Week 4 - Problem Solving: ROM

Question 1

What is the ultimate goal of restoring motions?

Answer 1

-to reduce impairments and enhance functional performance for ADLs and work and leisure activities.

Question 2

Name 3 complications of immobility on musculature.

Answer 2

• reduced muscle mass (strength)
• muscles become stiff/sore so movement becomes more difficult
• contractures may develop in 4 days

Question 3

What is the percentage of weekly muscle mass (strength) loss in elders due to immobilization?

Answer 3

10% loss weekly

Question 4

How long does it take ROM to go away due to contractures?

Answer 4

14 or 15 days

Question 5

• complicate care
• cause pain
• ROM lost by day 14,15

Answer 5

contractures

Question 6

ROM

Answer 6

the distance a joint can move and the direction in which it can move

Question 7

the available arc of motion within a joint which is assessed by goniometric measurements.

Answer 7

ROM assessment

Question 8

Name 4 causes of decreased ROM

Answer 8

• problem within the joint.
• swelling of tissue around the joint.
• stiffness of muscles
• pain

Question 9

the arc of motion achieved when the individual uses his own muscle power to effect joint motion.

Answer 9

active ROM

Question 10

the arc of motion achieved when the examiner applies an external force to the joint

Answer 10

passive ROM

Question 11

Name 3 things that passive ROM determines.

Answer 11

• limitation of movement
• joint stability
• muscle and other soft tissue elasticity

Question 12

a form of controlled PROM whereby the amount of external force applied by the examiner is measured; way to measure the force that it takes to move a joint passively.

Answer 12

torque ROM

Question 13

Name 7 causes of limited joint ROM.

Answer 13

• joint dislocation
• fracture - immobilization leads to peri-articular connective tissue changes.
• joint swelling
• arthritis
• muscle tear (RC tendonitis)
• peripheral nerve injury

Question 14

Name 7 factors affecting the outcome of ROM measurements.

Answer 14

• edema
• pain
• adhesions
• capsular tightness/laxity
• tendon excursion
• strength deficits
• muscle hypertrophy

Question 15

ROM measurements are ____ measures of factors other than ROM.

Answer 15

never

Question 16

T/F - ROM measurements may suggest a problem in other factors effecting the outcome, but they do not directly measure the other factors.

Answer 16

true

Question 17

movement within the UNRESTRICTED range in a joint that is produced by an external force.

Answer 17

passive ROM

Question 18

Name 4 examples of passive ROM.

Answer 18

• gravity
• machine
• therapist
• another part of pts. own body

Question 19

PROM is typically practiced on a joint that is _____.

Answer 19

inactive

Question 20

OT may perform PROM on pts. who are ____ or unable to ____ a specific joint.

Answer 20

paralyzed, mobilize

Question 21

PROM can help prevent what from occurring?

Answer 21

stiffness

Question 22

Codman’s exercise

Answer 22

• pendulum exercise
• pt. bends over, places one hand on table, trunk parallel with floor, move trunk so other arm swings with gravity (forward and back, L & R). As pt. bends down and joint is relaxed, there is a slight distraction within the joint (due to the weight of arm) which is helpful - gives it some space.

Question 23

PROM is produced by ___ ____.

Answer 23

external force

Question 24

Can the patient be asleep during PROM?

Answer 24

No - pt. must be relaxed but not asleep.

Question 25

movement within the UNRESTRICTED range in a joint that is produced by an active contraction of the muscles crossing the joint. exercises are highly independent, performed solely by the pt./client. OT's role may be simply to provide verbal cues.

Answer 25

AROM

Question 26

What is the goal of AROM?

Answer 26

to keep joints and soft tissue moving.

Question 27

How is AROM produced?

Answer 27

produced by active contraction of muscle crossing joint.

Question 28

-AROM in which ASSISTANCE is provided by an outside force (manual or mechanical) bc the prime movers (muscles) require assistance to complete the motion.

Answer 28

Active Assistive Exercise (AA ROM)

Question 29

Describe Active Assistive Exercise (AA ROM) exercises.

Answer 29

- more progressive, intended for the pt. to perform with manual assistance from the therapist or other force. - exercises may feel painful and the muscles can feel weak. increasing ROM with these exercises should be a gradual advancement.

Question 30

assistance is provided (by outside force) when prime mover cannot complete motion.

Answer 30

Active Assistive Exercise (AA ROM)

Question 31

Name 2 methods of Active Assistive Exercise (AA ROM).

Answer 31

- supination bar | - wall ladder

Question 32

Is Active Assistive Exercise (AA ROM) the same as PROM?

Answer 32

NO

Question 33

- OT assists with the rest of motion. - pt. begins and then OT assists to get to full ROM. - looks like it's passive but pt. starts then OT helps.

