Range of Motion Exercise(ROM)

Type of ROM Exercises

Passive ROM(PROM) is movement of a segment within the unrestricted ROM that is produced entirely by an external force is little to or no voluntary muscle contraction

Active ROM(AROM) Is movement of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing that joint

Active-Assistance ROM(AAROM) is a type of AROM in which assistance is produced manually or mechanically by an outside force because the prime mover muscles need assistance to complete the motion

Indications and Goals For ROM

Passive ROM(PROM) Primary goal for ROM is to decrease the complication with immobilization Cartilage degeneration adhesion and contracture formation sluggish circulation

Goal for PROM Maintain joint and connective tissue mobility Minimize the effects of the formation of contracture Maintain mechanical elasticity of muscle Assist circulation and vascular dynamics Enhance synovial movement for cartilage nutrition and diffusion of materials in the joint

Decrease or inhibit pain Assist with the healing process after injury or surgery Help maintain the patient’s awareness of movement

Active and Active assistive ROM A patient is able to contract the muscles actively and move a segment with or without assistance, AROM is used A patient has weak musculature and is unable to move a joint through the desired range, A- AROM is used to provide enough assistance to the muscles in a carefully controlled manner (progessively strengthened)

Goal for AROM Maintain physiological elasticity and contractility of the participating muscles Provide sensory feedback from the contracting muscles Provide a stimulus for bone and joint tissue integrity

Increase circulation and prevent thrombus formation Develop coordination and motor skills for functional activities

Limitations of ROM Exercises

Limitations of PROM Does not ; Prevent muscle atrophy Increase strength or endurance Assist circulation to the extent that active, voluntary muscle contraction does

Limitations of AROM For strong muscles, does not ; maintain or increase strength develop skill or coordination except in the movement patterns used

Principles and procedures for Applying ROM Techniques

Examination, Evaluation and Treatment Planning Examine and evaluate the patient’s impairment and level of function, determine any precautions and prognosis, and plan the intervention Determine the ability of the patients ; PROM, A-AROM or AROM Determine the amount of motion

Decide pattern can best the goal - Anatomic plane of motion ; frontal, sagittal, transverse - muscle range of elongation - combined patterns ; diagonal motion - functional pattern ; ADL

Monitor the patient’s general condition and responses during and after the examination and intervention : change in vital sign, warmth and color of the segment, ROM, Pain, quality of movement Document and communicate Re-evaluate and modify

Patient preparation Communicate with the patient : descirbe the plan and method Free the region from restrictive clothing etc Position the patient in a comfortable Position yourself so proper body mechanics can be used

Application of techniques To control movement, grasp the extremity around the joint Support areas of poor structural integrity : hyper-mobile joint, recent fracture site or paralyzed limb Move the segment through its complete pain free range to the point of tissue resitance Perform the motions smoothly and rhythmically, with 5 to 10 repetitions

Shoulder : Flexion and extension

Shoulder : hyper-extension

Shoulder : abduction and adduction

Shoulder : medial and lateral rotation

Shoulder : horizontal abduction and adduction

Scapular : elevation, depression, protraction, retraction, upward, downward rotation

Elbow : flexion and extension

Triceps Brachii muscle

Forearm : pronation and supination

Forearm : supination

Hand : cupping and flattening the arch of the hand at the Carpometacarpal

Elongation of extrinsic muscle of the wrist and hand : flexor and extensor digitorum muscles

Combined Hip and Knee : flexion and extension

Hip : hyperextension

Elongation of the two joint Hamstring muscle group

Hip : abduction and adduction

Hip : internal and external rotation

Ankle : dorsiflexion

Ankle : inversion and eversion

Joint of toes : flexion and extension abduction and adduction

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