Goniometry Principles

HIP: ER/IR Fulcrum, Stationary & Moving Arms

*Fulcrum* -Anterior Patella *Stationary Arm* -Perpendicular to floor *Moving Arm* -Tibial Crest (and point between malleoli)

ANKLE: Inversion/Eversion Fulcrum, Stationary & Moving Arms

*Fulcrum* -Anterior ankle between malleoli *Stationary Arm* -Tibial crest *Moving Arm* -Anterior midline of 2nd metatarsal

CERVICAL: Side bending/Lateral Flexion Fulcrum, Stationary, & Moving Arms

*Fulcrum* -C7 *Stationary Arm* -Spinous processes *Moving Arm* -Dorsal Midline of head Sitting position

FINGERS: DIP Flex/Ext Fulcrum, Stationary & Moving Arms

*Fulcrum* -Dorsal DIP joint *Stationary Arm* -Dorsal midline of middle phalanx *Moving Arm* -Midline of distal phalanx

THUMB: IP Flexion/Extension Fulcrum, Stationary & Moving Arms

*Fulcrum* -Dorsal IP joint *Stationary Arm* -Midline of proximal phalanx *Moving Arm* -Midline of dorsal phalanx

THUMB: MCP Flex/Ext Fulcrum, Stationary & Moving Arms

*Fulcrum* -Dorsal MCP joint *Stationary Arm* -Dorsal midline of metacarpal *Moving Arm* -Dorsal midline of proximal phalanx

FINGERS: MCP Flexion/Extension Fulcrum, Stationary & Moving Arms

*Fulcrum* -Dorsal MCP joint (knuckle) *Stationary Arm* -Dorsal midline of metacarpal *Moving Arm* -Dorsal midline of proximal phalanx

TOES: MTP Abduction/Adduction Fulcrum, Stationary & Moving Arms

*Fulcrum* -Dorsal MTP joint *Stationary Arm* -Dorsal midline of metatarsal *Moving Arm* -Dorsal midline of proximal phalanx

FINGERS: PIP Flex/Ext Fulcrum, Stationary & Moving Arms

*Fulcrum* -Dorsal PIP joint *Stationary Arm* -Dorsal midline of proximal p *Moving Arm* -Midline of distal p

TOES: DIP Flexion/Extension Fulcrum, Stationary & Moving Arms

*Fulcrum* -Dorsal aspect of DIP joint *Stationary Arm* -Dorsal midline of middle phalanx *Moving Arm* -Dorsal midline of distal phalanx

TOES: MTP Flex/Ext Fulcrum, Stationary & Moving Arms

*Fulcrum* -Dorsal aspect of MTP joint *Stationary Arm* -Dorsal midline of metatarsal *Moving Arm* -Dorsal midline of proximal phalanx

TOES: PIP Flexion/Extension Fulcrum, Stationary & Moving Arms

*Fulcrum* -Dorsal aspect of PIP joint *Stationary Arm* -Dorsal midline of proximal phalanx *Moving Arm* -Dorsal midline of distal phalanx

HIP: Flexion/Extension Fulcrum, Stationary & Moving Arms

*Fulcrum* -GT *Stationary Arm* -midline of pelvis/trunk *Moving Arm* -lateral midline of femur

SHOULDER: Flexion/Extension Fulcrum, Stationary & Moving Arms

*Fulcrum* -Greater Tubercle *Stationary Arm* -Mid-axillary line of trunk *Moving Arm* -Lateral midline of Humerus

ELBOW: Flexion/Extension Fulcrum, Stationary & Moving Arms

*Fulcrum* -Lateral Epicondyle of humerus *Stationary Arm* -Lateral midline of humerus *Moving Arm* -Lateral midline of radius, using radial head & SP for ref.

