goniometry ppt.pdf

Very well PPT for you know about all over goniometer

1. GONIOMETRY
By
CHUKWUEMEKA UCHE MARTHA
9/15/2015
1

2. OUTLINE
What is goniometry ?
Importance of goniometry
Types of goniometer
Universal Goniometer
Range of Motion
Planes and Axes of joint motion
Important Notes
Procedures for Goniometric measurement
ROM measurement
Current Trends
References
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3. WHATISGONIOMETRY
Goniometryisthemeasuringofanglescreatedby
thebonesofthebodyatthejoints.
1,2,3
ThetermgoniometryisderivedfromtwoGreek
words,goniameaningangleandmetron,meaning
measure.
1,2,3,4,5,
Systemtomeasurethejointrangesineachplane
ofthejointistermedgoniometry.
4
Thesemeasurementsaredonewithinstrument
suchasgoniometer,atapemeasure,
inclinometersorbyvisualestimate.
1,2,3,4,5
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4. IMPORTANCE OFGONIOMETRY
Goniometryisusefulindetermining
thepresenceofdysfunction
establishingadiagnosis
developinggoals
evaluatingprogress,
fabricatingorthoses
ameasurementforresearchpurposes
4,5,6
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5. TYPESOFGONIOMETERS
Universal goniometer
Gravity goniometer/
inclinometer
Electro goniometer
sensor with angle meter
Single and twin axis
goniometer
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6. Bubble goniometer
Smartphone soft wares
Digital goniometer
Arthroidal protractor
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7. UNIVERSALGONIOMETER
A universal goniometer may be constructed of metal
or plastic and it has three parts
A body
Fulcrum
Stationary arms
Moving arms
The body of the goniometer is designed like a
protractor and may form a full or half circle; and on
it is a scale from 0 to 180or 360
1, 2, 3
The fulcrum is a rivet or screw-like device at the
center of the body that allows the moving arm to
move freely on the body of the device.
1, 2, 3, 4, 5 6,
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8. UNIVERSALGONIOMETER
Thefulcrumandbodyisplacedoverthejointbeing
measured
3,4,5,6,7,8
Thestationaryarmwillbealignedwiththeinactive
partofthejointmeasuredwhilethemovingarmis
placedonthepartofthelimbwhichismovedin
thejoint’smotion
1,2,3,4,5,6,7.
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10. RANGEOFMOTION
Rangeofmotioncanbedefinedastheamount
ofmotionavailableatajoint.
5
Eachspecificjointhasanormalrangeofmotion
thatisexpressedindegrees.
1
Jointrangesaredividedinto
ActiverangeofmotionAROM
PassiverangeofmotionPROM
Thestructureinvolvedwithmovementofthe
bonesaswellasthebonyarrangementsare
factorsinlimitingmotion.
1,2,3,4.
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11. RANGEOFMOTION
Determinants of joint ROM
Normal
Age
Gender
Others such as ADL, right vsleft, body physique,
active vspassive ROM
Abnormal
Tight soft tissues around the joint
Muscle insufficiency
Adhesion
Foreign body
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12. RANGEOFMOTION
Theend-feelisthefeelingwhichisexperienced
bytheexaminerasabarriertofurthermotionat
theendofaPROM.
Thesenormalend-feelshavebeendescribedas
soft,firm,andhard.Thesametermsareusedto
describeabnormalend-feelswiththeadditionof
"empty".
1,2,3
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13. RANGEOFMOTION
Contraindications to ROM testing:
Dislocation or unhealed fracture in the region,
immediately following surgery,
On medication for pain or muscle relaxants (careful)
Regions of osteoporosis or bone fragility,
Patients with hemophilia,
Immediately after an injury where disruption of tissue is
present.
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14. PLANESANDAXESOFJOINTMOTION
Motionatajointoccursasaresultofmovementof
onejointsurfaceinrelationtoanother.
