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PT 153: Therapeutic Exercise IIPT 153: Therapeutic Exercise II
Range-of-motion Range-of-motion ExercisesExercises
Aila Nica J. Bandong, PTRPInstructor
Department of Physical Therapy
UP- College of Allied Medical Professions
Learning ObjectivesLearning Objectives
At the end of the lecture, the students should be able to:
Differentiate the types of range-of-motion (ROM) exercises in terms of◦ Goals of treatment◦ Indications◦ Treatment variables◦ Limitations◦ Contraindications
Identify the appropriate type of ROM exercise to employ given a condition
Perform ROM exercises properly (lab)
Why use ROM exercises?Why use ROM exercises?
Basic technique for movement examination
Technique used for initiating or incorporating movement into a therapeutic intervention program◦Full ROM vs Functional ROM
TYPES OF ROM TYPES OF ROM EXERCISESEXERCISESPassive range-of-motion exercises
◦PROM
Active range-of-motion exercises◦AROM
Active-Assistive range-of-motion exercises◦AAROM
PASSIVE ROM PASSIVE ROM EXERCISESEXERCISESMovement produced by
an external force within the unrestricted range of motion of a segment◦Gravity◦Machine◦Therapist or another
person◦Another part of the
individual’s own body
Little to or no muscle contraction elicited
GGOO
AALLS S
Maintain joint and connective tissue mobility
Minimize the effects of the formation of contractures
Maintain mechanical elasticity of musclesAssist circulationEnhance synovial movement along jointsDecrease painAssist with healing process after injury or
surgeryMaintain patient’s awareness of
movement
! Minimize ill-effects of immobilization
IINNDDIICCAATTIIOONNS S
Acute or inflamed tissue where active motion may disrupt the normal healing process
Patients who are unable to move or are not allowed to move such as when comatose, paralyzed, or on complete bed rest
For assessment purposesWhen teaching a patient movementTo prepare a patient for stretching
LLIIMMIITTAATTIIOONNSS
Passive ROM exercise WILL NOT:
prevent atrophy
increase strength or endurance
assist in circulation to the extent that active, voluntary muscle contraction does
Evidence in PracticeEvidence in Practice
Clinical Question:
Is there evidence to suggest the effectiveness of continuous passive motion following total knee arthroplasty?
Evidence in PracticeEvidence in PracticeKey articles:Grella, RJ (2008) Continuous passive
motion following total knee arthroplasty: a useful adjunct to early mobilisation? A systematic review
Brosseau L, et al (2004) Efficacy of continuous passive motion following total knee arthroplasty: A meta analysis
Lenssen AF, et al (2003) Continuous passive motion following primary total knee arthroplasty: Short- and long-term effects on range of motion
Evidence in PracticeEvidence in PracticeResults/conclusion:Conflicting evidence on the
effectiveness of continuous passive motion following total knee arthroplasty
Potential benefits may need to be weighed against additional cost and inconvenience
There is need for further trials to ascertain the effects of using continuous passive motion post-total knee arthroplasty
Movement produced on a segment upon active contraction of the muscles crossing the joint within the unrestricted range of motion.
Assistance is provided byan outside force (manual or mechanical), as the prime mover muscles is unable to complete the motion.
ACTIVE ROM ACTIVE ROM EXERCISESEXERCISES
ACTIVE-ASSISTIVE ROM EXERCISES
Maintain elasticity and contractility of 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
GGOO
AALLS S
When a patient is able to actively contract the muscles and move the segment with or without assistance
Muscle weakness and inability to move segment completely against gravity
Aerobic conditioning programs
During periods of immobilization, AROM is used in joints above and below the immobilized segment
IINNDDIICCAATTIIOONNS S
Active ROM exercise WILL NOT:
maintain or increase strength of already strong muscles
develop skill or coordination except in the movement patterns used
LLIIMMIITTAATTIIOONNSS
PRECAUTIONS AND PRECAUTIONS AND CONTRAINDICATIONS OF CONTRAINDICATIONS OF ROM EXERCISESROM EXERCISES
Should not disrupt the healing process◦Excessive movement/wrong
performance of movement leads to increased pain and inflammation
Should not be done if response will be life-threatening to the patient
PRINCIPLES OF ROM PRINCIPLES OF ROM TECHNIQUESTECHNIQUESExamination, Evaluation, and
Treatment Planning
Patient preparation
Application of techniques◦Application of PROM◦Application of AROM
Examination, Evaluation, and Examination, Evaluation, and Treatment PlanningTreatment PlanningExamine and evaluate the
impairments and level of function.◦Determine any precautions and prognosis,
and plan of interventionDetermine the ability to participate in
the ROM activity◦Note what type of ROM exercise to meet
goalsDecide on the patterns of movemento Anatomic plane vs muscle range of
elongation vs combined patterns vs functional patterns
Monitor the general condition and response during and after the examination and intervention◦Take vital signs, presence of pain,
quality of movement, change in ROMDocument and communicate
findings and interventionRe-evaluate and modify the
intervention as needed
Examination, Evaluation, and Examination, Evaluation, and Treatment PlanningTreatment Planning
Patient Preparation Patient Preparation Communicate with the patient that
plan of intervention and the method to be used
Remove all restrictive clothing, linen, splint, and dressings; drape appropriately
Position the patient comfortably maintaining proper alignment and stabilization while allowing movement along the available ROM
Maintain proper biomechanics (therapist)
Application of TechniquesApplication of TechniquesGrasp the extremity around the joints
providing support needed for controlSupport areas of poor structural
integrityMove the segment throughout its
pain-free range to point of tissue resistance
Perform the movements smoothly and rhythmically 5 to 10 reps◦Depends on the objectives of the
program and patient’s general condition and response to the exercise
Application of Passive Application of Passive ROMROMMovement is being provided by
an external forceNo active resistance or
assistance is provided by the muscles that cross the joint.
