CHAPTER 11: Range of Motion

CHAPTER OBJECTIVES

At the completion of this chapter, the reader will be able to:

1. List the different types of physiologic motions

2. Describe the differences among active motions, active-assisted motions, and passive motions

3. Describe the purpose of range of motion exercises

4. List the different types of diagonal patterns of motion that can be incorporated therapeutically

5. Interpret the findings of active and passive range of motion testing

6. Perform a range of motion examination using a goniometer

7. Apply passive range of motion techniques to the upper extremity

8. Apply passive range of motion techniques to the lower extremity

OVERVIEW

Physiologic motions are joint and soft tissue movements that can be produced actively or passively. Active motions are those that can be produced by the patient alone, whereas passive motions are those motions that require assistance to complete. Active-assisted motions are those that are combination of active and passive motions (see Chapter 4).

RANGE OF MOTION EXERCISES

Range of motion exercises are designed to move the joint and soft tissues through the available physiologic ranges of motion.

• Active range of motion (AROM): performed by the patient independently. AROM exercises are used when the patient is able to voluntarily contract, control, and coordinate a movement when such a movement is not contraindicated. Contraindications to AROM include a healing fracture site, a healing surgical site, severe and acute soft tissue trauma, and cardiopulmonary dysfunction. The presence of a number of conditions requires caution with AROM exercises. These include acute rheumatoid arthritis, significant pain or joint swelling, or if the symptoms are intensified with the exercise. The benefits of AROM exercises are outlined in Table 11-1.

• Active assisted range of motion (AAROM): performed when the patient needs assistance with movement from an external force because of weakness, pain, or changes in muscle tone. The assistance may be applied mechanically, manually, or by gravity while the patient performs a voluntary muscle contraction to the extent he or she is able. AAROM exercises are used in the presence of muscular weakness, fatigue, or pain.

• Passive range of motion (PROM): usually performed when the patient is unable or not permitted to move the body segment, and the clinician, or family member, moves the body segment. PROM exercises are typically used where there is paralysis, when the patient is comatose, in the presence of a healing fracture, or if pain is elicited during an active muscle contraction. One of the primary goals of PROM is to counteract the detrimental effects of immobilization. However, it is important to remember that PROM exercises cannot prevent muscle atrophy.