1
Arthrokinematicsisthetermusedtorefertothe
movementofjointsurfaces.Themovementsat
thejointsurfacesaredescribedasslides(glides),
spins,androlls.Thesethreeusuallyoccurin
combinationwitheachotherandresultin
movementoftheshaftsofthebones.
1,2,3,4,5,9,
Osteokinematicsreferstothemovementofthe
shaftsofthebones.Theseareusuallydescribed
intermsofrotarymovementaboutanaxisof
motion.
1,2,3
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15. PLANESANDAXESOFJOINTMOTION
Goniometrymeasurestheanglescreatedbythe
rotarymotionoftheshaftsofthebones.
1,2,3,4
Osteokinematicmotionsareclassicallydescribed
astakingplaceinoneofthethreecardinalplanes
ofthebody(sagittal,frontal,andtransverse)
aroundthreecorrespondingaxes(medial-lateral,
anterior-posterior,andvertical).
Thethreeplaneslieatrightanglestooneanother
whereasthethreeaxesarebothatrightanglesto
thecorrespondingplaneandtoeachother.
1,2,3,4
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16. PLANESANDAXESOFMOVEMENT
ANATOMICALPOSITION
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17. VALIDITYANDRELIABILITYOFGONIOMETER
AccordingtotheAmericanAcademyofOrthopeadic
Surgeons,KendallandMcCreary,Hoppenfeld,andthe
AmericanMedicalAssociation.
1,2,3,4,5,6,7
Contentvalidity–itisassumedthattheanglecreated
byaligningthearmsofthegoniometerwithbony
landmarkstrulyrepresentstheangle.“Theaccurate
applicationofknowledgeandskills,combinedwith
interpretingtheresultsasmeasurementofrangeof
motiononly,providesufficientevidencetoensure
contentvalidity.”
Reliability–overallgoodtoexcellentreliability.Higher
reliabilityhasbeenfoundformeasurementsofjoint
positioncomparedtorangeofmotion.
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18. VALIDITYANDRELIABILITYOFGONIOMETER
Reliabilityvariesdependingonthejointbeingmeasured.
Intratesterreliabilityisfoundtobehigherthanintertester
reliability
Advantages
• Good reliability and validity.
•Easeofuse.
•Inexpensive.
•Canbeusedtoestablishpresenceorabsenceofdysfunctionandalso
monitorprogress
Limitations
•Reliabilitydependentonexaminerexperience.
•Reliabilityvariesdependingonwhatjointismeasured.
•Requiresconsistencyinpositioning,stabilization,andalignment.
•Somedisagreementbetweensourcesfornormalvaluesofrangeof
motion.
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19. IMPORTANTNOTES
ThestartingpositionformeasuringallROMisthe
anatomicalpositionexceptforrotationin
transverseplane.
Beawareofthepositionthebodyissupposedto
beinformovementandanystabilizationissues.
Stabilizethepartofthebodythatisproximal
(stationaryportion)tothejointyouaretesting.
Thepatientdonotmovehisbodywhilethe
movingthejoint;thisstepisolatesthejoint
movementforamoreaccuratemeasurement.
Therearethreenotationofgoniometric
measurementwhichare0-180º,180-0ºand0-
360º.
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20. IMPORTANTNOTES
Zerodegreesistheneutralstartingposition
Consistentlyusethesamestationaryandmovable
landmarksonthebodywhenmeasuring,to
ensureconsistency.
Theangleofmovementfromthestationaryarmto
themovingarmisreadoffthebodyandreported
astheROM.
Lookatthereadingonthegoniometerateyelevel
beforeremovingitfromthepatient’sbody.
BesuretorecordtheROMofthejoint
Comparereadingwithcontralateralside
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21. PROCEDURE FORGONIOMETRIC MEASUREMENT
Thepatientispositionedintherecommendedtesting
position.
Whilestabilizingtheproximaljointcomponent,the
cliniciangentlymovesthedistaljointcomponentthrough
theavailablerangeofmotionuntiltheendfeelis
determined.
