1. PT 153: Therapeutic Exercise II Range-of-motion Exercises
Aila Nica J. Bandong, PTRP
Instructor
Department of Physical Therapy
UP- College of Allied Medical Professions

2. Learning Objectives
At the end of the lecture, the students should be able to:
Differentiate the types of range-of-motion (ROM) exercises in terms of
Goals of treatment
Indications
Treatment variables
Limitations
Contraindications
Identify the appropriate type of ROM exercise to employ given a condition
Perform ROM exercises properly (lab)

3. Why use ROM exercises? Basic technique for movement examination
Technique used for initiating or incorporating movement into a therapeutic intervention program
Full ROM vs Functional ROM

4. Types of ROM Exercises Passive range-of-motion exercises
PROM
Active range-of-motion exercises
AROM
Active-Assistive range-of-motion exercises
AAROM

5. Passive ROM Exercises
Movement produced by an external force within the unrestricted range of motion of a segment
Gravity
Machine
Therapist or another person
Another part of the individual’s own body
Little to or no muscle contraction elicited

6. ! Minimize ill-effects of immobilization
G o a l s
! Minimize ill-effects of immobilization
Maintain joint and connective tissue mobility
Minimize the effects of the formation of contractures
Maintain mechanical elasticity of muscles
Assist circulation
Enhance synovial movement along joints
Decrease pain
Assist with healing process after injury or surgery
Maintain patient’s awareness of movement

7. I n d I c a t I o n s
Acute or inflamed tissue where active motion may disrupt the normal healing process
Patients who are unable to move or are not allowed to move such as when comatose, paralyzed, or on complete bed rest
For assessment purposes
When teaching a patient movement
To prepare a patient for stretching

8. L I m I t a t I on s Passive ROM exercise WILL NOT: prevent atrophy
increase strength or endurance
assist in circulation to the extent that active, voluntary muscle contraction does

9. Evidence in Practice
Clinical Question: Is there evidence to suggest the effectiveness of continuous passive motion following total knee arthroplasty?

10. Evidence in Practice Key articles:
Grella, RJ (2008) Continuous passive motion following total knee arthroplasty: a useful adjunct to early mobilisation? A systematic review
Brosseau L, et al (2004) Efficacy of continuous passive motion following total knee arthroplasty: A meta analysis
Lenssen AF, et al (2003) Continuous passive motion following primary total knee arthroplasty: Short- and long-term effects on range of motion

11. Evidence in Practice Results/conclusion:
Conflicting evidence on the effectiveness of continuous passive motion following total knee arthroplasty
Potential benefits may need to be weighed against additional cost and inconvenience
There is need for further trials to ascertain the effects of using continuous passive motion post-total knee arthroplasty

12. Active-Assistive ROM Exercises
Active ROM Exercises
Movement produced on a segment upon active contraction of the muscles crossing the joint within the unrestricted range of motion.
Assistance is provided by
an outside force (manual or mechanical), as the prime mover muscles is unable to complete the motion.
Active-Assistive ROM Exercises

13. G o a l s Maintain elasticity and contractility of 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

14. I n d I c a t I o n s
When a patient is able to actively contract the muscles and move the segment with or without assistance
Muscle weakness and inability to move segment completely against gravity
Aerobic conditioning programs
During periods of immobilization, AROM is used in joints above and below the immobilized segment

15. L I m I t a t I on s Active ROM exercise WILL NOT:
maintain or increase strength of already strong muscles
develop skill or coordination except in the movement patterns used

16. Precautions and Contraindications of ROM Exercises
Should not disrupt the healing process
Excessive movement/wrong performance of movement leads to increased pain and inflammation
Should not be done if response will be life-threatening to the patient

17. Principles of ROM Techniques
Examination, Evaluation, and Treatment Planning
Patient preparation
Application of techniques
Application of PROM
Application of AROM

18. Examination, Evaluation, and Treatment Planning
Examine and evaluate the impairments and level of function.
Determine any precautions and prognosis, and plan of intervention
Determine the ability to participate in the ROM activity
Note what type of ROM exercise to meet goals
Decide on the patterns of movement
Anatomic plane vs muscle range of elongation vs combined patterns vs functional patterns

