RANGE OF MOTION

Therapeutics
Dr Ahsen Raza PT
KEMU Lahore
 PRINCIPLES AND PROCEDURES FOR
APPLYING ROM TECHNIQUES
• Examine and evaluate the patient’s impairments and level of function,
determine any precautions and their prognosis, and plan the
intervention.
• Determine the ability of the patient to participate in the ROM activity
and whether PROM, A-ROM, or AROM can meet the immediate
goals.
• Determine the safe amount of motion
• Decide what patterns can best meet the goals.
• 1.Anatomic planes of motion: frontal, sagittal, transverse
• 2.Combined patterns: diagonal motions or movements that incorporate
several planes of motiond.
 PATIENT PREPARATION

Describe the plan and method of intervention to meet the goals to the
patient.
Free the region from restrictive clothing, linen, splints, and dressings.
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
 APPLICATION OF TECHNIQUES

• To control movement, grasp the extremity around the joints.

• Support areas of poor structural integrity, such as a hypermobile joint,
recent fracture site, or paralyzed limb segment.
• 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.
• Repetitions depends on the objectives of the program and the patient’s
condition and response to the treatment.
 APPLICATION OF PROM

During PROM the force for movement is external; it is provided by a

therapist or mechanical device. Or patient may provide the force with
a normal extremity.
No active resistance or assistance is given by the patient’s muscles
that cross the joint. If the muscles contract, it becomes an active
exercise.
• The motion is carried out within the free ROM (no pain).
 APPLICATION OF AROM/AAROM

Demonstrate the motion desired using PROM; then ask the patient
to perform the motion. Have your hands in position to assist or
guide the patient if needed.
• Provide assistance only as needed for smooth motion.
• When there is weakness, assistance may be required only at the
beginning or the end of the ROM, or when the effect of gravity
has the greatest moment arm (torque).
• The motion is performed within the available ROM
SELF-ASSISTED ROM
 SELF-ASSISTANCE

• With cases of unilateral weakness or paralysis or

during early stages of recovery after trauma or
surgery, the patient can be taught to use the
uninvolved extremity to move the involve
extremity through ranges of motion. These
exercises may be done supine, sitting, or standing.
 WAND (T-BAR) EXERCISES

• When a patient has voluntary muscle control in an involved

upper extremity but needs guidance to complete the ROM
in the shoulder or elbow, a wand dowel rod, cane, wooden
stick, T-bar, or similar object
• The choice of position is based on the patient’s level of
function.
• Most of the techniques can be performed supine if
maximum protection is needed. Sitting or standing requires
greater control.
• The patient grasps the wand with both hands, and the
normal extremity guides and controls the motions.
 WALL CLIMBING

• Wall climbing (or use of a device such as a finger ladder can

provide the patient with objective reinforcement for performing
shoulder ROM.
• Wall Markings may also be used to provide visual feedback for
the height reached. The arm may be moved into flexion or
abduction
• PRECAUTION:
• The patient must be taught the proper motions and not allowed to
substitute with trunk side bending, toe raising, or shoulder
shrugging.
 OVERHEAD PULLEYS

• If properly taught, pulley systems can be

effectively used to assist an involved extremity in
performing ROM.
• Shoulder ROM
• Instruct the patient to hold one handle in each
hand, and with the normal hand, pull the rope and
lift the involved extremity forward (flexion), out to
the side (abduction), or in the plane of the scapula
(scaption is 30˚ forward of the frontal plane).
 SKATE BOARD/POWDER BOARD

• Use of a friction-free surface may encourage

movement without the resistance of gravity or
friction
• Any motion can be done, but most common are
abduction/adduction of the hip while supine
and horizontal abduction/adduction of the
shoulder while sitting.
 RECIPROCAL EXERCISE UNIT

Several devices, such as a bicycle, upper body or

lower body
• ergometer, or a reciprocal exercise unit, can be set
up to provide some flexion and extension to an
involved extremity using the strength of the
normal extremity
 CONTINUOUS PASSIVE MOTION

• Continuous passive
motion (CPM) refers to
passive motion
performed by a
mechanical device that
moves a joint slowly and
continuously through a
controlled ROM.
 BENEFITS OF CPM

• Effective in lessening the negative effects of joint immobilization in

conditions such as arthritis, contractures, and intra-articular fractures.
• Prevents development of adhesions and contractures and thus joint stiffness
• Provides a stimulating effect on the healing of tendons and ligaments
• Enhances healing of incisions over the moving joint
• Increases synovial fluid lubrication of the joint and thus increases the rate
of intra-articular cartilage healing and regeneration
• Prevents the degrading effects of immobilization
• Provides a quicker return of ROM
• Decreases postoperative pain
 GENERAL GUIDELINES FOR CPM

• The device may be applied to the involved extremity immediately after

surgery while the patient is still under anesthesia or as soon as possible
• The arc of motion for the joint is determined. Often a low arc of 20˚ to 30˚ is
used initially and progressed 10˚ to 15˚ per day as tolerated.
• The rate of motion is determined; usually 1 cycle/45 sec or 2 min is well
tolerated.
• The amount of time on the CPM machine varies for different protocols—
anywhere from continuous for 24 hours to continuous for 1 hour three times a
day.
• The longer periods of time per day reportedly result in a shorter hospital stay,
fewer postoperative complications, and greater ROM at discharge
• Physical therapy treatments are usually initiated during periods when
the patient is not on CPM, including active assistive and muscle-
setting exercises
• The duration minimum for CPM is usually less than 1 week or when
a satisfactory range of motion is reached. Because CPM devices are
portable, home use is possible in cases in which the therapist or
physician deems additional time would be beneficial. In these cases,
the patient, a family member, or a caregiver is instructed in proper
application.
 ROM THROUGH FUNCTIONAL
PATTERNS

• Functional patterning can be beneficial in initiating

the teaching of ADL and instrumental activities of
daily living (IADL)
• Utilizing functional patterns helps the patient
recognize the purpose and value of ROM exercises
and develop motor patterns that can be used in
daily activities as strength and endurance
improves.