1. Introduction part II

2. End feel: The sensation imparted to the examiner's hands at the end point of the available range of motion. It varies according to the
limiting structure or tissue.
The texture of resistance felt when a joint reaches the end of its range of motion. Can be bony (bone-to-bone contact), springy (soft tissue
approximation), abrupt (limited by protective muscle spasm), or empty (pain is felt well before the end of a normal range of motion, but no
organic resistance is identified). Abnormal end-feel can indicate causes of joint dysfunction.

4. Hypomobility
The term hypomobility refers to a decrease in ROM that is
substantially less than normal values for that joint, given the
individual’s age and gender.
Hypermobility
The term hypermobility refers to the ability of one or more
joints to actively or passively move beyond normal limits
given the individual’s age and gender.

5. Passive Insufficiency refers to inability of a multi-joint muscle to
lengthen to a degree that allows full range of motion of all the joints it crosses simultaneously.
When a full range of motion at any joint or joints that the muscle
crosses is limited by that muscle length, it is called passive
insufficiency.
It is defined as follows: the muscle can not be stretched beyond
certain limits without causing pain. (e. g. when a person tries to flex
the hip fully with maximal knee extension, he usually feels pain in the hamstring muscle if he has tight hamstrings.

6. Example: The triceps is a two-joint muscle that extends the elbow
and shoulder. The triceps is passively insufficient during full shoulder flexion and full elbow flexion. When an examiner assesses elbow
flexion ROM, the shoulder must be in a neutral position so there is
sufficient length in the triceps to allow full flexion at the elbow

7. Measurement Instruments
A variety of instruments are available to measure joint motion and
muscle length. These instruments range from tape measures to
manual universal and digital goniometers, manual and digital
inclinometers, cameras, electrogoniometers, motion analysis systems, and most recently goniometer and inclinometer applications (apps)
for smartphones.
Universal Goniometer: The universal goniometer is the instrument
recommended for obtaining ROM for the upper and lower
extremities.
The double inclinometer was the instrument recommended for
measuring spinal ROM.

8. Universal goniometers (UGs) may be constructed of plastic or metal

9. Typically the design includes a body and two thin extensions called arms—a stationary arm and a moving arm.
The body of a universal goniometer resembles a protractor and may form a half circle or a full circle
The scales on a half-circle goniometer read from 0 to 180 degrees
and from 180 to 0 degrees. The scales on a full-circle instrument
may read either from 0 to 180 degrees and from 180 to 0 degrees, or from 0 to 360 degrees and from 360 to 0 degrees

11. The arms of a universal goniometer are designated as moving or
Stationary. The stationary arm is a structural part of the body of the goniometer and cannot be moved independently from the body
The moving arm may have one or more of the following features: a pointed end, a black or white line extending the length of the arm, or a cut-out portion (window).

12. Alignment
Goniometer alignment refers to the alignment of the arms of the
goniometer with the proximal and distal segments of the individual’s
Joints.
The examiner must learn and use the bony anatomical landmarks.
The careful visualization, palpation, and alignment of the arms of the goniometer with the landmarks improve the accuracy and consistency of the measurements.
The stationary arm is aligned parallel to the longitudinal axis of the
proximal segment of the joint and the moving arm is aligned parallel
to the longitudinal axis of the distal segment of the joint

14. Therefore, we use the term proximal arm to refer to the arm of the goniometer that is aligned with the proximal segment of the joint
and the term distal arm to refer to the arm aligned with the distal segment of the joint. The anatomical landmarks provide reference
points that help to ensure that the alignment of the arms is correct.

15. The fulcrum of the goniometer is usually placed over the
approximate location of the axis of motion of the joint being
measured.
Gravity-Dependent Goniometers (Inclinometers)
Gravity-dependent goniometers or inclinometers use gravity’s
effect on pointers and fluid levels to measure joint position and
motion

17. Some inclinometers are specifically used for measuring spinal motionThe cervical range of motion (CROM) device and back range of
motion (BROM) device are examples of inclinometers that are
mounted on plastic frames.

18. The CROM device has three inclinometers fastened on a plastic
frame that fits over the head. The inclinometer located on the frame on the lateral side of the head is used to measure lateral cervical
flexion. The inclinometer on the front of the plastic frame is used to measure cervical flexion and extension. A compass inclinometer
attached to the top of the headpiece is used to measure cervical
rotation.

19. The BROM device

20. Measuring ROM
Steps
1. Introduce yourself and explain purpose of the visit.
2. Explain and demonstrate how the goniometer/inclinometer works and let the individual inspect the instrument.
3. Explain and demonstrate anatomical landmarks and why they
need to be exposed.
4. Explain and demonstrate testing position and why positioning is
important.
5. Explain and demonstrate the examiner’s and the individual’s roles.
6. Confirm the individual’s understanding and willingness to
participate.

21. Testing Procedure
Steps
1. Position the individual in the recommended testing position and
as close to the side of the bed or plinth as possible.
2. Stabilize the proximal joint segment.
3. Move the distal joint segment to the zero starting position. If the
joint cannot be moved to the zero starting position, it should be
moved as close as possible to the zero starting position. Slowly
move the distal joint segment to the end of the passive ROM and
determine the end-feel. Ask the individual whether there was any
discomfort during the motion.
4. Make a visual estimate of the ROM.

22. Testing Procedure
5. Return the distal joint segment to the starting position.
6. Palpate the bony anatomical landmarks.
7. Align the goniometer.
8. Read and record the starting position. Remove the goniometer.
9. Stabilize the proximal joint segment.
10. Move the distal segment through the full ROM.
11. Replace and realign the goniometer. Palpate the anatomical
landmarks again.
12. Read and record the ROM.

23. Validity is “the degree to which a useful (meaningful) interpretation can be inferred from a measurement.”
Stated in another way, the validity of a measurement refers to how well the measurement represents the true value of the variable of
interest and how well this measurement can be used for a specific
purpose.
The purpose of goniometry is to measure the angle created at a
joint by the adjacent bones of the body. Therefore, a valid
goniometric measurement is one that represents the actual joint
angle and one that can provide data for use in clinical
decision-making.

24. Reliability refers to the amount of consistency between successive measurements of the same variable on the same individual under
the same conditions.
A goniometric measurement is highly reliable if successive
measurements of a joint angle or ROM on the same individual and
under the same conditions yield the same results.
A highly reliable measurement contains little measurement error.
Assuming that a measurement is both highly reliable and valid, an
examiner can confidently use its results to determine a true absence, presence, or change in dysfunction.

25. Consistency is necessary for a measurement to be considered valid, an unreliable measurement is inconsistent, does not produce the
same results when the same variable is repeatedly measured on the same individual under the same conditions, and contains a large
amount of measurement error.
This lack of consistency and heightened error will make validity poor as well. A measurement that has poor reliability and validity is not
dependable and should not be used to make clinical decisions. The measurement of joint position and ROM of the extremities with a
universal goniometer has generally been found to have good-to-
excellent reliability.