KNEE: Flexion/Extension Fulcrum, Stationary & Moving Arms

*Fulcrum* -Lateral condyle *Stationary Arm* -Lateral midline of femur *Moving Arm* -Lateral midline of fibula

ANKLE: Dorsiflexion/Plantar flexion Fulcrum, Stationary & Moving Arms

*Fulcrum* -Lateral malleolus *Stationary Arm* -Lateral midline of fibula *Moving Arm* -Parallel to 5th metatarsal

THUMB: CMC Palmar Abduction/Adduction Fulcrum, Stationary & Moving Arms

*Fulcrum* -Lateral radial styloid p *Stationary Arm* -Lateral midline of 2nd met *Moving Arm* -Lateral midline of thumb

FINGERS: DIP Flexion/Extension Stabilize End-feel

*Stabilize* Both = Middle phalanx to prevent wrist, MCP, and PIP motion *End-feel* -Flex = *Dorsal* joint cap = FIRM -Ext = *Palmar* joint cap = FIRM

KNEE: Flexion/Extension Stabilize End-feel

*Stabilize* Both = Prevent hip movement *End-feel* -Flexion = Muscle bulk = SOFT -Extension = Posterior joint cap & knee ligaments = FIRM

FINGER: PIP Flex/Ext Stabilize End-feel

*Stabilize* Both = Prevent wrist and MCP movement *End-feel* 1. HARD = Phalanges against one another OR 2. FIRM = Dorsal capsule, extensor tendons OR 3. SOFT = Soft tissue

How does *Identification and palpation of landmarks* affect reliability?

All therapists should be knowledgeable of the body landmarks for each joint and be able to identify them appropriately. This will insure all therapists are aligning their goniometers the same.

*Reliability* of range of motion measurements refers to

Amount of *consistency and reproducibility* between successive goniometry measurements on the same variable, same subject, and under same conditions.

How does the *position of the patient* affect reliability?

As discussed with procedures for taking joint measurements, positioning is important for accurate goniometry measurements

How does the *amount of applied PROM* affect reliability?

Bc its subjective - and thats why it is important for the same therapist to perform the measurement each time

T/F You will not need to identify and/or palpate bony landmarks in order to assist aligning your goniometer

False -The examiner will use bony landmarks for each joint for reference points to insure appropriate goniometer alignment.

T/F Several authors (including AMA) have found the dorsal - volar technique of measuring wrist flexion and extension to be less reliable than other methods

False- dorsal-volar technique MORE reliable

T/F Grohmann's work indicates that there is a significant difference in measuring elbow extension and flexion when comparing over the joint method to the traditional lateral methods

False- he found there is NO significant difference

T/F Goniometric measurements are not reliable if successive measurements of joint angle or ROM, on the same subject, under the same conditions yield the same results.

False- they are highly reliable

TOES -MTP Flexion/Extension measure (Normal ROMs & Positioning)

Flex = 0- 45 Ext = 0-70 *supine or sitting; Foot in neutral

SHOULDER -Flexion/Extension measure (Normal ROMs & Positioning)

Flex = 0-180 Supine w knees flexed; palm facing body Ext = 0-60 Prone facing away from shoulder; no pillow; Elbow slightly flexed (if extended biceps will restrict- 2 joint m) *When testing for GH = don't need to stabilize and measure at same time; just find where they stopped & measure

FINGERS -PIP Flexion/Extension measures (Normal ROMs & Positioning)

Flex = 100 Ext = 0 Sitting w forearm and hand supported on table in neutral

HIP -Flexion/Extension measure (Normal ROMs & Positioning)

Flex = 120 Ext = 30 Flex = Supine w/ knee flexed Ext = Prone w/ knee extended to test hamstrings (if flexed, rectus femoris would restrict)

KNEE -Flexion/Extension measure (Normal ROMs & Positioning)

Flex = 135 Ext = 0 or 5-10 of hyperextension Supine; allow some hip flexion when coming into knee flexion, but not excessive flexion; *towel under ankle Alternate position = prone with towel under thigh

THUMB -CMC Flexion/Extension measure (Normal ROMs & Positioning)

