++
CHAPTER OBJECTIVES
At the completion of this chapter, the reader will be able to:
Define the various components of mobility and how they work together to produce functional movements
List the different types of physiologic motions
Describe the differences among active motions, active-assisted motions, and passive motions
Describe the purpose of range of motion (ROM) exercises
List the different types of diagonal patterns of motion that can be incorporated therapeutically
Interpret the findings of active and passive ROM testing
Perform a ROM examination using a goniometer
Apply passive range of motion (PROM) techniques to the upper extremity
Apply PROM techniques to the lower extremity
++
Normal mobility is necessary for efficient movement. The terms range of motion (ROM), flexibility, and accessory joint motion are often listed as components of mobility1:
++
ROM. Refers to the distance and direction (eg, flexion, extension, abduction, adduction, internal rotation, and external rotation) a joint can move.
Flexibility. Refers to the passive extensibility of connective tissue that provides the ability for a joint or series of joints to move through a full, nonrestricted, injury-free, and pain-free ROM.
Accessory joint motion. The amount of glide that occurs at the joint surfaces, termed joint play.
++
Physiologic motions are joint and soft tissue movements that can be produced actively or passively. Active motions 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 a combination of active and passive motions.
++
CLINICAL PEARL
For a joint to function completely, both the osteokinematic and arthrokinematic motions have to occur normally.
Osteokinematic motion: movements that can be performed voluntarily, eg, how the humerus moves during flexion of the shoulder.
Arthrokinematic motion: the motion(s) of the bone surfaces within the joint, eg, how the convex head of the humerus moves within the concave glenoid cavity of the scapula.
As osteokinematic and arthrokinematic motions are proportional to each other, such that one cannot occur completely without the other, it follows that if an active motion is decreased compared to the same joint on the other side of the body, one or both of these motions may be at fault.
+
++
++
ROM exercises are designed to move the joint and soft tissues through the available physiologic ranges of motion.
++
CLINICAL PEARL
ROM exercises aim to provide sensory stimulation and prevent the adverse effects of immobility (see Chapter 7). These adverse effects include the development of:
Adaptive muscle-tendon shortening
Joint contractures
Deep vein thrombosis (DVT)
Pneumonia and/or aspiration
Urinary tract infection (UTI)
Pressure ulcers
+...