TEST and MEASURMENT II Dr. Saeed Mohamed Ibraheem PHD, P.T, Cairo University Lecturer of physical therapy Basic Science Department October 6 University

Lecture objectives After completion this lecture the therapist student should be able to: Identify & Understand the importance of Range of motion assessment. Describe what is kinematics and its relation to range of motion assessment. Defining the planes and axis and demonstrate with examples. Describe the end feels and its types.

JOINT RANGE OF MOTION Joint: is where two bones come together and allow for movement of the skeleton. Types of joints: 1- Ball and socket joint: This allows wide range of motion and rotation as hip and shoulder joints. 2- Hinge joint: This allows for movement much like that of a door hinge as knee and elbow joints. 3- Biaxial joint: as wrist joint 4- Gliding joints: this allows bones to glide on each other as spine 5- Pivot joint: this allows bones to twist around other bones as radioulnar joint. Joint range of motion is the motion available at any single joint and is influenced by the associated bony structure and the physiologic characteristics of the connective tissue surrounding the joint.

KINEMATICS kinematics as " the description of motion without regard to forces." In other words, kinematics describes human movement and ignores the cause of the motion (for example, forces, momentum, energy). Kinematics : - arthrokinematics - osteokinematics

ARTHROKINEMATICS Arthrokinematics refers to the actual movements of the joint surfaces in relation to one another. In addition to the movement of the lever arm of the bone during range of motion activities, the articulating ends of the bone roll and slide (or glide) on each other.

OSTEOKINEMATICS Osteokinematic motion is the movement of the whole bone resulting from rolling and sliding (arthrokinematics) between the articulating surfaces that compose the joint measured. For example: when raising the arm overhead, the bony lever arm (the humerus) moving overhead is the osteokinematic motion. But in other way for this motion to occur, the head of the humerus must roll and slide on the glenoid fossa (arthrokinematic motion).

ARTHROKINEMATICS OSTEOKINEMATICS

Osteokinematic description of movement follows a generalized system based on definitions of planes of movement around axes of rotation. Osteokinematic movement may be described as occurring in one of three imaginary planes of the body arranged perpendicular to each other, with the axes of each plane intersecting the center of gravity of the body. These imaginary planes are referred to as the cardinal planes of the body. (Sagittal, Frontal and Transverse)

Sagittal Plane The sagittal plane is a vertical plane that divides the body into right and left sides . Joint movement in the sagittal plane occurs around a line perpendicular to the plane that is referred to as the medial- lateral axis (Frontal axis). Example: - flexion - Extension

Frontal Plane (coronal) Is a vertical plane that divides the body into anterior (ventral, or front) and posterior (dorsal, or back) halves. Joint movement in the frontal plane occurs around a line perpendicular to the plane that is referred to as the anterior- posterior axis (Sagittal). Osteokinematic motions : Abduction Adduction Lateral flexion of spine

Transverse Plane (horizontal) The transverse plane is a horizontal plane that divides the body into upper (superior, or cranial) and lower (inferior, or caudal) halves. Joint movement in the transverse plane occurs around a line perpendicular to the plane (a line running from cranial to caudal) that is referred to as the longitudinal (or long) axis (Vertical). osteokinematic motions : medial rotation, lateral rotation pronation, and supination

Special Case: Oblique Axis at the Foot and Ankle Motions occurring at the talocrural, subtalar, and midtarsal joints do not take place around the previously described cardinal axes. Previous explanations describe motion at these joints as occurring around oblique axes that lie at angles to all three cardinal planes. These so-called triplanar axes run in an anteromedial-to-posterolateral direction and allow motion in all three planes simultaneously. The motions : pronation (a combination of dorsiflexion, abduction, and eversion) supination (a combination of plantarflexion, adduction, and inversion).

Assessment of PROM Amount of movement possible at the joint Assessment of the PROM provides information about the following: Amount of movement possible at the joint Factors responsible for limiting movement Movements that cause or increase pain PROM is usually slightly greater than AROM, due to: the slight elastic stretches of tissues. in some instances, due to the decreased bulk of relaxed muscles. in the presence of muscle weakness. Assessment of PROM

To assess the PROM at a joint, for each joint movement, stabilize the proximal joint segment(s) and move the distal joint segment(s) through the full PROM and do the following: Visually estimate the PROM Determine the quality of the movement throughout the PROM Determine the end feel and factors that limit the PROM Note the presence of pain Determine whether a capsular or noncapsular pattern of movement is present

Normal Limiting Factors and End Feels The factors that normally limit movement and determine the range of the PROM at a joint include: • The stretching of soft tissues (i.e., muscles, fascia, and skin) • The stretching of ligaments or the joint capsule • The apposition of soft tissues • Bone contacting bone

The end feel: Is the sensation transmitted to the therapist’s hand at the extreme end of the PROM that indicates the structures that limit the joint movement. The end feel may be: Normal (physiological) Abnormal (pathological).

Normal (Physiological) End Feel End Feel General Terminology (Specific Terminology) Description Hard (Bony) A painless, abrupt, hard stop to movement when bone contacts bone. for example: passive elbow extension, the olecranon process contacts the olecranon fossa. Soft (Soft tissue apposition) When two body surfaces come together a soft compression of tissue is felt. for example: in passive knee flexion, the soft tissue on the posterior aspects of the calf and thigh come together. Firm (Soft tissue stretch)   A firm or springy sensation that has some give when muscle is stretched. for example: passive ankle dorsiflexion performed with the knee in extension is stopped due to tension in the gastrocnemius muscle. (Capsular stretch) A hard arrest to movement with some give when the joint capsule or ligaments are stretched. The feel is similar to stretching a piece of leather. for example: passive shoulder external rotation.

Abnormal (Pathological) End Feel Description Hard An abrupt hard stop to movement, when bone contacts bone, or a bony grating sensation, when rough articular surfaces move past one another. for example: in a joint that contains loose bodies, degenerative joint disease, dislocation, or a fracture. Soft A boggy sensation that indicates the presence of synovitis or soft tissue edema. Firm A springy sensation or a hard arrest to movement with some give, indicating muscular, capsular, or ligamentous shortening. Springy block A rebound is seen or felt and indicates the presence of an internal derangement. for example: the knee with a torn meniscus. Empty If considerable pain is present, there is no sensation felt before the extreme of passive ROM as the patient requests the movement be stopped, this indicates pathology such as: an extra-articular abscess, a neoplasm, acute bursitis, joint inflammation, or a fracture. Spasm A hard sudden stop to passive movement that is often accompanied by pain, is indicative of an acute or subacute arthritis, the presence of a severe active lesion, or fracture. If pain is absent a spasm end feel may indicate a lesion of the central nervous system with resultant increased muscular tonus. Abnormal (Pathological) End Feel