Kinesiology Week 11 ROM

c. Where should the moveable arm be placed and what action does it take?

Aligned with the plane of motion, but is distal to the joint being measured. (takes action by following the arc of the motion)

7. List all situations where ROM measurement is contraindicated (5 points)

All situations where ROM measurement is contraindicated are: -Attempting ROM measurement when the client has inflammation, significant pain, had a recent fracture, has bone carcinoma or a fragile bone condition, significant spasticity, dislocation of a joint, a diagnosis of myositis ossificans

8. List all situations when the therapist should proceed with caution when doing ROM (5 points)

All situations where the therapist should proceed with caution when doing ROM to prevent injury to the client are: -When client has a history of: cardiovascular conditions, high BP, COPD, conditions where fatigue may exacerbate the condition (MS), arthritis, significant pain. -When client has an infection or inflammatory condition, has had recent surgery, has an unhealed fracture, has marked osteoporosis, has bone cancer or fragile bone conditions, has hyper mobility, has hemophilia or a hematoma, has acute muscular injuries, has bone ankylosis

13. Why do you complete functional observation?

Before performing the MMT, the therapist should perform a screening of the patient. This screening, or functional evaluation, is not a formal assessment, but a method to allow the therapist to quickly determine which muscle groups need further testing. This will save time for the therapist and allow them to narrow down the specific muscles to test in the MMT evaluation.

Measurements with the goniometer are measured in ______ degree increments.

5

10. What should you do prior to performing MMT?

Before performing the MMT, the therapist should perform an informal screening of the patient to determine which muscle groups need testing. Next, the therapist should determine whether the gross, isolated, or both manual muscle tests would be more appropriate for the patient. After this has been completed, the therapist should place the patient in a comfortable position on a mat table, chair, or plinth (therapist should take consideration of positioning for gravity or gravity-eliminated motion). The following step consists of the therapist explaining the procedures for muscle testing and demonstrating the motion that will be requested of the patient. Lastly, it is important that the therapist has completed PROM prior to beginning the test to assess muscle tone and joint integrity because these may influence the accuracy of the MMT.

12. What is defined as compensation?

Compensation is when the patient uses alternative motions to achieve the AROM that has been requested by the therapist. An example of this is when a patient cannot perform full shoulder flexion, so he/she compensates by utilizing excessive trunk extension to increase shoulder flexion.

11. What are the hand placements for the therapist during MMT? (2 points)

During the MMT, the therapist places one hand proximal to the joint (axis) as a stabilizer, while the other hand is placed distal to the motion. This positioning allows the therapist to provide resistance with the hand placed distal to the motion.

Prior to start... Wash your hands. Place client in a comfortable position - body part must be in a position to allow muscle or group of muscles to act either against gravity or in a gravity eliminated plane Then you... -explain the procedure to the patient/client Next... -demonstrate the motion that will be requested 3rd step... -PROM to joint to assess muscle tone and joint integrity Now begin testing... -Ask client to demonstrate motion you demonstrated Then... -Stabilize joint by putting hand just proximal to joint. -Resistance hand is placed distal to the joint (resistance applied opposite of movement) Next... -Grade the muscle strength using 0 to 5 scale. Finally... - test both sides of body to check symmetry and establish "normal" strength

Order according to PP

4. What is PROM/AROM/AAROM? (3 points) -__________ is movement completed by the therapist, where the therapist moves the extremity through the available arc of motion without the assistance of the client. -__________ is movement completed by the client where the client moves the extremity through the available arc of motion without the assistance of the therapist. -___________ is movement completed by the client and the therapist where the client does AROM across the available arc of motion as much as he/she can, and the therapist manually assist the client to complete full ROM.

PROM AROM AAROM

2. Goniometer placement: a. Where should the Fulcrum be placed?

Placed over the axis of motion being measured (aka, the joint)

b. Where should the stationary arm be placed and what action does it take?

Stays fixed and aligned with the plane of motion proximal to the joint being measured. (does not take action- stays stationary)

5. What is the joint "End Feel"?

The joint "end feel" is the feeling elicited when the joint is brought through the entire available range of motion.

3. What are the two types of MMT and explain each grade by # and Letter: (14 points)

The two types of MMT are gross manual muscle test (muscle groups are tested) and isolated manual muscle tests (specific muscles are tested). Muscle grades by name, number, and definition, include:

1. What is a universal goniometer and what are the parts? (4 points)

The universal goniometer is the most commonly used instrument to measure joint motion. Goniometers come in many shapes and sizes and can be made of plastic or metal. The goniometer has three parts that include the body (a full or semicircle with a center point called the fulcrum), the stationary arm, and the moveable arm.

14. How do you ensure that substitutions are eliminated during ROM/MMT?

When a patient can't perform full ROM, he/she may try to compensate for a muscle by using other muscles as assists to complete the movement. It will be vital for the therapist to ensure that these substitutions are eliminated during ROM/MMT by correct the positioning of the patient, and stabilizing the joint. The therapist should pay extra careful attention to what is moving during the motion to prevent shifting of the body or any body parts during these tests.

9. How do you determine if there is a joint instability during ROM?

When performing PROM on a patient or watching AROM, the therapist needs to determine the cause of the decreased ROM if the patient cannot fully complete the moves. If the patient is able to complete some of the ROM for a movement, and the therapist can use PROM to easily and painlessly complete the rest, the patient has a muscle insufficiency. However, if the patient can only complete partial ROM for a movement and the therapist is not able to finish the full ROM for the patient, there is joint instability present.

6. Provide examples of Normal End Feel: (3 points)

a. Hard: when bone hits bone- elbow extension when the olecranon process enters the olecranon fossa to stop joint movement b. Soft: when soft tissue hits soft tissue- elbow or knee flexion when one muscle belly hits another to stop joint movement c. Firm: a stretching or springy feeling- hip flexion when the hamstrings stretch to stop joint movement

General Rules: _________ number are closer to 135 (higher numbers) _________ is closer to zero; only negative numbers exist in this position (lower numbers)

flexion extension

Before MMT, do a Functional observation: -observe client during a functional activity to determine what groups of muscles need to be tested.

functional observation

Normal (N)5 Complete ROM, against gravity, full resistance Good (G) 4 Complete ROM, against gravity, moderate resistance Good Minus (G-) 4- Complete ROM, against gravity, minimum resistance Fair Plus (F+) 3+ Complete ROM, against gravity, no resistance Fair 3 Complete ROM, against gravity, no resistance, but unable to sustain ROM Fair Minus (F-)3- Less than ½ ROM, against gravity, no resistance Poor Plus (P+)2+ Complete ROM, gravity-eliminated Poor 2 ½ to full ROM, gravity-eliminated Poor Minus (P-) 2- Less than ½ ROM, gravity-eliminated Trace (T) 1 Palpation of contraction only, no motion Zero (0) 0 No muscle contraction seen or palpated

muscle grades

Movements for ROM that we will work on... Shoulder flexion shoulder extension/hyperextension shoulder abduction shoulder adduction shoulder horizontal abduction shoulder horizontal adduction shoulder internal rotation should external rotation elbow flexion elbow extension forearm pronation forearm supination wrist flexion wrist extension wrist ulnar deviation wrist radial deviation

x16 movements