Flex = 15 Ext = 20, 80 Sitting w *forearm fully supinated*; wrist in neutral & fingers relaxed so EPL does not restrict motion; *Thumb against lateral side of 2nd digit = arbitrary zero*

ELBOW -Flexion/Extension measure (Normal ROMs & Positioning)

Flex = 150 Ext = 0 Supine w/ shoulder in neutral; palm facing ceiling; *towel under distal humerus to allow full elbow ext

THUMB -MCP Flexion/Ext measure (Normal ROMs & Positioning)

Flex = 50 Ext = 0 Sitting w *forearm in full supination*; wrist neutral & fingers relaxed

THUMB -IP Flex/Ext measures (Normal ROMs & Positioning)

Flex = 80 Ext = 20 Sitting w *forearm in full supination*; wrist neutral & fingers relaxed

WRIST -Flexion/Extension measure (Normal ROM & Position)

Flex = 80 Ext = 70 Sitting, forearm resting on table w hand off endue of table, palm down Flex = keep fingers *extended* Ext = keep fingers *flexed*

FINGERS -DIP Flexion/Extension measure (Normal ROMs & Positioning)

Flex = 90 Ext = 0 Sitting w forearm and hand supported on table and PIP flexed ~80

FINGERS -MCP Flexion/Extension measures (Normal ROMs & Positioning)

Flex = 90 Ext = 45 Sitting forearm & wrist in neutral *fingers relaxed* (if PIP or DIP flexed, then extensor indicis, digitorum, and digit minima will restrict motion)

FINGERS: MCP Abduction/Adduction Fulcrum, Stationary & Moving Arms

Goni layed flat *Fulcrum* -Dorsal MCP joint (knuckle) *Stationary Arm* -Dorsal midline of metacarpal *Moving Arm* -Dorsal midline of proximal phalanx

SHOULDER -IR/ER measures (Normal ROMs & Positioning)

IR = 70 ER = 90 Supine; shoulder ABD to 90; elbow flexed & just off table; palm facing feet *place towel under arm to humerus is level with acromion process

Why?

If the examiner is higher or lower than the goniometer, the scales may be distorted.

Face Validity:

Instrument generally *appears to measure* what it is proposed to measure----that is plausible. -Easily established for ROM because the instrument allows direct observation of the measured variable.

ANKLE -Inversion/Eversion measures (Normal ROMs & Positioning)

Inversion = 35 (PF, Sup, ADD) Eversion = 15 (DF, Pro, ABD) Sitting OR Supine w foot off edge of table

Why estimate the range for that joint prior to aligning the goniometer?

It will assist you with *reading the goniometer appropriately* and *eliminate error* with recording ROM for that joint.

How does the *effort of the client with AROM* affect reliability?

Its subjective and dependent upon the patient

Content Validity:

Judges whether or not an instrument adequately measures and represents the *domain of content* - the substance - of the variable of interest. The application of knowledge and skill of the therapist (anatomical knowledge, visual inspection, palpation of bony landmarks and accurate alignment of the goniometer) combined with their ability to interpret the results of the measurement provides sufficient evidence to ensure validity.

Criterion-related Validity:

Justifies the validity of the measuring instrument by *comparing* measurements made with the instrument to a well established *gold standard* of measurement the criterion.

THORACOLUMBAR: Flexion No goni; use tape measure or double inclinometer

Look over; i think S2 to C7? not sure

THUMB -CMC Opposition measure

Measure distance btwn thumb tip to base of 5th digit (or tip of 5th digit)

How do we know a goniometric measurement is valid?

Most support for the validity of goniometry is in the form of face, content and criterion-related validity.

