by the joint it crosses
 one-joint muscles v.s. two-joint muscles
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two-joint muscles shortens to a point known as active
insufficiency, where it can shorten no more.
when fully elongated it is in a position known as passive
insufficiency.
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To maintain normal ROM, the segments must be
moved through their available ranges periodically
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factors can lead to decreased ROM
◦ systemic, joint, neurological, or muscular diseases
◦ surgical or traumatic insults
◦ inactivity or immobilization for any reason.
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ROM activities are administered to maintain joint and
soft tissue mobility to minimize loss of tissue flexibility
and contracture formation.
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Passive ROM.
◦ movement of a segment within the unrestricted ROM that is
produced entirely by an external force
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Active ROM.
◦ movement of a segment within the unrestricted ROM that is
produced by active contraction of the muscles crossing that joint.
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Active-Assistive ROM.
◦ assistance is provided manually or mechanically by an outside force
because the prime mover muscles need assistance to complete the
motion.
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Regions of acute, inflamed tissue
Patient unable to or not supposed to actively move a
body segments
◦ comatose, paralyzed, or on complete bed rest
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decrease the complications that would occur with
immobilization
◦ cartilage degeneration, adhesion and contracture formation, and
sluggish circulation.
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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
Decrease or inhibit pain
Assist with the healing process after injury or surgery
Help maintain the patient's awareness of movement
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When a examining inert structures, PROM is used to
determine limitations of motion, to determine joint stability,
and to determine muscle and other soft tissue elasticity.
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When a teaching an active exercise program, PROM is used
to demonstrate the desired motion.
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When a therapist is preparing a patient for stretching,
PROM is often used preceding the passive stretching
techniques.
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patient able to contract the muscles actively and move a
segment with or without assistance
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patient has weak musculature and is unable to move a joint
through the desired range (usually against gravity)
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aerobic conditioning programs
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on the regions above and below the immobilized segment
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same goals of PROM can be met with AROM
◦ 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
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Passive motion does not:
◦ Prevent muscle atrophy
◦ Increase strength or endurance
◦ Assist circulation to the extent that active, voluntary muscle
contraction does
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For strong muscles, active ROM does not maintain or
increase strength.
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It also does not develop skill or coordination except
in the movement patterns used.
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when motion to a part is disruptive to the healing process
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Historically, ROM has been contraindicated immediately
after acute tears, fractures, and surgery; but ...
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stays within the range, speed, and tolerance of the patient
during the acute recovery stage
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Signs of too much or the wrong motion include increased
pain and increased inflammation
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ROM should not be done when patient response or the
condition is life-threatening.
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PROM may be carefully initiated to major joints and AROM
to ankles and feet to minimize venous stasis and thrombus
formation.
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After myocardial infarction, coronary artery bypass surgery,
or percutaneous transluminal coronary angioplasty, AROM of
upper extremities and limited walking are usually tolerated
under careful monitoring of symptoms.
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Examination, Evaluation, and Treatment Planning
◦ Examine and evaluate the patient's impairments and level of
function, determine any precautions and prognosis, and plan
the intervention.
◦ Determine the ability of the patient to participate in the ROM
activity and whether PROM, AAROM, or AROM can meet the
immediate goals.
◦ Determine the amount of motion that can be safely applied for
the condition of the tissues and health of the individual.
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Decide what patterns can best meet the goals
◦ Anatomic planes of motion: frontal, sagittal, transverse
◦ Muscle range of elongation: antagonistic to the line of pull of the
muscle
◦ Combined patterns: diagonal motions or movements that
incorporate several planes of motion
◦ Functional patterns: motions used in activities of daily living
(ADL)
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Monitor the patient's general condition and responses
during and after the examination and intervention
Document and communicate
Re-evaluate and modify the intervention as necessary.
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Communicate with the patient.
Free the region from restrictive clothing, linen, splints,
and dressings
Position the patient in a comfortable position with
proper body alignment and stabilization
Position yourself so proper body mechanics can be
used
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To control movement, grasp the extremity around the
joints.
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Support areas of poor structural integrity
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Move the segment through its complete pain-free range
to the point of tissue resistance.
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Perform the motions smoothly and rhythmically, with 5
to 10 repetitions.
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During PROM the force for movement is external,
being provided by a therapist or mechanical device.
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No active resistance or assistance is given by the
patient's muscles that cross the joint.
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The motion is carried out within the free ROM
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Demonstrate the motion desired using PROM; then
ask the patient to perform the motion.
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Provide assistance only as needed for smooth motion.
When there is weakness, assistance may be required
only at the beginning or the end of the ROM, or when
the effect of gravity has the greatest moment arm
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The motion is performed within the available ROM.