Anestimateismadeoftheavailablerangeofmotionand
thedistaljointcomponentisreturnedtothestarting
position.
Theclinicianpalpatestherelevantbonylandmarksand
alignsthegoniometer.
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22. PROCEDURE FORGONIOMETRIC MEASUREMENT
Arecordismadeofthestartingmeasurement.
Thegoniometeristhenremovedandthepatient
movesthejointthroughtheavailablerangeof
motion.
Oncethejointhasbeenmovedthroughthe
availablerangeofmotion,thegoniometeris
replacedandrealigned,andameasurementisread
andrecorded.
Repeatmeasurementthreetimesandrecordthe
averageasthegoniometricvalueforthejoint’s
ROM
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23. ROMMEASUREMENT
Shoulder ROM
Flexion:
Motion: 0-180º
Position:Subjectsupinewith
kneesflexedorsitting.elbow
extendedwiththepalmfacingthe
body
Goniometer:Axisatthe
acromionprocess,laterallythrough
theheadofthehumerus.
Stationaryarmisplacedalongthe
mid-axillarylineofthetrunk
Movingarmplacealongthelateral
mid-lineofthehumerusinlinewith
thelateralepicondyle.
Extension:
Motion: 0-45º~60º from
neutral position
Position:Subjectproneorsitting,
elbowinslightflexionwiththe
palmfacingthebody.
Goniometer:Axisattheacromion
process,laterallythroughtheheadof
thehumerus
StationaryArmalignedwithmid-
axillarylineofthetrunk
Movingarmalongthelateralmid-line
ofhumerusinlinewithlateral
epicondyle.
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24. Abduction:
Motion:0-180º
Position: Supine, prone or
sitting with the limb in
anatomic position
Goniometer:Axisatanterior
portionofacromionprocess.
Stationaryarmatlateralaspectof
anteriorsurfaceofchestparallelto
midlineofsternum.
Movingarmonanterioraspectof
armparalleltomidlineofhumerus
andinlinewithmedialepicondyle.
OR
Goniometer:Axisattheposterior
portionoftheacromionprocess;
Stationaryarmalignedparalleltospinous
processofthevertebralcolomn
Movingarmalignedwiththemidlineof
thehumerusinlinewithlateral
epicondyle
Adduction:
Motion: 0-30º
Aligmentof goniometer is
same for abduction.
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25. External rotation:
Motion:0-90º
Position:Supine.Shoulderis
abductedto90º.Elbowflexed
withforearminneutraland
perpendiculartotabletopsuch
thatthepalmisfacingthefeet.
Elbownotsupported.Humerus
isfullysupportedonthetable.
Stabilizethedistalhumerus,
thorax,andscapula.
Goniometer:Axisatolecranon
processoftheulna.
Stationaryarmplacedparalleltothe
tabletoporperpendiculartothe
floor.
Movingarmalongtheulnarshaft
alignedwiththestyloidprocessof
theulna.
Internal rotation:
Motion:0-65~90º
Positioningandgoniometer
alignmentissameasin
externalrotation
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26. Radio-ulnar ROM
Supination:
Motion: 0-80º~ 90º
Position:Subjectsittingor
supine,withtheelbowflexed
to90º.Shoulderinzero
degreesofits’ROM.Position
startsmidway between
SupinationandPronation.
Goniometer:Axisismedialto
theulnarstyloidprocess.
Stationaryarmisalignedparallel
totheanteriormidlineofthe
humerus.
Movingarmacrosstheventral
aspectofthewristonaline
betweenandproximaltothe
styloidprocessoftheradiusand
theulna.
Pronation:
Motion: 0-80º~ 90º
Position: same for supination
Goniometer: Axisislateral
totheulnarstyloidprocess.
Stationaryarmisalignedparalleltothe
anteriormidlineofthehumerus.
Movingarmacrossthedorsumofthe
wristonalinebetweenandproximalto
thestyloidprocessoftheradiusand
theulna.
