Assessing Range of Motion: Difference between revisions
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== Measuring Range of Motion == | == Measuring Range of Motion == | ||
There are different instruments used to measure ROM. The choice of instrument depends on the purpose of the measurement, the movement to be measured, the instrument’s accuracy, availability, cost, ease of use, size and its validity and reliability.<ref>Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis; 2016 Nov 18.</ref> | There are different instruments used to measure ROM. The choice of instrument depends on the purpose of the measurement, the movement to be measured, the instrument’s accuracy, availability, cost, ease of use, size and its validity and reliability.<ref>Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis; 2016 Nov 18.</ref> Reliability of range of motion is influenced by the types of measurement instrument used and procedures, differences among joint actions and body regions, passive versus active measurements, intra-tester versus inter-tester measurements, and different patient types. <ref>Gajdosik RL, Bohannon RW. Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Physical therapy. 1987 Dec 1;67(12):1867-72.</ref> | ||
=== | === Goniometry === | ||
A [[goniometer]] is the most common instrument used to measure range of motion in the clinical setting. The term 'goniometry' is derived from the greek words '<nowiki/>''gonia''<nowiki/>' meaning angle and '''metron''<nowiki/>' meaning measure, therefore goniometry refers to the measurement of angles, which in rehabilitation settings refers to the measurement of angles in each plane at the joints of the body. Generally the universal goniometer has been shown to have good to excellent reliability but is considered of limited use in movement analysis as it gives you a static end range measurement only. Overall, research shows high intra- and inter-rater reliability of the universal goniometer, with reliability in non-expert examiners improved with clear instructions on goniometric alignment. Reliability & validity of hand-held goniometry has been shown to be good to excellent but has limited use in movement analysis as it gives you a static end range measurement only, but is helpful as an outcome measure to assess effect of treatment in conjunction with functional testing. | |||
* Versatile: Measures joint position and range of motion at almost all joints of the body | * Versatile: Measures joint position and range of motion at almost all joints of the body |
Revision as of 16:38, 9 June 2023
Original Editors - Naomi O'Reilly and Tarina Van Der Stockt
Top Contributors - Naomi O'Reilly, Jess Bell, Ewa Jaraczewska and Tarina van der Stockt
Introduction[edit | edit source]
Range of motion (ROM) means the extent or limit to which a part of the body can be moved around a joint or a fixed point; the totality of movement a joint is capable of doing. Range of motion is essential to your body’s functional mobility. Bones, ligaments, muscles, and tendons support each joint in your body, enabling it to move within a specific range.
If you have limited range of motion in one or more joints, your body may compensate by placing stress on other joints or muscles, resulting in muscle imbalance and improper body alignment. Poor alignment and muscle imbalance present a greater risk of injury and pain and reduce functional mobility.
Types of Range of Motion[edit | edit source]
Active Range of Motion
- Active range of motion (AROM) is the range of movement that can be achieved when opposing muscles contract and relax, resulting in joint movement. For example, the active range of motion to allow the elbow to bend requires the biceps to contract while the triceps muscle relaxes. Active range of motion is usually less than passive range of motion.[1] Performed by the patient independently and when the patient is able to voluntarily contract, control, and coordinate a movement. AROM exercises are used when the patient is able to voluntarily contract, control, and coordinate a movement when such a movement is not contraindicated.
Active-assisted Range of Motion
- Active-assisted range of motion (AAROM) is the range of movement when the joint receives partial assistance from an outside force. Typically performed when the patient needs assistance with movement from an external force because of weakness, pain, or changes in muscle tone. The assistance may be applied mechanically, manually, or by gravity while the patient performs a voluntary muscle contraction to the extent they are able.
Passive Range of Motion
- Passive range of motion (PROM) is the range of movement that is achieved when an outside force exclusively causes movement of a joint. Usually performed when the patient is unable or not permitted to move the body part. It is also performed when the patient needs assistance with movement from an external force because of weakness, pain, or changes in muscle tone. The assistance may be applied mechanically or manually.
