THERAPEUTIC EXERCISE: Active, Active Assistive, and Passive ROM

Question 1

Range of motion (ROM) is the

Answer 1

full motion possible

Question 2

Functional excursion

Answer 2

• the distance a muscle is capable of shortening after it has been maximally elongated
  
  • Active insufficiency
  • Passive insufficiency

Question 3

What affects the amount of ROM?

Answer 3

• Structure of the joint
  Anatomical shape
  (e.g., hip vs. knee)
• Joint integrity
  Stability and condition
  (e.g., shoulder vs. elbow)
• Soft Tissue flexibility
  Length and elasticity of muscles, tendons, ligaments, and fascia (e.g., Thomas test)

Question 4

What affects ROM in a region?

Answer 4

Muscles
Joint surfaces
Synovial fluids
Joint Capsules
Ligaments

Fascia
Vessels
Nerves
Adipose tissue

Question 5

Active Insufficiency

Answer 5

• Muscle shortening is influenced by more than 1 joint crossing.
• Shorten muscle will reduce contraction force.

Question 6

Passive Insufficiency

Answer 6

• A fully lengthened muscle limits joint motion.
  
  • Resulting in decreased force production.
  • Two or multi-joint muscles normally function in the mid-portion of their functional excursion.

Question 7

What causes decreased ROM
Causes?

Answer 7

Disuse and immobility

Systemic disease
Surgical insults
Joint disease
Traumatic insults
Muscular disease
Inactivity or immobilization

Question 8

Contracture

Answer 8

• Adaptive shortening of the muscle-tendon units and surrounding soft tissue.
• Results-
  • Resistance to PROM and AROM
  • Limited motion
  • Compensatory movement patterns

Question 9

Types of ROM (Passive (PROM))

Answer 9

• Movement performed by an external force.
• No voluntary muscle contraction involved.

Question 10

External forces PROM

Answer 10

• Therapist
• Gravity
• Mechanical device
• Another individual or a patient’s other limb.

Question 11

PROM Indications

Answer 11

• Acute, inflamed tissue.
• Post-surgical protection
• Pt is unable to move a segment.

Question 12

Goals of PROM

Answer 12

• Maintain existing joint and soft tissue mobility.
• Prevent contractures.
• Assist circulation.
• Promote synovial fluid movement.
• Maintain the patient’s awareness of movement.

Question 13

PROM Additional uses

Answer 13

• Assess joint and soft tissue integrity.
• Decrease pain.
• Demonstrate movement (e.g., Pendulum exercise).

Question 14

AROM

Answer 14

Movement produced by an active contraction of the muscle(s) crossing the joint.

Question 15

AROM Indications

Answer 15

• Pt can contract muscle without assistance.
• Pt may have weakness.
• Prevent disuse.
• Aerobic and conditioning programs

Question 16

AROM Goals

Answer 16

• Same goals of PROM with the added benefits of muscle contraction.
  
  • Maintain elasticity and contractility of muscle(s).
  • Provide sensory feedback.
  • Provide bone and joint integrity.
  • Increase circulation and prevent clot formation.
  • Develop functional coordination.

Question 17

AROM Example and Goals

Answer 17

• Patient intervention is an aerobic conditioning program.
• Goals
  • Improve cardiovascular and respiratory responses.

Question 18

Active-assistive (AAROM)

Answer 18

Movement produced by patient’s muscle contraction.
Assistance is provided.

Question 19

AAROM Indications

Answer 19

• Weak muscles (MMT grade 2-<3)
• Patient needs assistance to complete movement.

Question 20

AAROM Goals

Answer 20

Same as AROM

• provide enough assistance to muscle in a controlled manner so that the muscle can function at its maximum level and progressively be strengthened.

Question 21

Special Considerations Immobilization

Answer 21

ROM should occur to the regions above and below the affected area to preserve function.

Question 22

Special Considerations Immobilization Goals

Answer 22

• Maintain the affected areas range in as normal a condition as possible.
• Prepare for functional activities, (e.g., crutch walking).

Question 23

Special Considerations Bed Rest

Answer 23

• Avoid complications
  
  • decreased circulation
  • bone demineralization
  • reduced cardiac and respiratory function.

Question 24

Limitations of PROM

Answer 24

True PROM may be difficult when the muscle is innervated and the patient is conscious.

Question 25

PROM WILL NOT

Answer 25

- Prevent muscle atrophy. - Increase strength or endurance. - Assist circulation to the extent that active, voluntary muscle contraction will.

Question 26

- AROM - Will NOT

Answer 26

Increase strength develop skill or coordination beyond practiced patterns

Question 27

Contraindications to PROM and AROM

Answer 27

- Disruption to the healing process - Immediately following acute tears (ligament, tendon or muscle). - Unhealed fracture. - Post-op restrictions (tendons, ligaments, muscles, joint capsules, or skin repairs).

Question 28

Contraindications to AROM

Answer 28

Unstable cardiovascular condition (jeopardize the patient’s life, e.g., immediately after a MI).

Question 29

- Rationale for Motion - **Early Intervention**

Answer 29

To avoid thrombus formation PROM may be initiated to the major joints along with some AROM to the ankles and feet. - **Progression** - Increase activity as patient tolerance improves.