Therapeutic Exercise Therapeutic Exercise

Range-of-motion ExercisesRange-of-motion Exercises

DR TAREK NASRALAAL AZHAR

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 EXERCISESTYPES OF ROM EXERCISES

• Passive range-of-motion exercises– PROM

• Active range-of-motion exercises– AROM

• Active-Assistive range-of-motion exercises– AAROM

PASSIVE ROM EXERCISESPASSIVE ROM EXERCISES• Movement 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

GGOOAALLS S

• Maintain joint and connective tissue mobility• Minimize the effects of the formation of

contractures• Maintain mechanical elasticity of muscles• Assist circulation• Enhance synovial movement along joints• Decrease pain• Assist with healing process after injury or

surgery

• Maintain 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 purposes

• When teaching a patient movement

• To 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

• 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 EXERCISESACTIVE ROM EXERCISES

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

GGOOAALLS 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 ROM CONTRAINDICATIONS OF ROM

EXERCISESEXERCISES

• 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 TECHNIQUESTECHNIQUES

• Examination, Evaluation, and Treatment Planning

• Patient preparation

• Application of techniques– Application of PROM– Application of AROM

Examination, Evaluation, and Examination, Evaluation, and Treatment PlanningTreatment Planning

• Examine and evaluate the impairments and level of function.– Determine any precautions and prognosis,

and plan of intervention

• Determine 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 ROM

• Document and communicate findings and intervention

• Re-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 Techniques

• Grasp the extremity around the joints providing support needed for control

• Support areas of poor structural integrity• Move 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 ROMApplication of Passive ROM

• Movement is being provided by an external force

• No 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:– baseline function of the patient– available resources

• Note the joint segments that are involved, therefore, require mobilization

• Identify joint motions required• State the number of repetitions, sets, and

the frequency (how often in a day) that the exercise is to be performed

EXERCISE PRESCRIPTIONEXERCISE PRESCRIPTION

Exercise prescriptionExercise prescription

AAROM exercise of the right upper and lower extremities, all planes x 10 repetitions x 1 set, 3 times daily