View
236
Download
6
Category
Preview:
Citation preview
Range of motion
Contents
• Definition• Type of ROM• Components of range of motion• Goniometry• Measurement
Definition
• Range of motion (ROM) is the term that is used to describe the amount of movement you have at each joint.
Type of ROM
• Active Range of Motion• Passive Range of Motion
Active Range of Motion
• Dynamic flexibility• Physiological movements• Joint motion that occurs because of
muscle contraction
Passive Range of Motion
• Static flexibility• Movement that is performed
completely by the examiner• Endpoints in the range of motion
Components of range of motion
• Sex• Age• Race• Shape of the bone and cartilage• Muscle power and tone• Muscle bulk• Ligaments and joint capsule laxity• Extensibility of the skin and subcutaneous
tissue
Goniometry
• measuring the available range of motion or the position of a joint
• typically this is a measure of PASSIVE motion
• If you are documenting active range of motion, document that this is so
Goniometry
• Stationary arm : placed parallel with the longitudinal axis of the fixed part
• Movable arm : along the longitudinal axis of the movable segment
• Axis of rotation(pin) : at the intersection of the stationary & movable arms
Goniometry
Goniometry procedure
• position joint in zero position and stabilize proximal joint component
• move joint to end of range of motion (to assess quality of movement)
• determine end-feel at point where measurement will be taken ( at end of available range of motion)
• identify and palpate bony landmarks • align goniometer with bony landmarks while
holding joint at end of range • read the goniometer • record measurement (e.g. elbow flexion =
130o)
Type of Goniometer
① full-circle manual universal goniometer most versatile &popular ② Gonoimeters for single joint motion
Type of Goniometer
③ fluid inclinometer
④ pendulum inclinometer
⑤ electrogoniometer
Measurement
•Upper Ext.
•Lower Ext.
•Spine
Upper Ext.Test Position
• Subject supine • Flatten lumbar spine (flex knees) • Shoulder no abduction, adduction or
rotation • (note: to measure gleno-humeral
motion, stabilize scapula)
Shoulder flexion (0~180°)Goniometer Alignment
• Axis – center of humeral head near acromion process
• Stationary arm – parallel mid-axillary line
• Moving arm – aligned with midline of humerus (lateral epicondyle)
Shoulder extension (0~60°)Test Position• Subject prone • Shoulder no abduction,
adduction or rotation • (note: to measure gleno-
humeral motion, stabilize scapula)
Goniometer Alignment• Axis – center of humeral head near acromion process • Stationary arm – parallel mid-axillary line • Moving arm – aligned with midline of humerus
(lateral epicondyle)
Shoulder abduction (0~180°)
Test Position• Subject supine • Shoulder 0° flexion and extension • Shoulder laterally (externally) rotated • Shoulder abducted • Stabilize thorax (note: to measure
gleno-humeral motion, stabilize scapula)
Shoulder abduction (0~180°)
Goniometer Alignment• Axis – center of humeral head near
acromion process • Stationary arm – parallel to sternum • Moving arm – aligned with midline of
humerus
Shoulder external rotation (0~90°)
Test Position • Subject supine • Shoulder 90° abduction • Forearm neutral • Elbow flexed 90° • Stabilize arm
Goniometer Alignment • Axis – olecranon process of ulna • Stationary arm – aligned vertically • Moving arm – aligned with ulna (styloid process)
Shoulder internal rotation (0~70°)Test Position• Subject supine • Shoulder 90° abduction • Forearm neutral • Elbow flexed 90° • Stabilize arm
Goniometer Alignment• Axis – olecranon process of ulna • Stationary arm – aligned vertically • Moving arm – aligned with ulna (styloid process)
Elbow flexion (0~150°)Test Position• Subject supine • Shoulder neutral (arm at
side) • Forearm supinated • Elbow flexed • Stabilize arm
Goniometer Alignment• Axis – lateral epicondyle of humerus • Stationary arm – aligned with humerus (center of
