Range of Motion (ROM)

Question 1

Describe range of motion (ROM)

Answer 1

• primarily used as an exam technique & to initiate movement into a program
• all anatomical structures are involved
• described as joint range or muscle range
• muscle range is related to functional excursion

Question 2

Define functional excursion

Answer 2

• the distance (range) a muscle is capable of shortening after it has been elongated to its maximum
• the combination of active and passive insufficiency

Question 3

Difference between one joint and multiple joints ranges

Answer 3

• One joint: muscle range is limited by the ROM available at a single joint (example brachialis)
• Multiple joint: muscle range is not limited by the ROM available at a single joint (example hamstrings)

Question 4

Difference between active insufficiency and passive insufficiency

Answer 4

• Active: muscle shortened to a point where it is too short to produce much tension
• Passive: muscle fully lengthened limits motion at one of the joints it crosses

Question 5

Describe PROM

Answer 5

• movement within unrestricted ROM done by externL force
• appropriate for tissue healing & mobility phase of the exercise framework
• Indications: acute/inflamed tissue when AROM is detrimental to healing process, after surgical repair of contractile tissue when AROM is not permitted, patient is comatose, bed bound, paralyzed or otherwise unable/not permitted to move a segment
• goal is to combat immobilization

Question 6

Describe AAROM and AROM

Answer 6

• AROM: movement in the segment within unrestricted ROM by active contraction of muscle crossing the joint
• AAROM: movement in the segment within unrestricted ROM by active contraction supplemented by an external force
• Indications: when body segment is immobilized AROM is permitted above & below the joint, aerobic conditioning & generalized movement against gravity, & AAROM used when patient is weak & unable to move through desired ROM
• Goals: maintain physiological elasticity & contractility of participating muscles, provide sensory feedback from muscle contractions to develop coordination & motor skills for functional activities, & stimulus for bone & joint tissue integrity

Question 7

Limitations of PROM

Answer 7

• does not prevent muscle atrophy
• does not increase strength/endurance
• does not assist in circulation better than voluntary muscle contraction

Question 8

Limitations of AAROM & AROM

Answer 8

• AROM does not maintain or increase strength for strong muscles
• no skill or coordination development except in the patterns used

Question 9

Precautions/Contraindications for ROM

Answer 9

• ROM should not be done when motion is disruptive to the healing process
• pain is your guide
• PROM is beneficial to the major joints
• AROM to minimize venous stasis/thrombus formation (ankle pumps)
• after MI, CABG (coronary artery bypass surgery), angioplasty AROM of the UE & limited walking are usually tolerated with careful monitoring
• sedation interruption followed by AROM with progression to sitting, standing, & walking may be initiated early on mechanically ventilated patients

Question 10

Application of ROM

Answer 10

• smooth and rhythmic motions
• start 5-10 reps to determine effectiveness then progress based on the goals of the treatment

Question 11

ROM through functional patterns

Answer 11

• early ROM training for functional UE & neck patterns may include activities such as: grasping an eating utensil, eating, reaching to various shelf heights, brushing or combing back of hair, holding a phone to the ear, or donning/doffing a shirt/jacket
• early ROM training for functional LE & truck patterns may include activities such as: transition from supine to sitting at the side of the bed, standing up/sitting down & walking, & putting on socks & shoes

Question 12

Describe continual passive motion (CPM)

Answer 12

• refers to passive motion performed by a mechanical device that move a joint slowly & continuously through a controlled ROM
• AROM & early physical therapy/mobility appear to be best practice for most patients
• occasionally CPM can be used in the setting of other comorbidities limiting patient’s ability to actively participate

Question 13

Describe diagonal patterns at the shoulder, UE, pelvis, & LE

Answer 13

• D1 flexion: flexion, adduction, & external rotation
• D1 extension: extension, abduction, & internal rotation
• D2 flexion: flexion, abduction, & external rotation
• D2 extension: extension, adduction, & internal rotation