Objectives

Passive movement
• นักศึกษาสามารถอธิบายหลักการ และวิธีการออก
Therapy กําลังกายโดยกระทําให้ได้
• นักศึกษาสามารถเลือกใช้วิธีการออกกําลังกายโดย
MUJALIN PRASANNARONG, Ph.D. กระทําให้ สําหรับผูป้ ว่ ยได้อย่างถูกต้อง และเหมาะสม
Department of Physical Therapy,
Chiang Mai University

6th Nov, 2013 514222

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Range of motion (ROM) Range of motion (ROM) (cont.)

Movements
• Basic technique used for CNS
the examination of
movement and for
initiating movement into a Muscle contraction
program of therapeutic
intervention. Bones move with
• The full motion possible is respect to each
called the range of motion other at the
(ROM). connecting joints

Movements
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Range of motion (ROM) (cont.) Range of motion (ROM) (cont.)
• Moving the segment • ROM is mostly described in term of joint
through its ROM. range of motion (term: flexion, abduction,
The affected rotation, etc.) and muscle range.
structures are
• Joint motion are usually measured with
– Muscles
goniometer and recorded in degrees.
– Joint surfaces
– Capsules • Muscle range is related to the functional
– Ligaments excursion of muscles.
– Faciae
– Vessels
– Nerves

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Range of motion (ROM) (cont.) ROM for therapeutically purposes

• To maintain normal ROM, the segments must
be through their available ranges • Maintain joint and soft
periodically. tissue mobility.
• Factors lead to decreased ROM such as the • Minimize loss of tissue
following abnormalities of flexibility and contracture
– Systemic formation.
– Joint • Healing of tissues.
– Neurological
– Muscular

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 Type of ROM exercise Type of ROM exercise
--
--Passive
Passive ROM (PROM) or passive movement--
movement--

• Passive ROM (passive movement) • Movement of a segment within the

• Active ROM unrestricted ROM.
• Produced entirely by an external force:
• Active
Active--assistive ROM
gravity, a machine, another individual,
another part of the individual’s own body.
• There is little to or no voluntary muscle
contraction.
• PROM ≠ passive stretching

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Type of ROM exercise Type of ROM exercise

--
--Active
Active ROM (AROM)--
(AROM)-- --
--Active
Active--assistive ROM (A-
(A-AROM)
AROM)--
--

• Movement of a segment within the • Movement of a segment within the

unrestricted ROM.
• Produced entirely by an active contraction
of the muscle crossing that joint.
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unrestricted ROM.
• Produced entirely by an active-assistive
contraction of the muscle crossing that joint.
• AROM with an assistance is provided
manually or mechanically by an outside
force.
• The prime mover muscles need assistance to
perform the full ROM.
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Indications of passive movement
• The patient is not able to perform actively
move a segment (or segments) of the body,
such as comatose, paralyzed, or complete
bed rest.
• Acute, inflamed tissue: detrimental to the
healing process. Inflammation after injury or
surgery usually lasts 2-6 days.
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Passive movement in ICU patients
• Early rehabilitation may comprise passive movement
for patients who are unable to participate activity
(sedated or unconscious).
• Possible effects of passive movements
– Increase in metabolic and hemodynamic demands: venous
return and stroke volume
– Influence the inflammatory process
– Increase minute ventilation
– Increase oxygen consumption
– Increase collagen re-organisation after injury
– Maintain joint range
– Decrease contracture
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Goalss of passive movement

Goal Goalss of passive movement
Goal
• Decrease complications that would occur • Minimize the effects of the formation of
with immobilization. contractures.
– Cartilage degeneration
– Adhesion
– Contracture formation
– Sluggish circulation
• Maintain joint and connective tissue
mobility.

• Maintain mechanical elasticity of muscle.

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Goalss of passive movement (cont.)
Goal
• 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.
• Maintain the patient's awareness of
movement.
Goalss of passive movement (cont.)
Goal
• Used for determining limitations of motion,
joint stability, muscle and other soft tissue
elasticity.
• Used to demonstrate the desire motion
when the therapist teach an active exercise
program.
• Used for preceding the passive stretching
techniques.

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Limitations of passive movement Precautions and contraindications

• In early phase of healing and recovery,
• Passive movement cannot
passive movement is needed to be carefully
– Prevent muscle atrophy
– Increase muscle strength or controlled motion within the limits of pain-
endurance free motion.
– Assist circulation to the extent
that active muscle contraction
• Increased pain and inflammation are signs of
dose too much or the wrong motion of passive
• Relaxed passive movements, especially in individuals who
movement may be have injury or after surgery.
difficult to obtain when • Carefully controlled motion of passive
– Muscle is innervated movements that involved
– The patient is conscious • Carefully initiated to major joints to minimize
venous stasis and thrombus formation.
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 Principles and procedures Principles and procedures
• Examine and evaluate impairments and level • Monitor clinical symptoms and response
of function of the patient
determine during and after the examination and
precautions and prognosis
plan the intervention.
intervention. – Vital signs
• Determine the amount of motion that can be – Color and temperature of the segment
safely applied for the patient's condition. – Change of the ROM
• Decide patterns of movement. – Pain
– Quality of movement
• Re-evaluate and modify the intervention as
necessary.

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Techniques Techniques (cont.)

• To control movement • Do not force beyond the available range.
– Grasp the extremity around • Perform the motion smoothly and
the joints. rhythmically.
– Joints are painful: modify the – 5 – 10 repetitions
grip that provide adequate
support for control. – The number of repetitions depends on the
objectives of the program and the patient’s
• Support areas of condition.
– Hypermobile joint • Passive movement may be taught to the
– Recent fracture site patient to perform with a normal extremity.
– Paralyzed limb segment
• The motion is carried out within the pain-
free range without forced motion.
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 References
• Kisner, C., Colby, LA. (2005). Therapeutic exercise:
foundations and techniques, 5th ed., Philadelphia:
F.A. Davis.
• Stockley RC, Hughes J, Morrison J, Rooney J. An
END OF LECTURE
investigation of the use of passive movements in
intensive care by UK physiotherapists. Physiotherapy.
2010;96(3):228-33.

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