1. Range of Motion Exercise
Chapter 3. Range of Motion

2. INTRODUCTION
ROM is a basic technique used for the examination of movement and for initiating movement into a program of therapeutic intervention.
The structure of the joints, as well as the integrity and flexibility of the soft tissues that pass over the joints, affects the amount of motion that can occur between any two bones.
all structures are affected by ROM

3. INTRODUCTION To describe joint range  flex. Ext. …
measured with a goniometer and recorded in degrees.
Muscle range  functional excursion of muscles.
the distance a muscle is capable of shortening after it has been elongated to its maximum.
directly influenced by the joint it crosses
one-joint muscles v.s. two-joint muscles
two-joint muscles shortens to a point known as active insufficiency, where it can not shorten any more.
when fully elongated it is in a position known as passive insufficiency.

5. INTRODUCTION
To maintain normal ROM, the segments must be moved through their available ranges periodically
Factors can lead to decreased ROM
systemic, neurological, or muscular diseases
surgical or traumatic insults
inactivity or immobilization for any reason.
ROM activities are administered to maintain joint and soft tissue mobility to minimize loss of tissue flexibility and contracture formation.

6. TYPES OF ROM EXERCISES Passive ROM (PROM). Active ROM (AROM).
movement of a segment within the unrestricted ROM that is produced entirely by an external force
Active-Assistive ROM (A-AROM).
assistance is provided manually or mechanically by an outside force because the prime mover muscles need assistance to complete the motion.
Active ROM (AROM).
movement of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing that joint.
The external force may be from gravity, a machine, another individual, or another part of the individual’s own body.

7. Indications for PROM Regions of acute, inflamed tissue
Patient unable to or not supposed to actively move a body segments
comatose, paralyzed, or on complete bed rest

8. Goals for PROM Maintain joint and connective tissue mobility
Minimize the effects of the formation of contractures
Maintain mechanical elasticity of muscle
Assist circulation and vascular dynamics
Enhance synovial movement for cartilage nutrition
Decrease or inhibit pain
Assist with the healing process after injury or surgery
Help maintain the patient's awareness of movement

9. Other Uses for PROM
When a examining inert structures, PROM is used to determine limitations of motion, to determine joint stability, and to determine muscle and other soft tissue elasticity.
When a teaching an active exercise program, PROM is used to demonstrate the desired motion.
When a therapist is preparing a patient for stretching, PROM is often used preceding the passive stretching techniques.

10. Indications for AROM, AAROM
patient able to contract the muscles actively and move a segment with or without assistance. AROM
patient has weak musculature and is unable to move a joint through the desired range (usually against gravity) A-AROM
aerobic conditioning programs. AROM + A-AROM
on the regions above and below the immobilized segment

11. Goals for AROM same goals of PROM can be met with AROM
Maintain physiological elasticity and contractility of the participating 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

12. Limitations of ROM exercises PROM:
Passive motion does not:
Prevent muscle atrophy
Increase strength or endurance
Assist circulation to the extent that active, voluntary muscle contraction does

13. Limitations of ROM exercises AROM:
For strong muscles, active ROM does not maintain or increase strength.
It also does not develop skill or coordination except in the movement patterns used.

14. Precautions and contraindications to ROM exercises
when motion can disrupt the healing process
Historically, ROM has been contraindicated immediately after acute tears, fractures, and surgery; but ...
stays within the range, speed, and tolerance of the patient during the acute recovery stage
Signs of too much or the wrong motion include increased pain and increased inflammation

15. Precautions and contraindications to ROM exercises
ROM should not be done when patient response or the condition is life-threatening.
PROM may be carefully initiated to major joints and AROM to ankles and feet to minimize venous stasis and thrombus formation.
After myocardial infarction, coronary artery bypass surgery AROM of upper extremities and limited walking are usually tolerated under careful monitoring of symptoms.

16. Principles and Procedures for applying ROM techniques
Examination, Evaluation, and Treatment Planning
Examine and evaluate the patient's impairments and level of function, determine any precautions and prognosis, and plan the intervention.
Determine the ability of the patient to participate in the ROM activity and whether PROM, AAROM, or AROM can meet the immediate goals.
Determine the amount of motion that can be safely applied for the condition of the tissues and health of the individual.

17. Principles and procedures for applying ROM techniques
Decide what patterns can best meet the goals
Anatomic planes of motion: frontal, sagittal, transverse
Muscle range of elongation: antagonistic to the line of pull of the muscle
Combined patterns: diagonal motions or movements that incorporate several planes of motion
Functional patterns: motions used in activities of daily living (ADL)
Monitor the patient's general condition and responses during and after the examination and intervention
Document and communicate
Re-evaluate and modify the intervention as necessary.

18. Patient Preparation Communicate with the patient.
Free the region from restrictive clothing, splints, and dressings
Position the patient in a comfortable position with proper body alignment and stabilization
Position yourself so proper body mechanics can be used

19. Application of Techniques
To control movement, grasp the extremity around the joints.
Support areas of poor structural integrity
Move the segment through its complete pain-free range to the point of tissue resistance only .
Perform the motions smoothly and rhythmically, with 5 to 10 repetitions.

20. Application of PROM
During PROM the force for movement is external, being provided by a therapist or mechanical device.
No active resistance or assistance is given by the patient's muscles that cross the joint.
The motion is carried out within the free ROM

21. Application of AROM
Demonstrate the motion desired using PROM; then ask the patient to perform the motion.
Provide assistance only as needed for smooth motion. When there is weakness, assistance may be required only at the beginning or the end of the ROM, or when the effect of gravity has the greatest moment arm
The motion is performed within the available ROM.