Rehabilitation Chapter 6
Passive Range of Motion
movement of a joint or body segment by a force external to the body within an unrestricted and normal range of motion and without any active, voluntary muscle contraction by the patient
Active Range of Motion
movement of a joint or body segment produced by an active, voluntary muscle contraction by the patient within the restricted normal ROM
What must happen to maintain the functional length of multi joint muscles
must be lengthened simultaneously over each joint they cross
Empty end feel
no end feel is elicited because the patient does not permit full motion to occur, usually secondary to acute pain
Firm end feel
joint capsule or ligaments are stretched-hip rotation
Springy block
(abnormal) intra-articular block such as torn cartilage or loose body in joint
Benefits of PROM
1. Preserve or maintain ROM 2. Minimize contracture and adhesion formation 3. Maintains mechanical elasticity of muscle 4. Promotes local circulation 5. Promotes awareness of joint motion (proprioception) 6. Evaluates joint ROM, stability, flexibility, and muscle tone 7. Enhances cartilage nutrition 8. Inhibits or reduces pain
Limitations of PROM
Does not prevent muscle atrophy, reduce adipose tissue, increase muscle tone, strength, or endurance....not as effective as active exercise for circulation maintenance
What type of muscles require special consideration
Multi-joint muscles
No assistance by patient, an external force is applied whether manually, mechanically, or gravitationally to provide movement to segment
PROM
Types of ROM
PROM, AROM, AAROM
Use when a patient is unable to actively move a body segment, to avoid pain, undesired movements or patterns of motion, development of undesired muscle tone and stress to a localized site of poor integrity, and to reduce cardiopulmonary stress
Passive Exercise
ROM is performed in what directions?
anatomical planes or in diagonal planes of motion (PNF)
Hard end feel
bony block is reached-elbow extension
Active Assistive Range of Motion
form of active exercise whereby an external force is used to assist the patient to perform the exercise.
For PROM a PTA must understand-----
joint ROM and recognize the resistance of the tissues as the exercise is being performed
Contraindications for finger flexion in C6 spared SCI
limitation of finger flexors when combined with active wrist extension can provide the person with a passive grip-tenodesis
Difference between PROM and passive stretching?
no increase in joint range is to be expected with PROM while with passive stretching the goal is to increase the restricted joint range by elongating soft tissue (tendon, ligament, muscle)
Multi-joint muscles
quads, hamstrings, gastroc, biceps, triceps, extrinsic finger flexors and extensors
End feel
resistance of completion of range-application of an overpressure at the end of the range
Soft end feel
soft tissues are compressed-knee or elbow flexion
Contraindications for erector spinae muscles in SCI
trunk stability in sitting is improved by limited range of extensors
Documentation for ROM
type of ROM, joints, end feel, patient positioning, patient tolerance, patient feedback, any changes noted
PROM should be performed through the entire-----------
unrestricted, normal range of the joint and soft tissue
Indication for Passive Exercise
used when patient is unable to perform any form of active exercise (paralysis, comatose, painful muscle contractions, recovery from trauma or surgical procedure, unhealed fracture to avoid displacement, avoid cardiopulmonary stress
Contraindications for Passive Exercise
when in increases the patient's symptoms or intensifies the condition or when patient is capable of active exercise
When is AAROM used?
when muscular weakness, fatigue, or pain limit performance