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