FOREARM -Pronation/Supination measure (Normal ROMs & Positioning)

Normal = 0-80 for both Sitting w elbow flexed to 90; start midway; Forearm supported by PT so thumb points to ceiling; elbow close next to trunk

SHOULDER -Extension measure (pic w positioning)

Normal Ext = 0-60 *elbow slightly flexed so that biceps does not restrict movement

TOES -MTP Extension measure (pic)

Normal ROM ext = 70

SHOULDER -Horizontal Abduction/Adduction measure (Normal ROMs & Positioning)

Normal ROMs = not given Sitting; shoulder ABD to 90; elbow flexed with forearm in neutral rot

FINGERS -MCP Abduction/Adduction measures (Normal ROMs & Positioning)

Normal ROMs not given Sitting w hand on table, palm down; wrist in neutral

The *stationary arm* may be aligned with either the...

proximal or distal segment of the joint.

SHOULDER: Abduction/Adduction Fulcrum, Stationary & Moving Arms

*Fulcrum* -Anterior Acromion *Stationary Arm* -Parallel to sternal midline *Moving Arm* -Anterior midline of humerus

"Validity" is defined as:

"The degree to which an instrument measures what it is purported to measure; the extent to which it fulfils its purpose." -aka how well the measurement represents the true value of the variable of interest

TOES: DIP Flexion/Extension Stabilize End-feel

(Exact same as PIP flex/ext) *Stabilize* Both = Metatarsal to prevent plantar flexion *End-feel* Both = Dorsal joint cap = FIRM

HIP: Abduction/Adduction Fulcrum, Stationary & Moving Arms

*Fulcrum* -ASIS *Stationary Arm* -Imaginary line between ASIS *Moving Arm* -Anterior midline of femur

WRIST: Flexion/Extension Fulcrum, Stationary & Moving Arms

*Fulcrum* -Lateral wrist over triquetrium *Stationary Arm* -Lateral midline of ulna (olecranon) *Moving Arm* -Lateral midline of 5th met. (pinky- make sure on 5th met, not where tissue is)

SHOULDER: IR/ER Fulcrum, Stationary & Moving Arms

*Fulcrum* -Olecranon *Stationary Arm* -Perpendicular to floor *Moving Arm* -Ulnar styloid process

SHOULDER: Horizontal ABD/ADD Fulcrum, Stationary & Moving Arms

*Fulcrum* -Over Acromion *Stationary Arm* -Perpendicular to trunk *Moving Arm* -Lateral midline of humerus

WRIST: Radial & Ulnar Deviation Fulcrum, Stationary & Moving Arms

*Fulcrum* -Over capitate on dorsal part of wrist *Stationary Arm* -Dorsal midline of forearm (Olecranon) *Moving Arm* -Dorsal midline of 3rd met. (don't follow middle finger!)

THUMB: CMC Flex/Ext Fulcrum, Stationary & Moving Arms

*Fulcrum* -Palmar CMC joint *Stationary Arm* -Midline of radius *Moving Arm* -Ventral midline of thumb

FOREARM:Pronation/Supination Fulcrum, Stationary & Moving Arms

*Fulcrum* -Pronation: lateral and proximal to Ulnar styloid -Supination: medial and proximal to Ulnar sytloid *Stationary Arm* -Parallel to anterior humerus *Moving Arm* -Across dorsal forearm, parallel to styloid processes

THORACOLUMBAR: Side bending/Lateral Flexion Fulcrum, Stationary, & Moving Arms

*Fulcrum* -S2 (between PSIS) *Stationary Arm* -Perpendicular to ground *Moving Arm* -In line with C7

CERVICAL: Rotation Fulcrum, Stationary, & Moving Arms

*Fulcrum* -Top/cranial aspect of head *Stationary Arm* -Imaginary line btwn acromion processes *Moving Arm* -In line with the nose Supine position

SHOULDER: Flexion GH & SC Stabilize End-feel

*GH Stabilize* Hold scapula to prevent elevation *GH End-Feel* FIRM = Posterior joint cap, teres m&m, infraspin. *SC Stabilize* -Thorax to prevent spinal ext *SC End-feel* FIRM = latissiumus dorsi

