Applied sciences of rom exercises

PROM,AROM,AAROM,PAROM

1. APPLIED SCIENCES of ROM EXERCISES

2. TYPES OF ROM EXERCISES Passive ROM. Passive ROM (PROM) the unrestricted ROM that is produced entirely by an external force; there is little to or no voluntary muscle contraction. The external force may be from gravity, a machine, another individual, or another part of the individual’s own body. Active ROM. Active ROM (AROM) is movement of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing that joint. Active-Assistive ROM. is a type of AROM in which assistance is provided manually or mechanically by an outside force because the prime mover muscles need assistance to complete the motion

3. PRINCIPLES AND PROCEDURES FOR APPLYING ROM TECHNIQUES 1. Examine and evaluate the patient’s impairments and level of function, determine any precautions and prognosis, and plan the intervention. 2. Determine the ability of the patient to participate in the ROM activity and whether PROM, A-AROM, or AROM can meet the immediate goals. 3. Determine the amount of motion that can be safely applied for the condition of the tissues and health of the individual. 4. Decide what patterns can best meet the goals. ROM techniques may be performed in the Anatomic planes of motion: frontal, sagittal, transverse Muscle range of elongation: antagonistic to the line of pull of the muscle Combined patterns: diagonal motions or movements that incorporate several planes of motion Functional patterns: motions used in activities of daily living (ADL) 5. Monitor the patient’s general condition and responses during and after the examination and intervention ; note any change in vital signs, any change in the warmth and color of the segment, and any change in the ROM, pain, or quality of movement. 6. Document and communicate findings and intervention. 7. Re-evaluate and modify the intervention as necessary. Examination, Evaluation, and Treatment Planning

4. Patient Preparation Communicate with the patient. Describe the plan and method of intervention to meet the goals. Free the region from restrictive clothing, linen, splints, and dressings. Drape the patient as necessary. Position the patient in a comfortable position with proper body alignment and stabilization but that also allows you to move the segment through the available ROM. Position yourself so proper body mechanics can be used

5. Application of Techniques To control movement, grasp the extremity around the joints. If the joints are painful, modify the grip, still providing support necessary for control. Support areas of poor structural integrity, such as a hypermobile joint, recent fracture site, or paralyzed limb segment. Move the segment through its complete pain-free range to the point of tissue resistance. Do not force beyond the available range. If you force motion, it becomes a stretching technique. Perform the motions smoothly and rhythmically, with 5 to 10 repetitions. The number of repetitions depends on the objectives of the program and the patient’s condition and response to the treatment

6. INDICATIONS AND GOALS FOR ROM A cute, inflamed tissue, passive motion is beneficial; active motion would be detrimental to the healing process . Inflammation after injury or surgery usually lasts 2 to 6 days. When a patient is not able to or not supposed to actively move a segment or segments of the body, as when comatose, paralyzed, or on complete bed rest, movement is provided by an external source.

7. Goals for PROM Maintain joint and connective tissue mobility Minimize the effects of the formation of contractures Maintain mechanical elasticity of muscle Assist circulation and vascular dynamics Enhance synovial movement for cartilage nutrition and diffusion of materials in the joint Decrease or inhibit pain Assist with the healing process after injury or surgery Help maintain the patient’s awareness of movement

8. Other Uses for PROM When a therapist is examining inert structures, PROM is used to determine limitations of motion, to determine joint stability, and to determine muscle and other soft tissue elasticity. When a therapist is teaching an active exercise program, PROM is used to demonstrate the desired motion. When a therapist is preparing a patient for stretching, PROM is often used preceding the passive stretching techniques

9. Active and Active-Assistive ROM Whenever a patient is able to contract the muscles actively and move a segment with or without assistance, AROM is used. When a patient has weak musculature and is unable to move a joint through the desired range (usually against gravity), A-AROM is used to provide enough assistance to the muscles in a carefully controlled manner so the muscle can function at its maximum level and be progressively strengthened. Once patients gain control of their ROM, they are progressed to manual or mechanical resistance exercises to improve muscle performance for a return to functional activities AROM can be used for aerobic conditioning programs. When a segment of the body is immobilized for a period of time, AROM is used on the regions above and below the immobilized segment to maintain the areas in as normal a condition as possible and to prepare for new activities, such as walking with crutches.

10. Goals for AROM Maintain physiological elasticity and contractility of the participating 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

11. PROM Upper Extremity Shoulder: Flexion and Extension Hand Placement and Procedure Grasp the patient’s arm under the elbow with your lower hand. With the top hand, cross over and grasp the wrist and palm of the patient’s hand. Lift the arm through the available range and return NOTE: For normal motion, the scapula should be free to rotate upward as the shoulder flexes. I Flexion

12. PROM Upper Extremity Shoulder-Extension

13. PROM Shoulder: Abduction and Adduction Hand Placement and Procedure Use the same hand placement as with flexion, but move the arm out to the side. The elbow may be flexed NOTE: To reach full range of abduction, there must be external rotation of the humerus and upward rotation of the scapula