Kisner Ch 3- ROM

Question 1

What is functional excursion

Answer 1

the distance a muscle is capable of shortening after it has been elongated to its maximum

Question 2

Types of ROM?

Answer 2

Passive ROM
Active ROM
Active Assisted

Question 3

Indications for PROM?

Answer 3

Acute, inflamed tissue, passive motion is beneficial

When are pt. is not able to or not supposed to move actively

Question 4

Goals of PROM

Answer 4

Maintain joint and connective tissue mobility
Minimize the effects of the formation of contractures
Maintain mechanical elasticity of muscle
Assist circulation & vascular dynamics
Enhance synovial movement for cartilage nutrition & diffusion of materials in the joint
Decrease or inhibit pain
Assist w/ the healing process after injury
Help maintain the patient’s awareness

Question 5

What are limitations of PROM?

Answer 5

Passive motion does not:
Prevent muscle atrophy
Increase strength or endurance
Assist in circulation to the extent that active, voluntary muscle contraction does

Question 6

Indications for AROM & AAROM

Answer 6

When the pt. is able to contract the muscles actively

Use AAROM when the patient’s musculature is too weak or unable to move joint through the desired range

Question 7

Goals of AROM & AAROM

Answer 7

Maintain physiological elasticity & contractility of muscles in use
Provide sensory feedback from the contracting muscles
Provide a stimulus for bone & joint tissue integrity
Increase circulation & prevent thrombus formation
Develop coordination and motor skills for functional activities

Question 8

Precautions & Contraindications to ROM exercises

Answer 8

ROM should not be done when motion is disruptive to the healing process
Use carefully controlled motions with in pain free range
Too much wrong motion will increase pain & inflammation
ROM should not be done when pt. response or the condition is life threatening
PROM may be carefully initiated to major joints
AROM to ankles & feet to minimize venous stasis & thrombus formation

Question 9

What types of activities can be done after myocardial infarction, coronary artery bypass surgery or percutaneous transluminal coronary angioplasty?

Answer 9

AROM of the UE & limited walking

Question 10

Principles & Procedures for applying ROM techniques

Answer 10

Evaluate pt. impairments & level of function
Determine ability of pt. to participate in ROM activity and amount of motion that can be safely
Decide what patterns best meet the goals; ADLs, muscle range elongation, anatomical planes, diagonal motions
Monitor pt. response during and after intervention
Document
Re-evaluate and modify intervention, if necessary

Question 11

How do you prepare the patient for ROM activities?

Answer 11

Describe the plan and goals w/ patient
Free the region from restrictive clothing, linen, splints, & dressings
Position pt. in comfortable position w/ proper body alignment & stabilization
PT position to use proper body mechanics

Question 12

Application of PROM

Answer 12

PT moves through ROM
No active resistance or assistance is given by the pt’s muscles
Motion carried out in the free ROM- the range available w/o forced motion or pain

Question 13

Application of AROM

Answer 13

Demonstrate to pt desired motion using PROM, then ask pt to perform motion
PT provides assistance only as needed for smooth motion
Motion performed within available ROM

Question 14

What are forms of self-assisted ROM?

Answer 14

Wand, finger ladder, wall climbing, ball rolling, pulleys, skateboard/ powder board, reciprocal exercise devices

Question 15

What is continuous passive motion (CPM)?

Answer 15

passive motion performed by a mechanical device that moves a joint slowly and continuously through a controlled ROM

Question 16

Benefits of CPM

Answer 16

Prevents development of adhesions & contractures thus joint stiffness
Provides a stimulating effect on the healing of tendons and ligaments
Enhances healing of incisions over the moving joint
Increases synovial fluid lubrication of the joint and thus increase the rate of intra-articular cartilage healing & regeneration
Prevents degrading effects of immobilization
Provides a quicker return of ROM
Decreases postoperative pain

Question 17

Static stretching

Answer 17

Place muscle in elongated position
Pt. should feel mild tension (NOT DISCOMFORT)
Hold for 30 sec/ 3-5 times

Question 18

Ballistic stretching

Answer 18

Get into elongated position of muscle & bounce into a more elongated position
repeat 10 to 15 times

Question 19

Why is ballistic stretching dangerous?

Answer 19

Ballistic stretching may activate the muscle spindle that would in turn cause the muscle to actually resist the stretch
May increase risk of injury or cause microscopic trauma to muscle

Question 20

In what situations would you NEVER use ballistic stretching?

Answer 20

Injured muscle or tendon

Sedentary, unconditioned, elderly persons, or persons w/ altered cognitive or sensory systems

Question 21

What is an alternate technique for ballistic stretching?

Answer 21

Static stretching that gradually works up to faster oscillations at end range

Question 22

Who is ballistic stretching best used for?

Answer 22

In athletes that require rapid end range responses that are ballistic in nature

Question 23

What was PNF designed to influence? How?

Answer 23

Muscle performance

By providing input to the kinesthetic and proprioceptive sensors

Question 24

What can PNF be used for?

Answer 24

ROM, strengthening, or stretching

Question 25

Describe the PNF technique?

Answer 25

``` Brief contraction (isometric or concentric) before a brief static stretch Called contract- relax ```

Question 26

What is PNF autogenic inhibition?

Answer 26

By fatiguing the AGONIST you will get relaxation in the agonist muscle, making it easier to stretch

Question 27

What is the autogenic inhibition technique?

Answer 27

Passively move joint to elongated position ISOMETRIC contraction of AGONIST in elongated position for 10 sec Followed by instruction to relax Passively move into a MORE elongated position & hold for 10 to 15 sec Repeat 3-5 times

Question 28

What is PNF reciprocal inhibition?

Answer 28

Fatiguing the ANTAGONIST will cause it to relax so that the agonist can contract and produce motion

Question 29

What is the reciprocal inhibition technique?

Answer 29

Passively move joint to elongated position CONCENTRIC contraction of ANTAGONIST in elongated position for 10 sec Followed by instruction to relax Passively move into a static stretch & hold for 10 to 15 sec Repeat 3-5 times

Question 30

What is Combination PNF?

Answer 30

Combines both Autogenic & Reciprocal techniques

Question 31

Combination PNF technique

Answer 31

Alternates using Autogenic for 1 repetition then Reciprocal | Repeated for 3 to 5 times

Question 32

Age related considerations

Answer 32

Geriatrics decreased soft tissue flexibility Stretching weakness phenomena- aging and disuse of muscle alters performance Recommendations: functional flexibility training or dynamic flexibility + AROM to end ROM and static stretching Pediatrics developing muscles are maximally flexible Use static and PNF stretching techniques over ballistics