1. Therapeutic Exercise I Chapter 3
Range of Motion (ROM)

2. What is ROM? It is therapeutic intervention and
examination of movement, it is described
as joint range and muscle range (functional excursion), it is measured with the use of a goniometer and recorded in degrees
Muscles and external forces cause ROM

3. Muscle/External force
ROM can be affected by structures of the joints, the integrity of the soft tissue and the flexibility of the soft tissues over the joints
These structures can be: muscles, joint surfaces, ligaments, fasciae, vessels, and nerves

4. Active versus Passive Insufficiency
To fully elongate a
muscle
Example: Passive wrist
and finger flexion,
passive elbow extension
Active
An active muscle that
can no longer be
shortened
Example: wrist flexion
with finger flexion,
prone HS curls

5. Types of ROM PROM – not passive stretching AAROM AROM
The usual progression of ROM is:
PROM-AAROM-AROM-Resisted Strengthening….however, you must
understand the MD orders and if there are any specific restrictions to
follow or specific program guidelines to follow
Neither PROM/AAROM/AROM should be performed if it is disruptive to the
healing process
You must be aware of the patient’s normal ROM

6. Purposes of ROM Maintain joint and soft tissue mobility
Minimize loss of tissue flexibility
Minimize contracture formation

7. PROM
To be done after injury or surgery during the inflammation period when a patient can not perform and AROM
PROM: decreases complications from immobilization, maintains joint/connective tissue mobility, minimizes contractures, maintains muscle elasticity, assists circulation/vascular dynamics, enhances synovial movement, decreases/inhibits pain, assists healing, and maintains patient’s awareness
It also serves as a guide for the PT/PTA to determine limitations to the joint and muscle/tendons
Can be done preceding passive stretching techniques

8. AAROM/AROM
To be initiated when a patient can contract a muscle, if weak-AAROM
Working towards full available functional ROM and then progress towards strengthening (covered in chap. 6)
To maintain muscle elasticity/contractility of muscles, provide feedback (muscles) and stimulus (bones/joint); to increase circulation, and develop coordination/motor skills

9. Continuous Passive Motion (CPM)
BENEFITS
Improve mobility at a faster rate
Improve recovery rate/healing of incisions
Increase synovial fluid lubrication, allowing increase rate of intra-articular cartilage healing and regeneration
Decrease post-operative pain

10. General Guidelines for CPM
Applied immediately after surgery
Often started degrees & progressed degrees daily (Pt tolerance & available ROM)
Amount of time applied will vary but ranges from continuous (24 hours) to 1 hour 3x/day.
Rate of motion is determined – 1 cycle 45 sec or 2 min

11. General Guidelines CPM (continued)
P.T. is initiated when pt not in CPM (AAROM & muscle setting exercises)
Duration usually < 1 week or when ROM is achieved
CPM is adjustable, controllable, portable

12. Application of Techniques
ALWAYS MAKE SURE YOU REVIEW THE PATIENT”S CHART/POC AND DISCUSS THE PATIENT WITH THE SUPERVISING THERAPIST
Control the movement with a grasp of the extremity around the joint (make sure the patient is comfortable)
Support areas of weakness of poor structural integrity (hyper-mobile joint, fracture site paralyzed limb)
Move through pain-free ROM (if you force ROM beyond, it then becomes a passive stretching-to be covered in Chap. 4)
The optimal # of repetition is between 5-10 reps, but it does depend on the objectives and how the patient is responding to the treatment….the movement should be done slowly, smoothly, and controlled

13. Things to Remember
Always introduce yourself as a student physical therapist assistant
Always educate your patient on the purpose of the exercise/activity
Always demonstrate the exercise/activity you are asking of the patient
Remember to use good body mechanics for both you and your patient
Remember to always communicate with your supervising PT and with all others Health Care providers who are involved directly with the patient’s care
Always practice within your standards of practice and ethics
Always be timely with documentation and be thorough as required by state laws and the facility

14. Break for Lab with Lecture on UE’s and LE’s
PROM
AAROM
AROM
CPM