Factors Impacting Range of Motion[edit | edit source]
Age
Gender
Body Mass Index
Test Position
Instrument Used
Contraindications[edit | edit source]
Conditions where active range of motion may be contraindicated include the following;
- Suspected or Confirmed
- Joint dislocation or subluxation
- Unhealed or unstable bone fracture
- Rupture of tendon or ligament
- Infectious or acute inflammatory process
- Post-surgery if movement disrupts the healing process
- Regions of osteoporosis or bone fragility, as forced measurements may cause iatrogenic injury
Precautions[edit | edit source]
Conditions where measurement of range of motion is appropriate with added precautions include the following;
- Infection or inflammation around a joint
- Severe pain aggravated by movement
- Hypermobility or instability
- Presence of pain or muscle spasms
Measuring Range of Motion[edit | edit source]
There are different instruments used to measure ROM. The choice of instrument depends on the purpose of the measurement, the movement to be measured, the instrument’s accuracy, availability, cost, ease of use, size and its validity and reliability.[2] Reliability of range of motion is influenced by the types of measurement instrument used and procedures, differences among joint actions and body regions, passive versus active measurements, intra-tester versus inter-tester measurements, and different patient types. [3]
Goniometry[edit | edit source]
A goniometer is the most common instrument used to measure range of motion in the clinical setting. The term 'goniometry' is derived from the greek words 'gonia' meaning angle and 'metron' meaning measure, therefore goniometry refers to the measurement of angles, which in rehabilitation settings refers to the measurement of angles in each plane at the joints of the body. Generally the universal goniometer has been shown to have good to excellent reliability but is considered of limited use in movement analysis as it gives you a static end range measurement only. Overall, research shows high intra- and inter-rater reliability of the universal goniometer, with reliability in non-expert examiners improved with clear instructions on goniometric alignment. Reliability & validity of hand-held goniometry has been shown to be good to excellent but has limited use in movement analysis as it gives you a static end range measurement only, but is helpful as an outcome measure to assess effect of treatment in conjunction with functional testing.
- Versatile: Measures joint position and range of motion at almost all joints of the body
- Construction: Typically plastic, contains a body (similar to a protractor) and two lever arms (stationary and movable)
- Alignment: Arms align with proximal and distal segments of the individual’s joints
- Cost: Varies from $5 to $100
Smart Phones[edit | edit source]
Can be loaded with appropriate software applications
- Allows smartphones to function as inclinometers by using built-in tilt-sensitive systems
- Data on reliability and validity are currently insufficient to support use in the clinical setting
Visual Estimation[edit | edit source]
Yields only subjective information in contrast to objective goniometric measurements so not recommended. Visual estimates made prior to goniometric measurements may help to reduce errors attributable to incorrect reading of the goniometer, however, knowledge of the estimate has been shown to influence goniometric measurement results.
Principles of Measurement[edit | edit source]
Positioning[edit | edit source]
- Testing Position
- Body positions recommended for obtaining goniometric and muscle length measurements
- Places the joints in a zero starting position when measuring range of motion (ROM)
- Helps to stabilise the proximal joint segment
- Important for the comfort of the examiner and individual being measured
- Stabilises the body and proximal joint segment
- Isolates the motion to one joint to ensure that a true measurement of the motion is obtained
End Feel[edit | edit source]
End feel is the quality of the tissue resistance to motion at the end of the passive range of motion. Each joint has a normal end feel at a normal point in the range of motion (ROM). Abnormal end feel, or correct end feel but at the incorrect point in the range indicate pathology.
End Feel | Description | Example |
---|---|---|
Soft | Soft Tissue Approximation End Feel
|
Knee Flexion
Contact between soft tissue of posterior leg and posterior thigh |
Firm | Capsular End Feel
|
Extension of Metacarpophalangeal Joints Tension in the Anterior Capsule |
Ligamentous End Feel
|
Forearm Supination
Tension in the Palmar Radioulnar Ligament of Inferior Radioulnar Joint, Interosseous Membrane, Oblique Cord | |
Muscular End Feel
|
Hip flexion with the knee straight
Passive elastic tension of the Hamstring Muscles | |
Hard | Bone on Bone
|
Elbow Extension
Contact between Olecranon Process of the Ulna and the Olecranon Fossa of the Humerus |
End Feel | Description | Example |
---|---|---|
Empty | No real end feel
Movement definitely beyond the anatomical limit or Pain prevents the body part from moving through available ROM |
|
Soft | Occurs sooner or later in the Range of Motion than is usual or in a joint that normally has a hard end feel. |
|
Firm | Occurs sooner or later in the Range of Motion than is usual or in a joint that normally has a soft or firm end feel. |
|
Hard | Occurs sooner or later in the Range of Motion than is usual or in a joint that normally has a soft or firm end feel. A bony grating or bony block is felt. |
|
Spasm | Involuntary muscle contraction that prevents normal ROM due to pain (guarding; eg, muscle spasm) |
|
Loose | Extreme Hypermobility |
|
Clinical Significance[edit | edit source]
Resources[edit | edit source]
References [edit | edit source]
- ↑ Hudson S. Rehabilitation Methods and Modalities for the Cat. In: Handbook of Veterinary Pain Management 2009 Jan 1 (pp. 538-577). Mosby. Available:https://www.sciencedirect.com/science/article/pii/B9780323046794100280 (accessed 25.10.2021)
- ↑ Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis; 2016 Nov 18.
- ↑ Gajdosik RL, Bohannon RW. Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Physical therapy. 1987 Dec 1;67(12):1867-72.
- ↑ Magee D. Orthopaedic Physical Assessment WB Saunders. pg. 2002;478:483-631.