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27. Wrist ROM
Flexion:
Motion: 0-60º~80º
Position:Subjectsitting,
shoulderin90ºofabduction;
elbowflexedto90º.Theforearm
placedinbetweensupination
andpronationsuchthatthe
palmofthehandparallelsthe
floor.
Goniometer:Axisisdistaltothe
ulnarstyloidprocessoroverthe
lateralaspectofthewristoverthe
triquetrum
Stationaryarmparalleltoandover
thelateralmidlineoftheulna,inline
withtheolecranon.
Movingarmalongthelateral
midlineofthe5
th
MC.
Extension:
Motion: 0-60º~70º
Position and goniometer: same
for flexion
Ulnar deviation:
Motion: 0-30º~35º
Radial deviation:
Motion: 0-20º
Position: same for wrist flexion
Goniometer:Axisisatthemiddleof
thedorsalaspectofthewristoverthe
capitate.
Stationaryarmmidlineonthedorsal
surfaceoftheforearminlinewiththe
lateralepicondyleofthehumerus.
Movingarmalongmidlineofthedorsal
surfaceofthe3
rd
MC.
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28. HANDJOINTSROM
7
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29. Hip ROM
Flexion:
Motion: 0-100º~125º
Position:Supineorsidelying
ontheoppositelimbtobe
measured;limbinanatomical
positionwithkneeflexedatthe
endofthemotion.
Goniometer:Placetheaxisat
thelateralaspectofthehipjoint
overthegreatertrochanter.
stationaryarmisparalleltothelong
axisofthetrunkinlinewiththe
greatertrochanterorthelateral
midlineofthepelvis
movingarmisplacedalongthe
lateralmidlineofthefemurinline
withlateralepicondyleofthefemur
Extension:
Motion: 0-10º~30º
Position:ProneorSidelyingon
theoppositelimbtomeasured;the
limbinanatomicalposition
Goniometer alignment is the
same for hip flexion.
*Stabilise the pelvis when
measuring hip flexion and
extension.
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30. Abduction:
Motion: 0 -40º~50º
Position:Supinewiththelimb
inanatomicalposition(0ºofall
limbjointsROM)
Goniometer:axisattheanterior
superioriliacspine(ASIS)ofthe
measuredlimb.
Stationaryarmisatanimaginary
horizontallineextendingfromone
ASIStotheother.
Movingarmiswiththeanterior
midlineofthefemur,inlinewiththe
midlineofthepatella.
Adduction:
Motion: 0-20º~30º
Position: Supine, with opposite
limb abducted
Goniometeralignmentis
sameasforhipabduction
*Stabilisethepelvis
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31. External Rotation:
Motion: 0-40º~50º
Position:Supine,withknees
extendedoverthetableOR
PronewithkneeflexedOR
Highsittingwith90ºflexionof
hipandknee,0ºofhip
abductionandadduction
Goniometer:axisoverthe
anteriormidpatella
Stationaryarmisparalleltothe
supportingsurfaceorthefloor
Movingarmisplacedalongthe
anteriorsurfaceofthetibia
midwaybetweenthemalleoli.
Internal Rotation:
Motion: 0-40º~45º
Positioning and goniometer
alignment is same as in hip
external rotation
*Stabilise the femur pelvis
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32. Knee ROM
Flexion:
Motion: 0-135º~150º
Position:Supine,kneesin
extensionwithhipflexedto
90
o
atendofthemotionOR
pronelyingwithknee
extendedfootovertheedge
ofthesupportingsurface.
Goniometer:Axisisplaced
overthelateralepicondyleofthe
femur
Stationaryarmisparalleltothe
lateralmidlineofthefemurinline
withthegreatertrochanter
Movingarmisplacedlateralat
themidlineofthefibulainline
withthelateralmalleolus.
Extension:
Motion: note any
hyperextension
Positioningandgoniometer
alignmentissamewithknee
flexion.