Answer 33

Active Assistive Exercise (AA ROM)

Question 34

When should PROM be used?

Answer 34

when pt. is unable to or should not move a segment.

Question 35

Name 5 conditions in which PROM would be necessary.

Answer 35

- coma - paralysis - bed rest - inflammatory process - surgical repair of soft tissue

Question 36

Name 7 goals of PROM treatment.

Answer 36

1. maintain joint and soft tissue integrity. 2. maintain mechanical elasticity of muscle. 3. maintain awareness of movement. 4. prevent contractures 5. assist circulation and vascular dynamics 6. enhance synovial movement for cartilage nutrition.

Question 37

Name 4 indications for AROM and AAROM.

Answer 37

- same as PROM but with added benefits of muscle contraction. - maintain physiologic and contractility of muscles - sensory feedback - circulation

Question 38

What is the goal of Active Assistive Exercise (AA ROM).

Answer 38

-when pt. has weak muscles, AAROM is used to give enough assistance so that muscles can function at a maximum level and progressively be strengthened.

Question 39

Name 3 limitations of PROM.

Answer 39

PROM will not: - prevent muscle atrophy - increase strength or endurance - assist circulation to the same extent as an active muscle contraction

Question 40

Name 2 limitations of AROM.

Answer 40

AROM will not: - maintain or strengthen already strong muscle. - develop skill/coordination except in patterns used.

Question 41

Name 3 strategies to improve ROM.

Answer 41

- orthotics (splinting) and casting - joint mobilization - exercises - PROM, stretching, muscle strengthening

Question 42

passively moving joint

Answer 42

joint mobilization

Question 43

Name 3 clinical examples of when PROM or AROM will disrupt the healing process.

Answer 43

- tendon injury (don't do AROM early on) - open wound (limited in range) - wrist fracture (passive - no, active - yes)

Question 44

AROM is contraindicated when _____ ____ is unstable.

Answer 44

cardiovascular status

Question 45

PROM is not synonymous with ______.

Answer 45

stretching

Question 46

why should you not perform PROM on a pt. with a fracture (Ex: 12 days post ORIF for distal radius fracture).

Answer 46

-can disrupt hardware. must wait for passive stretch.

Question 47

what should you do for a pt. with a fracture with deep tendon lacerations across the wrist?

Answer 47

- wound care - pt. education - elevation (gravity will help the edema) - start with PROM since tendons have been injured.

Question 48

Is PROM or AROM used early in fracture care?

Answer 48

AROM

Question 49

Is PROM or AROM used early in tendon injuries?

Answer 49

PROM

Question 50

Why should AROM not be used in pts. with flexor tendon lacerations?

Answer 50

- tendon and muscle injuries that are 2 parts sewn together - cannot do AROM until about 3 weeks out from surgery. - can do active extension but not active flexion.

Question 51

How long should a pt. or OT wait to do AROM with tendon lacerations?

Answer 51

about 3 weeks out from surgery.

Question 52

a commonly used method of stretching in which soft tissues are elongated just past the point of tissue resistance and then held in the lengthened position with a sustained stretch force over a period of time.

Answer 52

static stretching

Question 53

How long should you wait to do any motion with pts. with skin grafts? What type of motion should be used?

Answer 53

7-10 days and then its AROM.

Question 54

Mirror imaging

Answer 54

pt. keeps their unaffected side outside of mirror while affected side is inside mirror box. It looks like R & L sides and reflection looks like affected side is working and can lead to increased movement. helps brain relearn how to move.

Question 55

contract/relax

Answer 55

pt. contracts tight muscle against resistance applied by OT at point of limitation and holds for 2-5 seconds. pt. then relaxes and OT moves part in OPPOSITE direction.

Question 56

Describe an example of contract/relax.

Answer 56

-goal is for pt. to extend elbow better. -ask pt. to flex against resistance, tell pt. to keep it there for 2-5 seconds and pull it out. -biceps get fatigued from holding and then extension is better. OR -hold against resistance. OT pushes toward flexion while pt. tries to push toward extension then release and extend arm.

Question 57

maximal manual stretch of tight muscle, followed by isotonic contraction of OPPOSITE muscle.

Answer 57

agonist contraction

Question 58

combination of contract/relax but done quickly.

Answer 58

contract/relax/contract

Question 59

- small amplitude rhythmic oscillating movement at the beginning of ROM - manage pain and spasm

Answer 59

Grade 1 - Maitland Joint Mobilization Grading Scale

Question 60

- large amplitude rhythmic oscillating movement within midrange of movement - manage pain and spasm

Answer 60

Grade 2 - Maitland Joint Mobilization Grading Scale

Question 61

grading based on amplitude of movement and where within available ROM the force is applied.

Answer 61

Maitland Joint Mobilization Grading Scale