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ROM:
AROM PROM ISO AROM PROM ISO
Fl or ff Ext
Lat flex R: R: R: Rot. R: R: R:
L: L: L: L: L: L:
Abd Add
In rot Ex Rot
Sup Pron
Ulnar Dev Radial Dev
Ev Inv
Df Pf
Treatment
Techniques Used:
Stroking Vibrations Tapotement HCB Hydrotherapy
Rocking Shaking Rhythmic Mobilization Gr. Joint Mobilization
Effleurage Lymphatic Drainage Stretch PNF
Frictions Skin Rolling Deep Fascial AP ROM
Petrissage Trigger Point Muscle Stripping DB
GTO Muscle Approx. Origin & Insertion Intra-oral
Areas Treated:
BLR Back BLR Chest Wall BLR Breast PA Neck/Head
BLR Shoulder BLR Arm BLR Hand Face
BLR Hip BLR Inner/Upper Thigh BLR Leg BLR Feet
BLR Glute/Buttock Intra-Oral Abdomen PA Full Body
Clinical findings:
Recommended Self-Care:
Additional Notes:
CC: Tx Goals: ROM: ; OA: Area Tx: Consent: Ci’d: