Chap. (1,2,3) Goniometry
What is being described? the arc of motion produced by the individual's muscle contraction assisted by an external force. During the examination process the external force is provided by the examiner.
Active Assistive ROM
the arc of motion produced by the individual's voluntary unassisted muscle contraction.
Active ROM
the term used to refer to the movement of joint surfaces. Motion at a joint occurs as the result of movement of one joint surface in relation to another joint surface.
Arthrokinematics
refers to the alignment of the arms of the goniometer with the proximal and distal segments of the individual's joints.
Goniometer alignment
refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body.
Goniometry
refers to the ability of one or more joints to actively or passively move beyond normal limits given the individual's age and gender.
Hypermobility
refers to a decrease in ROM that is substantially less than normal values for that joint, given the individual's age and gender.
Hypomobility
Which of the two types of reliability involves a GROUP getting the same results?
Inter-rater reliability
Which of the two types of reliability involves YOUR ability to get consistent results?
Intra-rater reliability
Muscle length testing: ____ is the greatest extensibility (stretchability) of a muscle-tendon unit. It is the maximal distance between the proximal and the distal attachments of a muscle to ___. Clinically, muscle length is not measured ___; instead, it is measured indirectly by determining the ____ of the joint(s) crossed by the muscle. Muscles can be categorized by the _____ they cross from their proximal to their distal attachments. ____ muscles cross and therefore influence the motion of only one joint.
Maximal muscle length, bone, directly, maximal passive ROM, number of joints, one-joint
What is proper goniometric alignment and why is it so important? (cont'd) -Therefore, we use the term ___ to refer to the arm of the goniometer that is aligned with the proximal segment of the joint and the term ___ to refer to the arm aligned with the distal segment of the joint. The ____ provide reference points that help to ensure that the alignment of the arms is correct. The ____ of the goniometer is usually placed over the approximate location of the axis of motion of the joint being measured. However, because the axis of motion changes during movement, the location of the fulcrum must be _____. ____ in measuring joint position and motion with a goniometer can occur if the examiner is not careful. When aligning the arms and reading the scale of the goniometer, the examiner must be at ___ with the goniometer to avoid parallax. This situation occurs if the examiner is ___ or ___ than the goniometer; as a consequence, the alignment and scales are _____.
proximal arm, distal arm, anatomical landmarks, fulcrum, adjusted accordingly, errors, eye level, higher or lower, distorted
-Osteokinematic motions are classically described as taking place in one of the three cardinal planes of the body (___, ____, ____) around three corresponding axes (_____-_____, ____-____, _____). -The motions of flexion and extension occur in the ____ plane. All motions in the sagittal plane take place around a ___-____ axis. The motions occurring in the frontal plane are ___ and ____. The axis around which the motions of abduction and adduction take place is an ____-_____ axis.
-sagittal, frontal, transverse, medial-lateral, anterior-posterior, vertical -sagittal, medial-lateral, abduction and adduction, anterior-posterior
Review Documentation systems: The three notation systems used to define ROM are the ____ degree system, the ___ degree system, and the ____ degree system. In the 0-to 180-degree notation system, the upper and lower extremity joints are at __ degrees for flexion-extension and abduction-adduction when the body is in the anatomical position, and at __ degrees for rotation when the body is in the neutral position. Normally, a ROM begins at __ degrees and proceeds in an arc toward ___ degrees. This 0- to 180- degree system of notation, also called the neutral zero method, is ____ throughout the world. The term ____ is used to describe a greater than normal extension ROM.
0-to 180-, 180-to 0-, 360-, 0, 0, 0, 180, widely used, hyperextension
Review Documentation systems: (cont'd) **(THESE NOTATION SYSTEMS ARE NOT ONES THAT WE USE)** The ___ degree notation system defines the anatomical position as 180 degrees. The ROM begins at ___ degrees and proceeds in an arc toward __ degrees. The ___ degree notation system also defines the anatomical position as 180 degrees. The motions of flexion and abduction begin at ___ degrees and proceed in an arc toward __ degrees. The motions of extension and adduction begin at ___ degrees and proceed in an arc toward ___ degrees. These two notation systems are more difficult to interpret than the 0- to 180- degree notation system and are ___ used.
180- to 0-, 180, 0, 360-, 180, 0, 180, 360, infrequently
Cyriax proposed that pathological conditions involving the entire joint capsule cause a particular pattern of restriction involving all or most of the passive motions of the joint. This pattern of restriction is called a ____.
Capsular pattern
What is being described? -refers to the gross movement of the shafts of bony segments rather than the movement of joint surfaces. The movement of the shafts of bones are usually described in terms of the rotary or angular motion produced, as if the movement occurs around a fixed axis of motion.
Osteokinematics
the arc of motion produced by the application of an external force by the examiner; the individual remains relaxed and plays no active role in producing the motion.
Passive ROM
What is being described? -the arc of motion in degrees between the beginning and the end of a motion in a specific plane. The arc of motion may occur either at a ____ joint or at a ____ of joints.
Range of motion, single, series
refers to the amount of consistency between successive measurements of the same variable on the same individual under the same conditions.
Reliability
refers to the positions of the body recommended for obtaining both goniometric and muscle length measurements.
The testing position
What is being described? The degree to which a useful (meaningful) interpretation can be inferred from a measurement. Stated in another way, 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.
Validity
What is the purpose of goniometry measurements? (cont'd) -Goniometry is used to measure and document the amount of ____ and _____ joint motion as well as ____ joint positions. Following the examination of active and passive range of motion, resisted ____ muscle contractions, joint ___, and ____ tests, and special tests for specific body regions are used in conjunction with goniometry to help identify the ____ anatomical structure.
active and passive, abnormal fixed, isometric, integrity, mobility, injured
What is proper goniometric alignment and why is it so important? -The examiner must learn and use the bony ____ to more accurately visualize the joint segments. These landmarks, which have been identified for all joint measurements, should be ____ so that they may be easily located and palpated. The careful ____, palpation, and ____ of the arms of the goniometer with the ____ improve the accuracy and consistency of the measurements. Customarily, the ____ is aligned parallel to the longitudinal axis of the proximal segment of the joint and the ___ is aligned parallel to the longitudinal axis (center of) the distal segment of the joint. In some situations, because of limitations imposed by either the goniometer or the individual, it may be necessary to ____ the alignment of the two arms so that the moving arm is aligned with the ___ and the stationary arm is aligned with the _____. However, the angle measured by the goniometer will be the ____ regardless of which arms are aligned with the proximal or distal segments of the joint.
anatomical landmarks, exposed completely, visualization, alignment, landmarks, stationary arm, moving arm, reverse, distal part, distal part, same
The starting position for measuring all ROM is either the ___ or ____ position.
anatomical or neutral
Discuss how to record correctly: (cont'd) The following items are recommended to be included in the recording: -For ROM, include the number of degrees at the ___ and ____ of the motion. For muscle length, include only the degrees at the ___ of the motion. -Type of motion being measured (___ or ____) -Any ___ information, such as discomfort or pain, that is reported by the individual during the testing. -Any ___ information obtained by the examiner during testing, such as a protective muscle spasm, crepitus, or capsular or noncapsular patterns of restriction. -A complete description of any ___ from the recommended testing position.
beginning and end, end, passive or active, subjective, objective, deviation
List the different parts of the universal goniometer: Typically the design includes a ___ and two thin extensions called ___—a ____ and a ____ arm. A relatively new innovation is a ____ that can be slipped on to one arm of the goniometer. The level helps to ensure that the goniometer arm is either ___ or ____.
body, arms, stationary, moving, gravitational level, vertical or horizontal
List the different parts of the universal goniometer: (cont'd) The ____ of a universal goniometer resembles a protractor and may form a half circle or a ___ circle. The scales on a half-circle goniometer read from ____ degrees and from ___ degrees. The scales on a full-circle instrument may read either from ___ degrees and from ___ degrees, or from 0 to 360 degrees and from 360 degrees to 0 degrees. The arms of a universal goniometer are designated as ___ or ____ according to how they are attached to the body of the goniometer.
body, full, 0 to 180, 180 to 0, 0 to 180, 180 to 0, moving or stationary
The testing positions will do the following: 1) Ensure that the individual being tested is in a ____, safe, and ___ position. 2) Place the joint being measured in a starting position of ___ degrees when testing for ROM. 3) Permit complete and ____motion of the joint when testing for ROM. 4) Place the muscle in a ____ position at all of the joints that the muscle crosses except for the one joint that will be measured for ___ when testing for muscle length. 5) Provide stabilization for the ____ joint segment.
comfortable, stable, 0, obstructed, lengthened, motion, proximal
What are the knowledge & skills necessary to correctly perform goniometry? -If a recommended testing position cannot be attained because of restrictions imposed by the environment or limitations of the individual, the examiner must use ____ to decide how to obtain a particular joint measurement. The alternative testing position that is created must serve the same five functions as the ____ testing position. In addition, the examiner must describe the position precisely in the individual's ___ so that the same position can be used for ___ measurements.
creativity, recommended, record, all subsequent
The examiner obtains goniometric measurements by placing the parts of the measuring instrument, called a ____, along the bones immediately ____ and ____ to the joint being evaluated.
goniometer, proximal and distal
Goniometric data used in conjunction with other information can provide a basis for the following: determining the presence, absence, or change in _____; establishing a ____; developing a ____, treatment goals, and ____; evaluating progress or lack of progress toward ____; modifying treatment; motivating the individual; researching the effectiveness of ____ techniques or regimens (for example, measuring outcomes following exercises, medications, and surgical procedures.); fabricating orthotics and ___ equipment.
impairment, diagnosis, prognosis, plan of care, rehabilitative goals, therapeutic, adaptive
What are the two different types of reliability?
intra-rater reliability and inter-rater reliability
Why is stabilization so important? -The testing position for ROM helps to stabilize the individual's body and proximal joint segment so that a motion can be isolated to the ____. Isolating the motion to one joint helps to ensure that a ____ of the motion is obtained, rather than a measurement of combined motions that occur at a ___ of joints.
joint being examined, true measurement, series
What is the purpose of goniometry measurements? -Goniometry may be used to determine both a particular ____ and the _____ available at a joint. Goniometry is an important part of a comprehensive examination of joints and surrounding ____. The performance of active joint motions by the individual during the examination allows the examiner to screen for _____ and gain information about the individual's willingness to ____. If abnormal active motions are found, the examiner performs ____ joint motions in an attempt to determine reasons for joint ____.
joint position, total amount of motion, soft tissue, abnormal movements, move, passive, limitation
Discuss how to record correctly: (cont'd) The following items are recommended to be included in the recording: -Individual's ___, age, and ___. -___ name or initials. -Date and ___ of measurement. -Type of ____. -Side of the ____, joint, and ___ being measured (Ex: left knee flexion)
name, gender, examiner's, time, goniometer/inclinometer used, body, motion
Discuss how to record correctly: Goniometric measurements are recorded in ___, in pictorial charts, or within the written text of an ____. Regardless of which method is used, recordings should provide enough information to permit an ____ of the measurement.
numerical tables, evaluation, accurate interpretation
What are the knowledge & skills necessary to correctly perform goniometry? -When testing for muscle length, it is necessary to use an ___ position in which all of the tissues are ___ and taut. It is important for an examiner to use the ___ testing position and ideally conduct tests at the same ___ during successive measurements so that the relative amounts of tension in the soft tissue structures are the same as in previous measurements. Testing positions involve a variety of body positions such as ____, prone, sitting, and ____. When an examiner intends to test several joints and motions during one testing session, the goniometric examination should be planned to ____ the individual unnecessarily.
opposite, stretched, same, time of day, supine, standing, avoid moving
The movement of joint surfaces are described as ____, ____, and ____.
slides (or glides), spins, and rolls
List the different parts of the universal goniometer: (cont'd) The ___ is a structural part of the body of the goniometer and cannot be moved independently from the body. The ___ is attached to the center of the body of most plastic goniometers by a rivet that permits the arm to move freely on the body. The length of the arms varies among instruments from approximately ___ to ___ inches. These variations in length represent an attempt on the part of the manufacturers to adapt the size of the instrument to the ____.
stationary arm, moving arm, 1 to 14, size of the joints
The motion of rotation occurs in the ____ plane around a ____ axis. Because of the uniaxial design of the goniometer, only motion occurring in a ____ can be measured in goniometry. A joint that allows motion in only one plane is described as having ____ degree of freedom.
transverse, vertical, single plane, one
Muscle length testing: (cont'd) ___ muscles cross and influence the motion of two joints, whereas ____ muscles cross and influence multiple joints. If a one-joint muscle is abnormally lax, passive tension in the capsule and ligaments may initially maintain a _____. In contrast to one-joint muscles, the length of two-joint and multi-joint muscles is usually not sufficient to allow full ____ to occur ____ at all joints crossed by these muscles. This inability of a muscle to lengthen and allow full ROM at all of the joints the muscle crosses is termed ____ To allow full ROM at the joint under consideration and to ensure sufficient length in the muscle, the muscle must be ____ at all of the joints the muscle crosses that are not being assessed.
two-joint, multi-joint, normal ROM, passive ROM, simultaneously, passive insufficiency, put on slack
the instrument most commonly used to measure ROM in the clinical setting.
universal goniometer
Positioning is an important part of goniometry because it is used to place the joints in a ____ when measuring range of motion, and to ____ a multi-joint muscle over all but the ___ crossed by the muscle when measuring muscle length.
zero-starting position, lengthen, last joint