SHOULDER: Internal/Medial Rotation GH & SC Stabilize End-feel

*GH Stabilize* Humerus, scapula to maintain position & prevent *anterior* tilt (may have to put pressure on anterior part of shoulder to keep it from popping up) *GH End-feel* FIRM = Post joint cap; teres minor & infra (ERs) *SC Stabilize* Humerus then thorax *SC End-Feel* FIRM = Rhomboids

SHOULDER: External/Lateral Rotation GH & SC Stabilize End-feel

*GH Stabilize* Humerus, scapula to maintain position & to prevent *posterior* tilt *GH End-feel* FIRM = Pec major, lat, teres major (all IRs) *SC Stabilize* Humerus then thorax *SC End-Feel* FIRM = Pec minor

SHOULDER: Extension GH & SC Stabilize End-feel

*GH Stabilize* Stabilize scapula *GH End-feel* FIRM = Ant. joint cap & Ant. coracohumeral lig *SC Stabilize* Thorax to prevent spinal flex *SC End-feel* FIRM =Pec m&m; & Serratus Ant.

SHOULDER: Abduction GH & SC Stabilize End-feel

*GH Stabilize* Stabilize scapula *GH End-feel* FIRM = inferior joint cap, pec major, lat *SC Stabilize* Thorax to make sure they aren't lateral flex *SC End-Feel* FIRM = rhomboids, lower trap

Pictorial Charts

*Include a diagram* with the normal values for the starting and ending positions of the motion. When recording the values, numbers are used on the diagram to document the ROM, date and therapist who took the measurement.

Numerical Tables (Refer to Appendix C of your text for examples of numerical tables)

*List joint motions in columns* on the form for both the right and left sides. When recording the values, numbers are used to record the starting measurement and end measurement of the joint.

THUMB: MCP Flexion/Ext Stabilize End-feel

*Stabilize* -1st MC (to prevent any CMC movement) *End-feel* -Flex = Hard or Firm -Ext = Firm (palmar joint capsule)

THUMB: CMC Opposition measure Stabilize End-feel

*Stabilize* -5th met (pinky) to prevent moving *End-feel* -SOFT (mm bulk) or Firm (EPB)

THUMB: IP Flex/Ext Stabilize End-Feel

*Stabilize* -Proximal phalanx to prevent MCP movement *End-feel* -Flex = *dorsal* joint lig = FIRM -Ext = *palmar* joint lig = FIRM

HIP: Abduction/Adduction Stabilize End-feel

*Stabilize* ABD = Prevent ER, pelvic rotation & lateral tilt ADD = Prevent pelvic rotation & lateral tilt *End-feel* ABD = FIRM = *Inferior* joint cap (& pubo- & ischiofemoral ligs) ADD = FIRM = *Superior* joint cap (& iliofemoral lig)

FOREARM: Pronation/Supination Stabilize (think about what wants to compensate in shoulder) End-feel

*Stabilize* Both = Distal humerus to prevent any IR/ABD (during pronation) and ER/ADD (during Supination) *End-feel* Pronation = 1. HARD = Ulna & radius 2. FIRM = Supinator & biceps Supination = FIRM = Pronator teres and quadratus

ELBOW: Flexion/Extension Stabilize End-feel

*Stabilize* Both = Distal humerus to prevent shoulder flex *End-feel* -Flexion: 1. *SOFT (mm. bulk)* or 2. HARD (coronoid process & fossa) or 3. FIRM (post joint cap, triceps) -Extension: 1. *HARD (olecranon process & fossa)* or 2. FIRM (tension of ant mm.)