acromion process) • Moving arm – aligned with radius (styloid process)
Elbow extension (150~0°)Test Position • Subject supine • Shoulder neutral (arm at
side) • Forearm supinated • Elbow extended • Stabilize arm
Goniometer Alignment • Axis – lateral epicondyle of humerus • Stationary arm – aligned with humerus (center of
acromion process) • Moving arm – aligned with radius (styloid process)
Forearm pronation (0~80°)Test Position• Subject sitting • Shoulder neutral (arm at
side) • Elbow flexed to 90° • Stabilize arm • Pronate forearm
Goniometer Alignment• Axis – lateral to ulnar styloid • Stationary arm – parallel to humerus • Moving arm – aligned with dorsum of radius
Forearm supination (0~80°)Test Position• Subject sitting • Shoulder neutral (arm at
side) • Elbow flexed to 90° • Stabilize arm • Supinate forearm
Goniometer Alignment• Axis – medial to ulnar styloid • Stationary arm – parallel to humerus • Moving arm – aligned with ventral aspect of radius
Wrist flexion (0~80°)Test Position• Subject seated • Forearm stabilized on table • Flex wrist
(fingers relaxed)
Goniometer Alignment• Axis – lateral wrist (triquetrum) • Stationary arm – aligned with ulna • Moving arm – aligned with fifth metacarpal
Wrist extension (0~70°)Test Position • Subject seated • Forearm stabilized on
table • Extend wrist
(fingers relaxed)
Goniometer Alignment • Axis – lateral wrist (triquetrum) • Stationary arm – aligned with ulna • Moving arm – aligned with fifth metacarpal
Radial deviation (0~20°)Test Position• Subject sitting with
forearm resting on table • Stabilize forearm to
prevent pronation or supination
Goniometer Alignment• Axis – capitate • Stationary arm – aligned with forearm (lateral
epicondyle) • Moving arm – aligned with metacarpal of middle
finger
Ulnar deviation (0~30°)Test Position• Subject sitting with
forearm resting on table • Stabilize forearm to
prevent pronation or supination
Goniometer Alignment• Axis – capitate • Stationary arm – aligned with forearm (lateral
epicondyle) • Moving arm – aligned with metacarpal of middle
finger
Lower Ext.Test Position • Subject supine • Allow knee to flex (to avoid
limitation by tight hamstrings)
• Stabilize pelvis to prevent rotation, Hip flex.
Hip flexion (0~120°)• Goniometer Alignment• Axis – greater trochanter • Stationary arm – aligned with midline of plevis • Moving arm – aligned with femur (lateral epicondyle)
Hip extension (0~30°)
Test Position• Subject prone • Stabilize pelvis to prevent
rotation • Extend hip
Goniometer Alignment• Axis – greater trochanter • Stationary arm – aligned with midline of plevis • Moving arm – aligned with femur (lateral
epicondyle)
Hip abduction (0~45°)Test Position• Subject supine • Stabilize pelvis to
prevent pelvic list • Abduct hip
Goniometer Alignment• Axis – anterior superior iliac spine (ASIS) • Stationary arm – aligned with opposite ASIS • Moving arm – aligned with femur (center of
patella)
Hip adduction (0~30°)Test Position• Subject supine • Stabilize pelvis to prevent
pelvic list • Abduct opposite hip (to allow
room for tested limb to adduct)
• Adduct hip
Goniometer Alignment• Axis – anterior superior iliac spine (ASIS) • Stationary arm – aligned with opposite ASIS • Moving arm – aligned with femur (center of patella)
Hip internal rotation (0~45°)
Test Position• Subject sitting on table • knee flexed • Stabilize distal thigh • medially (internally)
rotate hip
Goniometer Alignment• Axis – center of patella • Stationary arm – aligned vertically • Moving arm – aligned with leg (crest of tibia)
Hip external rotation (0~45°)• Test Position• Subject sitting on table • knee flexed • Stabilize distal thigh • hip laterally (externally)
rotated
• Goniometer Alignment• Axis – center of patella • Stationary arm – aligned vertically • Moving arm – aligned with leg (crest of tibia)
Knee flexion (0~135°)
