Professional Documents
Culture Documents
EXERCISE
DEFINITON OF ROM AND OTHER
RELATED TERMS
Range of motion – is the full motion
possible in a joint.
PASSIVE ROM
ACTIVE ROM
ACTIVE ASSISTIVE ROM
FUNCTIONAL EXCURSION
ACTIVE INSUFFICIENCY
PASSIVE INSUFFICIENCY
INDICATIONS FOR ROM EXERCISES
Active ROM
It will not maintain or increase strength.
It will not develop skill or coordination except
in the movement pattern used.
It may encourage compensatory rather than
normal movement patterns
PRECAUTIONS AND CONTRAINDICATION
TO ROM EXERCISES
When motion disrupts the healing process as
in acute joint inflammations and immediately
after skin graft etc.
Immediately following acute tears, fractures
and surgery.
Unstable cardiovascular conditions.
Signs of too much or wrong motion include
increased pain and increased
inflammations(greater swelling, heat ,redness)
PRINCIPLES AND PROCEDURE FOR
APPLYING ROM TECHNIQUES
Determine whether PROM, AAROM, or AROM will meet the
goals based on evaluation of the patient’s impairment and
level of function.
Place the patient in a comfortable position that will allow you
to move the segment through the available ROM(patient has
proper body alignment)
Position yourself so that proper body mechanics can be used.
Support areas of poor structural integrity such as hyper
mobile joint, recent fracture site or paralyzed limb.
Move the segment through its complete pain – free range( do
not force beyond the available range – it becomes stretching
technique)
PRINCIPLES AND PROCEDURE FOR
APPLYING ROM TECHNIQUES
Perform the motion smoothly and rhythmically
ROM techniques may be performed in the :
1. Anatomical planes of ROM
2. Muscle range of elongation
3. Combined patterns
4. Functional patterns
Monitor the patient’s general condition during and after
the procedure.
Document observable and measurable reactions to the
treatment.
Modify or progress the treatment as necessary.
ROM TECHNIQUES
UPPER EXTREMITY
1.Shoulder : flexion and extension
Hand Placement and Motion
grasp the patient’s arm under the elbow with your lower
hand.
with the top hand, cross over and grasp the wrist and palm
of the patient’s hand.
Lift the arm through the available range and return. Note:
for normal motion, the scapula should free to rotate
upward as the shoulder flexes. If the motion of only the
glenohumeral joint is desired, the scapula is stabilized.
Shoulder : extension(hyperextension)
Alternate Position
Extension is possible if the patient’s shoulder
is at the edge of the bed when supine or if the
patient positioned side- lying or prone.
Shoulder :abduction and adduction
Hand Placement and Motion
use the same hand placement as with flexion,
but move the arm out to the side. The elbow
may be flexed.
Note: to reach the full range of abduction,
there must be external rotation of the
humerus and upward rotation of the scapula.
Shoulder: internal (medial) and
external(lateral) rotation
Initial Position of the Arm
If possible the arm is abducted 90⁰, the elbow
is flexed to 90⁰ and forearm is held in neutral
position. Rotation may also be performed
with the patient’s arm at the side of thorax,
but full internal rotation will not be possible.
Hand Placement and Motion
Grasp the hand and the wrist with your index
finger between the patient’s thumb and index
finger.
Place your thumb and the rest of your fingers on
either side of the patient’s wrist, thus stabilizing
the wrist.
With the other hand, stabilize the elbow. Rotate
the humerus by moving the forearm like a spoke
in a wheel.
Shoulder: horizontal abduction(extension) and
adduction(flexion)
Position of the Arm
to reach the full horizontal abduction, the shoulder
must be at the edge of the table. Begin with the
arm either flexed or abducted 90⁰.
Hand Placement and Motion
-same as with flexion, but the therapist turn his or
her body and faces the patient’s head as the patient
arm is moved out to the side then across the body.
Scapula: elevation/depression, protraction/retraction, and
upward/downward rotation
Alternate Position
prone , with the patient’s arm at the side, or side lying, with
the patient facing the therapist and the patient’s arm draped
over the therapist bottom arm.
Hand Placement and Motion
cup the top hand over the acromion process and place the
other hand around the inferior angle of the scapula.
For elevation, depression, protraction, retraction, the clavicle
also moves as the scapular motions are directed at the
acromion process.
For rotation, direct the scapular motions at the inferior angle.
Elbow: flexion and extension
Hand Placement and Motion
same as with shoulder flexion except the motion
occurs at the elbow as it is flexed and extended.
Note: control forearm supination and pronation
with your fingers around the wrist. Perform
elbow flexion and extension with forearm
pronated as well as supinated. The shoulder
should not protract when the elbow extends:
this disguises the true range.
Elongation of two joint muscle crossing the shoulder and elbow
Biceps brachii muscle
Position of the Patient
supine with the shoulder at the edge of the treatment table so
that shoulder can be extended past the neutral position.
Hand Placement and Motion
-first pronate the patient’s forearm by grasping around the
wrist, and extend the elbow by supporting under the elbow.
-The shoulder is then extended (hyperextended) until the
patient experiences discomfort in the anterior arm region. At
this point, full available lengthening of the two joint muscles is
reached.
Long head of the triceps brachii muscle
Alternate Position
when near normal range of this muscle is available, the
patient must be sitting or standing to reach the full
ROM. With marked limitation in muscle range, ROM can
be performed in supine position.
Hand Placement and Motion
First, flex the patient’s elbow full range with one hand
on the distal forearm
Then flex the shoulder by lifting up on the humerus with
the other hand under the elbow.
Full available range is reached when discomfort is
experienced in the posterior arm region.
Forearm: pronation and supination
Hand Placement and Motion
grasp the patient’s wrist, supporting the hand with the index finger and
placing the thumb and the rest of the finger on either side of the distal
forearm.
The motion is a rolling of the radius around the ulna at the distal
radius.
Stabilize the elbow with the other hand.
Alternate Hand Placement
sandwich the patient’s distal forearm between the palms of both hand.
Flexion
bring both the patient’s knees to the chest by
lifting under the knees(hip and knee flexion)
flexion of the spine occurs as the hips are
flexed full range and the pelvis starts to rotate
posteriorly.
greater range of flexion can be obtained by
lifting under the patient’s sacrum with the
lower hand.
Extension
the patient is prone
with hands under the thigh, lift the thighs
upward until the pelvis rotates anteriorly and
the lumbar spine extends.
Rotation
the patient is hook lying.
push both of the patient’s thorax with the top
hand
repeat in the opposite direction.
SELF- ASSISTED ROM