ANKLE: Dorsiflexion/Plantarflexion Stabilize End-feel

*Stabilize* Both = Distal tibia & fibula to prevent knee & hip motion *End-feel* DF = Achilles tendon & post joint cap = FIRM PF = Anterior joint cap = FIRM

ANKLE: Inversion/Eversion Stabilize End-feel

*Stabilize* Both = Distal tibia/fibula to prevent -knee extension & IR; and -hip abduction *End-feel* -Inversion = FIRM via *Lateral* ligaments, joint capsules, fibularis longus & brevis -Eversion = FIRM via *Deltoid* ligaments, jioint capsules, tibialis posterior; or HARD via calcaneus on talus

FINGERS: MCP Abduciton/Adduction Stabilize End-feel

*Stabilize* Both = Metacarpals to prevent wrist moving *End-feel* ABD = Collateral ligs, web fascia = FIRM ADD = Soft tissue = SOFT (pic)

TOES: PIP Flexion/Extension Stabilize End-feel

*Stabilize* Both = Metatarsal to prevent plantar flexion *End-feel* Both = Dorsal joint cap = FIRM

TOES: MTP Abduction/Adduction Stabilize End-feel

*Stabilize* Both = Metatarsals to prevent eversion/inversion *End-feel* Abd = collateral ligs = FIRM Add = collateral ligs = FIRM

WRIST: Flexion/Extension Stabilize End-feel

*Stabilize* Both = Radius and ulna to *prevent pronation/supination* *End-feel* Flexion = FIRM = *Dorsal* radiocarpal lig & joint cap Extension = 1. FIRM = *Palmar* radiocarpal lig & joint cap 2. HARD = Radius & Carpal bones

WRIST: Radial & Ulnar Deviation Stabilize End-feel

*Stabilize* Both = Radius and ulna to *prevent pronation/supination* *End-feel* -Radial Dev = 1. HARD = Radial styloid process & scaphoid 2. FIRM = *Ulnar collateral* ligament -Ulnar Dev = FIRM = *Radial collateral* lig

SHOULDER: Horizontal ABD/ADD Stabilize End-feel

*Stabilize* Both = trunk & scapula *End-feel* Horizontal ABD = Anterior joint cap = FIRM Horizontal ADD = Post joint cap = FIRM (may be soft too)

HIP: ER/IR Stabilize End-feel

*Stabilize* ER = Prevent hip ADDuction or flexion IR = Prevent lateral tilt *End-feel* ER = *Anterior* Joint cap & iliofemoral/pubofemoral ligs = FIRM IR = *Posterior* Joint cap & ischiofemoral lig = FIRM

HIP: Flexion/Extension Stabilize End-feel

*Stabilize* Flex = Prevent posterior tilt or pelvic rotation Ext = Prevent *anterior tilt* or pelvic rotation *End-feel* Flex: Muscle bulk = SOFT Ext: Ant. joint cap & iliofemoral lig = FIRM

TOES: MTP Flexion/Extension Stabilize End-feel

*Stabilize* Flexion = Metatarsal to prevent ankle *PF* Ext = Metatarsal to prevent ankle *DF* *End-feel* -Flexion = *Dorsal* joint cap & = FIRM -Ext = *Palmar* joint cap = FIRM

THUMB: CMC Palmar Abduction Stabilize End-feel

*Stabilize* -Carpal bones to prevent wrist mooing *End-feel* -Web space, Add P = FIRM

THUMB: CMC Flex/Ext Stabilize End-feel

*Stabilize* Both = Carpal bones to prevent wrist moving *End-feel* -CMC Flex = 1. SOFT = mm. bulk 2. or FIRM = EPB and APB -CMC Ext = FIRM = Flexor pol. brev, AD, OP

FINGERS: MCP Flexion/Extension Stabilize End-feel

*Stabilize* Both = Metacarpals to prevent wrist motion *End-feel* Flexion: 1. FIRM = *Dorsal* joint cap = FIRM or 2. HARD Extension = FIRM = *Palmar* joint cap

Therefore, a valid goniometric measurement is one that...

*truly* represents a joint angle or total range of motion.