• Test Position• Subject supine • Allow hip to flex • Flex knee
• Goniometer Alignment• Axis – lateral epicondyle of femur • Stationary arm – aligned with greater trochanter • Moving arm – aligned with lateral malleolus
Knee extension (135~0°)
• Test Position• Subject prone • Stabilize femur • Extend Knee
• Goniometer Alignment• Axis – lateral epicondyle of femur • Stationary arm – aligned with greater trochanter • Moving arm – aligned with lateral malleolus
Ankle plantar flexion (0~50°)
• Test Position• Subject supine • Extend knee • Stabilize leg • Plantarflex ankle
• Goniometer Alignment• Axis – lateral malleolus • Stationary arm – aligned with fibular head • Moving arm – aligned with fifth metatarsal
Ankle dorsiflexion (0~20°)• Test Position• Subject prone • Flex knee • Stabilize sub-talar in neutral • Dorsiflex ankle by pushing
through 5th metatarsal head
• Goniometer Alignment• Axis – lateral malleolus • Stationary arm – aligned with fibular head • Moving arm – aligned with fifth metatarsal
Ankle inversion (0~35°)• Test Position• Subject prone • Stabilize tibia in sagittal
plane (rotate hip or pelvis to align tibia)
• Invert calcaneus
• Goniometer Alignment• Axis – automatically positioned by alignment of
goniometer arms • Stationary arm – aligned with midline of leg • Moving arm – aligned with midline of calcaneus
Ankle eversion (0~15°)• Test Position• Subject supine • Stabilize calcaneus
and talus • Evert forefoot
• Goniometer Alignment• Axis – automatically positioned by alignment of
goniometer arms • Stationary arm – aligned with midline of leg • Moving arm – aligned with plantar aspect of
metatarsal heads
SpineCERVICAL SPINE FORWARD BENDING (flexion)
Test Position• Subject sitting with lumbar
and thoracic spines supported
• Stabilize lumbar and thoracic spines
• Flex cervical spine
• Goniometer Alignment• Axis – external auditory meatus • Stationary arm – vertical • Moving arm – aligned with nostrils
CERVICAL SPINE BACKWARD BENDING (extension)
• Test Position• Subject sitting with lumbar and
thoracic spines supported • Stabilize lumbar and thoracic
spines • Mouth relaxed and slightly open
• Extend cervical spine
• Goniometer Alignment• Axis – external auditory meatus • Stationary arm – vertical • Moving arm – aligned with nostrils
CERVICAL SPINE SIDEBENDING
• Test Position• Subject sitting with lumbar
and thoracic spines supported
• Stabilize lumbar and thoracic spines
• Sidebend cervical spine
• Goniometer Alignment• Axis – spinous process of C7 • Stationary arm – spinous processes of thoracic spine • Moving arm – posterior midline of head at occipital
protuberance
CERVICAL SPINE ROTATION
• Test Position• Subject sitting with lumbar
and thoracic spines supported
• Stabilize lumbar and thoracic spines
• Rotate cervical spine
• Goniometer Alignment• Axis – center of superior aspect of head • Stationary arm – aligned with acromion processes • Moving arm – aligned with tip of nose
THORACO-LUMBAR SPINE FORWARD BENDING (flexion)
• Test Position• Subject standing • Flex thoracic and
lumbar spines
• Tape Measure Alignment
• Spinous processes of C7 and S1
THORACO-LUMBAR SPINE BACKWARD BENDING
(extenion)
• Test Position• Subject standing • Extend thoracic and
lumbar spines
• Tape Measure Alignment
• Spinous processes of C7 and S1
THORACO-LUMBAR SPINE SIDEBENDING
• Test Position• Subject standing • Stabilize pelvis • Sidebend thoracic and
lumbar spines
• Goniometer Alignment• Axis - S1 spinous process • Stationary arm - vertical • Moving arm - C7 spinous process
THORACO-LUMBAR SPINE ROTATION
• Test Position• Subject sitting • Stabilize pelvis • Do not allow sidebending, forward
bending or backward bending • Rotate thoracic and lumbar spines
• Goniometer Alignment• Axis - center of superior aspect of head • Stationary arm - aligned with anterior superior iliac spines • Moving arm - aligned with acromion processes
Recommended