Motion is performed within the available or free ROM◦There should be no pain or forced
motion elicited
Demonstrate the desired motion through PROM
Ask the patient to perform the movement independently◦Be ready to provide assistance or
guidance when necessary To complete movement smoothly In the presence of weakness (may provide at
the beginning or end of ROM, or when torque is greatest)
Perform the motion within the available range
Application of Active ROMApplication of Active ROM
Identify the appropriate ROM exercise for the case with due consideration to the ff:◦baseline function of the patient◦available resources
Note the joint segments that are involved, therefore, require mobilization
Identify joint motions requiredState the number of repetitions, sets,
and the frequency (how often in a day) that the exercise is to be performed
EXERCISE EXERCISE PRESCRIPTIONPRESCRIPTION
You are a physical therapist working in an aged care facility. A 67-year old female diagnosed with cerebrovascular accident was referred to you for management. She presents with weakness of both the right upper and lower extremity muscles. Result of which, she has difficulty moving her involved extremities to full range. One of your goals is to maintain joint flexibility. You deem that a regular ROM exercise may be beneficial.
SAMPLE CASE 1SAMPLE CASE 1
What does the case tell What does the case tell you?you?Patient has inability to move both
upper and lower extremities to full range due to weakness of muscles
There’s a need for an ROM exercise that will maintain joint flexibility
What does evidence say?What does evidence say?Tseng et al, in 2007, reported that a
simple range-of-motion exercise can generate positive effects in physical function of older people with stroke.
* randomized controlled trial* statistically significant improvements in joint angles, activity function, and perception of pain and depressive symptoms
What ROM ex is What ROM ex is appropriate?appropriate?AROM?AAROM?PROM?
WHY?
Exercise prescriptionExercise prescription
AAROM exercise of the right upper and lower extremities, all planes x 10 repetitions x 1 set, 3 times daily
ReferencesReferencesBrosseau, L., Milne, S., Wells, G., Tugwell, P., Robinson, V.,
Casimiro, L., Pelland, L., Noel, M.J., Davis, J., and Drouin, H. (2004) Efficacy of continuous passive motion following total knee arthroplasty: a metaanalysis. The Journal of Rheumatology. 31(11): 2251-2264.
Encabo, M. (2004). Lecture notes on PT 153: Therapeutic exercises II, range of motion exercise and stretching. UP-College of Allied Medical Professions
Grella, R. J. (2008) Continuous passive motion following total knee arthroplasty: a useful adjunct to early mobilisation? Physical Therapy Reviews. 3(4): 269-279.
Kisner, C., Colby, L. (2007). Therapeutic exercise: Foundations and techniques (4th ed). Philadelphia: F. A. Davis Company.
Lenssen, A. F., Koke, A., de Bie, R. A., and Geesink, R. (2003). Continuous passive motion following primary total knee arthroplasty: short- and long-term effects on range of motion. Physical Therapy Reviews. 8(3):113-121.
Rothstein, J., Roy, S., and Wolf, S. (2005). The rehabilitation specialist’s handbook (3rd ed). Philadelphia: F. A. Davis Company.
Tseng, C. N., Chen, C. C., Wu, S. C. & Lin, L. C. (2007). Effects of a range of motion exercise programme. Journal of Advanced Nursing. 57(2): 181-191.