Other information that should be included with goniometry documentation

-Subjects name, age and gender -Examiner's name -Date and time of measurement -Type of goniometer used -Type of motion being measured, active or passive -Side of the body, joint and motion being measured -Deviations from recommended testing position -Subjective information such as discomfort, pain reported by subject

For Cervical and Thoracolumbar: Need to know all for final but only testing on: cervical = Lateral flex & rot thoracolumbar = Side bending & flex Also - no "normals" for these

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GONIOMETRY

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Thumb kinda tricky.. to get measurements: 1. Measure thumb in resting position (usually around 15-30 degrees) 2. Then measure the flexion (make number 4 w hand) Difference between starting position & ending position = Measurement

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UPPER EXTREMITY.

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SHOULDER -Abduction/Adduction measure (Normal ROMs & Position)

Abduction = 180 (ER then abducut) Adduction = 0? Supine w palm facing ant. & Elbow extended *ER first then Abduct, watch for lateral trunk bending

After the client has been positioned and stabilized, you will then

1. *Move* the body part through the entire range 2. Determine the *end feel* 3. And *estimate the range* (based upon normal range)

Goniometry Highlights to Remember -You should AVOID what 5 things?

1. Avoid *visual estimates* as the only source of ROM; use estimates to eliminate error only. 2. Avoid reading goniometer from *above or below eye level*. 3. Avoid *interchanging goniometers* for the same joint measurement. 4. Avoid *poor body mechanics*. 5. Avoid using the *wrong size* goniometer.

How can we as therapist *improve reliability*? (7)

1. Follow *consistent testing procedure* 2. Use anatomical *landmarks correctly* 3. Be consistent with manual *pressure* with PROM 4. *Advise client* to exert the same effort when performing AROM 5. Take *repeated* measurements 6. Use the proper *size* goniometer 7. The *same examiner* should perform each measurement

When aligning the goniometer, there will be a landmark used for aligning with the (3)

1. Fulcrum (axis of motion) 2. Proximal arm (proximal segment of the joint) 3. Distal arm (the distal segment of the joint)

Factors Affecting Reliability (7)

1. Identification and palpation of *landmarks* 2. *Weight* of the limb 3. *Position* of the patient 4. Amount of *applied PROM* 5. *Effort* of the client with AROM 6. *Substitution* 7. *Size* of the goniometer

Positioning the client appropriately prior to taking ROM measurements is very important. -Appropriate positioning insures: (4)

1. Joint measured can be placed at starting position of zero 2. Allows full ROM of the joint 3. Allows proximal joints to be stabilized therefore avoiding substitution of motion and isolating the joint being measured. 4. Eliminates the effects of soft tissue structures that can limit ROM

What are some ways of recording goniometry measurements?

1. Numerical tables 2. Pictorial charts 3. Narrative documentation (written text in an evaluation/assessment)

Other things to consider

1. Watch them for PAIN 2. Know the common compensations 3. Know about the affects of 2 joint muscles- should arm be bent or extended? 4. Know how to document measurement 5. Know alternate positions

ANKLE -Eversion measure (pic)

15 Eversion = Dorsiflexion, Pronation & ABD

TOES -PIP Flexion/Extension measure (Normal ROMs & Positioning)

1st IP = 90 2nd-5th = 35 Sitting or Supine w foot off table and in neutral; other toes allowed to flex

THUMB -CMC Extension measure (pic)

20, 80

TOES -DIP Flexion/Extension measures (Normal ROMs)

2nd-5th = 60

WRIST -Ulnar Deviation measure (pic)

30 *hand off table with fingers extended

HIP -Internal Rotation measure (pic)

45

FINGERS -MCP Extension measures (Pic)

45 Sitting; Forearm & wrist in neutral; Fingers relaxed

WRIST -Extension measure (pic)

70 -Fingers flexed

SHOULDER -External rotation measure (pic)

90 *towel

HIP -Abduction/Adduction measure (Normal ROMs & Positioning)

Abd = 45 Add = 30 Supine w knee extended ABD - hold near ankle, prevent ER and pelvic rotation ADD - make sure contralateral hip is abducted