19. Examination, Evaluation, and Treatment Planning
Monitor the general condition and response during and after the examination and intervention
Take vital signs, presence of pain, quality of movement, change in ROM
Document and communicate findings and intervention
Re-evaluate and modify the intervention as needed

20. Patient Preparation
Communicate with the patient that plan of intervention and the method to be used
Remove all restrictive clothing, linen, splint, and dressings; drape appropriately
Position the patient comfortably maintaining proper alignment and stabilization while allowing movement along the available ROM
Maintain proper biomechanics (therapist)

21. Application of Techniques
Grasp the extremity around the joints providing support needed for control
Support areas of poor structural integrity
Move the segment throughout its pain- free range to point of tissue resistance
Perform the movements smoothly and rhythmically 5 to 10 reps
Depends on the objectives of the program and patient’s general condition and response to the exercise

22. Application of Passive ROM
Movement is being provided by an external force
No active resistance or assistance is provided by the muscles that cross the joint.
Motion is performed within the available or free ROM
There should be no pain or forced motion elicited

23. Application of Active ROM
Demonstrate the desired motion through PROM
Ask the patient to perform the movement independently
Be ready to provide assistance or guidance when necessary
To complete movement smoothly
In the presence of weakness (may provide at the beginning or end of ROM, or when torque is greatest)
Perform the motion within the available range

24. Exercise Prescription
Identify the appropriate ROM exercise for the case with due consideration to the ff:
baseline function of the patient
available resources
Note the joint segments that are involved, therefore, require mobilization
Identify joint motions required
State the number of repetitions, sets, and the frequency (how often in a day) that the exercise is to be performed

25. Sample Case 1
You are a physical therapist working in an aged care facility. A 67-year old female diagnosed with cerebrovascular accident was referred to you for management. She presents with weakness of both the right upper and lower extremity muscles. Result of which, she has difficulty moving her involved extremities to full range. One of your goals is to maintain joint flexibility. You deem that a regular ROM exercise may be beneficial.

26. What does the case tell you?
Patient has inability to move both upper and lower extremities to full range due to weakness of muscles
There’s a need for an ROM exercise that will maintain joint flexibility

27. What does evidence say?
Tseng et al, in 2007, reported that a simple range-of-motion exercise can generate positive effects in physical function of older people with stroke. * randomized controlled trial * statistically significant improvements in joint angles, activity function, and perception of pain and depressive symptoms

28. What ROM ex is appropriate?
AROM?
AAROM?
PROM?
WHY?

29. Exercise prescription
AAROM exercise of the right upper and lower extremities, all planes x 10 repetitions x 1 set, 3 times daily

30. References
Brosseau, L., Milne, S., Wells, G., Tugwell, P., Robinson, V., Casimiro, L., Pelland, L., Noel, M.J., Davis, J., and Drouin, H. (2004) Efficacy of continuous passive motion following total knee arthroplasty: a metaanalysis. The Journal of Rheumatology. 31(11): Encabo, M. (2004). Lecture notes on PT 153: Therapeutic exercises II, range of motion exercise and stretching. UP-College of Allied Medical Professions Grella, R. J. (2008) Continuous passive motion following total knee arthroplasty: a useful adjunct to early mobilisation? Physical Therapy Reviews. 3(4): Kisner, C., Colby, L. (2007). Therapeutic exercise: Foundations and techniques (4th ed). Philadelphia: F. A. Davis Company. Lenssen, A. F., Koke, A., de Bie, R. A., and Geesink, R. (2003). Continuous passive motion following primary total knee arthroplasty: short- and long- term effects on range of motion. Physical Therapy Reviews. 8(3): Rothstein, J., Roy, S., and Wolf, S. (2005). The rehabilitation specialist’s handbook (3rd ed). Philadelphia: F. A. Davis Company. Tseng, C. N., Chen, C. C., Wu, S. C. & Lin, L. C. (2007). Effects of a range of motion exercise programme. Journal of Advanced Nursing. 57(2):