1. Copyright © 2013. F.A. Davis Company Part II: Applied Science of Exercise and Techniques Chapter 3 Range of Motion

2. Copyright © 2013. F.A. Davis Company  Basic technique used for examination of movement and for initiating movement into a purposeful therapeutic intervention – Range of motion (ROM) – Functional excursion – Active insufficiency – Passive insufficiency Range of Motion

3. Copyright © 2013. F.A. Davis Company  Passive ROM (PROM) – Motion produced by an external force, manual or mechanical  Active ROM (AROM) – Motion produced by active contraction of the muscles  Active-Assistive ROM (A-AROM) – Motion produced by a combination of external force and active muscle contraction (type of AROM) Types of Range of Motion (ROM) Exercises

4. Copyright © 2013. F.A. Davis Company  Passive ROM (PROM) – Indications for PROM – Goals for PROM – Other Uses for PROM Indications, Goals, and Limitations of ROM

5. Copyright © 2013. F.A. Davis Company  Active and Active-Assistive ROM (AROM and A-AROM) – Indications for AROM – Goals for AROM – Limitations of A-AROM Indications, Goals, and Limitations of ROM (cont'd)

6. Copyright © 2013. F.A. Davis Company  ROM should not be done when motion is disruptive to the healing process – Follow specific precautions during early phases of healing  ROM should not be done when the patient’s response or condition is life threatening – Follow specific precautions when the patient’s condition is critical or severe Precautions and Contraindications to ROM Exercises

7. Copyright © 2013. F.A. Davis Company  Examination, Evaluation, and Treatment Planning – Determine appropriate level of ROM – Determine safe amount of motion – Decide the pattern of motion to best meet goals – Monitor patient response to ROM intervention – Document and communicate findings – Re-evaluate and modify as appropriate Principles and Procedures for Applying ROM Techniques

8. Copyright © 2013. F.A. Davis Company  Patient Preparation – Describe the intervention to meet set goals – Free the area from restriction – Drape the patient – Position the patient for alignment and stabilization – Position yourself for proper body mechanics Principles and Procedures for Applying ROM Techniques (cont'd)

9. Copyright © 2013. F.A. Davis Company  Application of Techniques – Control movement grasping around the joint – Support areas of poor structural integrity – Move the segment through pain-free range to the point of resistance – Perform motions smoothly and slowly – Repetitions are determined in the plan of care Principles and Procedures for Applying ROM Techniques (cont'd)

10. Copyright © 2013. F.A. Davis Company  Application of PROM – Movement of the segment by a therapist, PTA,or mechanical device – No active muscle contraction – Motion only through the pain-free ROM without tissue resistance Principles and Procedures for Applying ROM Techniques (cont'd)

11. Copyright © 2013. F.A. Davis Company  Application of AROM – Demonstrate the motion using PROM – Ask the patient to perform the motion – Provide assistance for smooth motion, weakness, at the beginning or end of range only as needed – Motion within available pain-free ROM Principles and Procedures for Applying ROM Techniques (cont'd)

12. Copyright © 2013. F.A. Davis Company  Upper Extremity  Lower Extremity  Cervical Spine  Lumbar Spine ROM Techniques

13. Copyright © 2013. F.A. Davis Company  Self-Assistance  Equipment – Wand (T-bar) – Wall climbing, finger ladder – Ball rolling – Overhead pulleys – Skate board/powder board – Reciprocal exercise unit Self-Assisted ROM

14. Copyright © 2013. F.A. Davis Company  Passive motion that is performed by a mechanical device that moves a joint slowly and continuously through a pre-set, controlled range of motion Continuous Passive Motion (CPM)

15. Copyright © 2013. F.A. Davis Company  Prevents development of adhesions, contractures  Stimulates healing of tendons, ligaments  Enhances healing of incisions  Increases synovial fluid lubrication  Prevents degrading effects of immobilization  Quicker return of ROM  Decreases postoperative pain Benefits of CPM

16. Copyright © 2013. F.A. Davis Company  Device is applied immediately after surgery  Arc of motion is adjustable and determined  Rate of motion is adjustable and determined  Duration on the machine is determined  Physical therapy is included during off periods  Devices are often portable and battery operated to allow patients to be functionally active General Guidelines for CPM

17. Copyright © 2013. F.A. Davis Company  Assists in teaching ADLs and IADLs  Helps patient realize purpose and value of ROM exercises  Assists in developing motor patterns ROM Through Functional Patterns

18. Copyright © 2013. F.A. Davis Company  Critical Thinking and Discussion  Laboratory Practice Independent Learning Activities