TOES -MTP Abduction/Adduciton (Normal ROMs & Positioning)

Abd = ?? Add = 0 Sitting or supine; foot off edge with foot & toes in neutral

Parts of goniometer

Body Stationary arm = doesn't move Movement arm = moves independently

ORDER OF TESTING

Check *Unaffected side 1st* 1. Actively move 2. PROM 5x 3. Measure Affected side 1. Actively move 2. PROM 5x 3. Measure

Knee ROM measurements where taken on 30 subjects both on radiograph and the person. When compared there was a high correlation between the two. Example of what kind of validity?

Criterion-realated Validity

ANKLE -Dorsiflexion/Plantar flexion measures (Normal ROM & Positioning)

DF = 20 PF = 50 1. Supine w/ foot off edge & knee flexed to at least 30 (if knee is extended gastroc will restrict) 2. Sitting 3. DF Standing in runners stance with knee flexed a little

HIP -ER/IR measures (Normal ROMs & Positioning)

ER = 45 IR = 45 Recommended = Sitting *towel under distal femur to keep it horizontal Alternate = Supine

Narrative Documentation example -Symbols used?

Examples: 30 degrees of extension to 140 degrees of right shoulder flexion. 0 degrees of extension to 100 degrees of left knee flexion. (-) and (+) symbols are sometimes used with ROM documentation. -The (-) symbol is used to document a *lack of motion* to neutral and can only be used with narrative documentation. -The (+) symbol is used to document *excessive motion* past neutral.

Which 2 of these 3 are based on subjective opinions?

Face and content validity

THUMB -CMC Abduction/Adduction measures (Normal ROMs & Positioning)

Palmar ABD = 70 Sitting w forearm and wrist in neutral supported on table

WRIST -Radial/Ulnar Deviation measures (Normal ROMs & Positioning)

RD = 20 UD = 30 Sitting, forearm resting on table w hand off edge of table, palm down, fingers extended

How does *substitution* affect reliability?

Stabilization and positioning is important to prevent substitution of motions in order to isolate joint movement.

How does the *size of the goniometer* affect reliability?

The wrong size goniometer for the joint can alter your measurement.

Additional Info for ankle

To get mid foot = need to stabilize calcaneus Hind foot = very limited ROM Eversion = DF, Pronation, ABD Inversion = PF, Supination, ADD

T/F A five degree margin of error is acceptable for goniometric measurements of joints in the hand by an experienced therapist.

True

T/F According to studies, the measurements of joint position and range of motion with a universal goniometer has generally been found to have good to excellent reliability.

True

T/F In order for goniometry to provide meaningful and respected information, the measurements we take must be valid and reliable.

True

T/F Often, external stabilization by the therapist with positioning is required to isolate joint motion.

True

T/F When reading the goniometer, the instrument must be at eye level

True

T/F Studies show that reliability was higher when successive measurements were taken by the same examiners than when successive measurements were taken by different examiners.

True (for studies that measured joint position and ROM of the extremities and spine with a universal goniometer)

Narrative Documentation

Used within the *context of a written assessment*. Examples: 30 degrees of extension to 140 degrees of right shoulder flexion. 0 degrees of extension to 100 degrees of left knee flexion. (-) and (+) symbols are sometimes used with ROM documentation. The (-) symbol is used to document a lack of motion to neutral or the normal beginning position and can only be used with narrative documentation. The (+) symbol is used to document excessive motion past neutral.

How does the *weight of the limb* affect reliability?

changes in weight of limb can affect patient's ability to voluntarily move the limb with AROM

Many studies of joint measurement methods have found _______________ to be higher than _______________.

intra-tester reliability (same person) inter-tester reliability (different persons).

ANKLE -Plantarflexion measure (pic)

normal PF ROM = 50

The best gold standard used to establish criterion related validity of goniometry measurements of joint position with ROM is what?

radiography or X-ray