Extensionisanopposite
motiontoflexion
*Thethighshouldbestabilized
in flexion motion
measurement
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33. Ankle ROM
Dorsiflexion:
Motion:0-20º
Position:Subjectwassitting
withlegsoffthetableoron
highsittingwithlowerlegat
rightangletothethighandthe
footatrightangletothelower
legasthezerostarting
position.
Goniometer:fulcrumwasaligned
slightlyinferiortothelateral
malleolus.
Stationaryarmiswiththemidline
ofthelateralaspectofthelower
leg,inlinewiththeheadoffibula.
Movingarmwasparalleltothe5
th
metatarsal.
Plantarflexion:
Motion:0-40º~50º
Positioningand goniometer
alignmentissame with
dorsiflexion
Inversion:
Motion:0-15º~20º
Position: same with dorsiflexion
Goniometer:axisismidway
betweenthetwomalleoliatthe
anterioraspectoftheankle
Stationaryarmiswiththeanterior
midlineoftibiainlinewiththetibial
tuberosity
Movingarmiswiththeanterior
midlineofthe2
nd
metatarsal.
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34. Eversion:
Motion:0-15º~20º
positioningandgoniometer
alignmentissameasfor
inversion
Subtalar ROM
Inversion:
Motion:0-5º
Position:pronelyingwithhipand
kneein0ºofalltheirjoints’ROM,foot
isoffthesupportingsurfacesuchthat
thetoesarepointdownwards
Goniometer:axisisovertheposterior
aspectoftheanklemidwaybetweenthe
twomalleoli.
Stationaryarmiswithposteriormidlineof
theleg
Movingarmiswithposteriormidlineofthe
calcaneus.
Eversion:
Motion:0-5º
Positioning and goniometer alignment
is same as for inversion.
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35. Cervical ROM
Flexion:
Motion:0-45º
Position:sittingwithhead
andneckinanatomical
position,lumbarandthoracic
regionsupportedonbackrest
Goniometer:axisonthe
externalauditorymeatus
Stationaryarmisperpendicularto
thefloorinlinewithhead
Movingarmiswiththebaseofthe
nares
Extension:
Motion:0-45º
Positioning and goniometer
alignment is same as flexion
Lateral flexion:
Motion:0-45º
Position: same as flexion
goniometer:axisisonthespinous
processofthe7
th
cervicalvertebra
Stationaryarmiswiththespinous
processesofthethoracicvertebrae
perpendiculartothefloor
Movingarmiswiththeposterior
midlineoftheheadinlinewithoccipital
protuberance
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36. Rotation:
Motion:0-60º~80º
Position:sameasforflexion
Goniometer:axisoverthe
centreofthecranialaspectofthe
head
Stationaryarminlinewithan
imaginarylinebetweenthetwo
acromialprocesses
Movingarmiswiththetipofthe
nose
Lumbar ROM
Flexion:
Motion: 4inches
Position: standing and in
anatomical position
TapeMeasure:Placedproximately
attheC7spinousprocessanddistallyat
S1;calculatethedifferencebetween
standingandflexionendingposition.
Extension:
Motion:2inches
Position: same with flexion
TapeMeasure:Placedproximately
attheC7spinousprocessanddistallyat
S1;calculatethedifferencebetween
standingandextensionendingposition.
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37. Lateral flexion:
Motion: 0-25º~35º
Position: same as flexion
Goniometer:axisoverthe
spinousprocessof1
st
sacral
vertebra
Stationary arm is
perpendiculartothefloor
Movingarmisinlinewiththe
spinousprocessoftheofthe
7
th
cervicalvertebra
TapeMeasure:Placed
proximallyatthefingertips
anddistallyatthelateral
malleolus;calculatethe
differencebetweensideswhen
standing andwithside
bending.
Rotation:
Motion:0-30º~45º
Position: same as flexion
Goniometer:axisatthecentreof
thecranialaspectofthehead
Stationaryarmisparallelwiththe
imaginarylinebetweenthetwo
prominenttuberclesontheiliaccrest.
Movingarmiswithanimaginaryline
betweenthetwoacromialprocesses
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38. CURRENTTRENDS
TheuseofinclinometersoftwaretomeasureROMina
joint.InastudybyBrianetal,(2013),itwasinferredthat
Smartphoneshavegoodcorrelationwiththe“gold
standard”goniometerformeasuringshoulderrangeof
motion.Additionally,thereisgoodcorrelationamongst
differentlevelsofproviderswithmeasurementsobtained
usingthesmartphone
Drgoniometer
12
Theuseofsensorandgoniometerprobesetuptomeasure
jointROM.Itusuallyconvenientforlargejoints
Itisdesignedasasensorpadconnectedtoa
potentiometeroraprobeconnectedtoasensorangle
meter
7,8
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39. 9/15/2015
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40. Example of goniometric measurement
using DrGoniometeras it appears on the
smartphonescreen
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41. CONCLUSION
Goniometricmeasurementisanimportantskillall
physiotherapistmusthaveasitemployedinalmostall
areaofphysiotherapypractice.
Therearedifferentinstrumentformeasurementofjoint’s
rangeofmotionbuttheuniversalgoniometreremainsthe
goldstandardduetoit’sexcellentvalidityandreliabilityin
mostarticles.Italsohasadvantagessuchaseaseofuse,
inexpensive,easilyavailableandaccuracy.
Thoughsomeotherinstrumentareasreliableandvalidas
theuniversalgoniometerbutthecostofpurchase,
availabilityandeaseofusemaynotbemet.
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42. REFERNCES
1.Norkin, C.C. & White, D.C. (1988) Techniques and procedures, in Measurement of joint motion:
A guide to goniometry.In Norkin & White, Eds. FA Davis: Philadelphia. p. 9-24.
2.Norkin, & White.(1995) Measurement of Joint Motion: A Guide to Goniometry. 2nd ed.
Philadelphia, PA: F.A. Davis Company.
3.Norkin, & White.(2003) Measurement of Joint Motion: A Guide to Goniometry. 3rd ed.
Philadelphia,PA: F.A. Davis Company;.
4.The British Orthopaedic Association (1983) Joint motion: method of measuring and recording. In
Heck, C.V., Hendryson, I.E., Rowe, C.R. (eds). Edinburg: Churchill Livingstone.
5.Gadjosik, & Bohannon(1987) Clinical measurement of range of motion: review of goniometry
emphasizing reliability and validity. Physical Therapy; 67: 1867-1872.
6.Gogia, Braatz, Rose, & Norton.(1987) Reliability and validity of goniometric measurements at the
knee. Physical Therapy; 67: 192-195.
7.Nadeau, Kovacs, Gravel, Piotte, Moffet, Gagnon, & Hebert.(2007) Active movement
measurements of the shoulder girdle in healthy subjects with goniometer and tape measure
techniques: A study on reliability and validity. Physiotherapy Theory and Practice.;23: 179-187.
8.Brian, C.W., Chris, M.K., Justin, W.G., Matthew, L.L., Joseph, M.H., & Stephen F.B.(2013)
Shoulder Range of Motion: Validation of an Innovative Measurement Method Using a
Smartphone The Orthopaedic Journal of Sports Medicine, 1(4)(suppl1)
9.MacDermid, et al.(1999) Range of motion measurement.Journal of Hand Therapy;12:187-192.
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43. REFERNCES
10.Rasmussen,O.(1985)Stabilityoftheanklejoint.ActaOrthop.Scandinavica;Suppl.
211:p.56-78.
11.Seto,J.L.&Brewster,C.E.(1985)Treatmentapproachesfollowingfootandankleinjury.
ClinicalSportsMedicine;13:p.295
12.Ferriero,G.,Sartorio,F.,Foti,C.,Primavera,D.,Brigatti,E.&Vercelli,S.(2012)
ReliabilityofaNewApplicationforSmartphones(DrGoniometer)forElbowAngle
Measurement.TheAmericanAcademyofPhysicalMedicineandRehabilitation;Vol.
3:1153-1154
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