What is the main purpose of performing range of motion and passive range of motion?

RANGE OF MOTION

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Range of motion is the capability of a joint to go through its complete spectrum of movements.

Range of motion of a joint can be passive or active.

Passive range of motion can be defined as the range of motion that is achieved when an outside force (such as a therapist) causes movement of a joint and is usually the maximum range of motion that a joint can move.

Active range of motion is the range of motion 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.

Range of motion therapy is beneficial in healing and in recovery from soft tissue and joint lesions, maintaining existing joint and soft tissue mobility, minimizing the effects of contracture formation, assisting neuromuscular reeducation, and enhancing synovial movement.

Observation of the cat's gait can help determine gross deficits in range of motion. However, the evaluation of the quality of the resistance of the joint as the end point of a passive movement of the joint provides information about the complete range of motion for that joint (Table 28-2).

21.2.3 Range of motion

Range of motion is the capability of a joint to go through its complete spectrum of movements. It can be passive or active. Passive range of motion can be defined as what is achieved when an outside force, such as a therapist, causes movement of a joint. It is usually the maximum range of motion. Active range of motion is what can be achieved when opposing muscles contract and relax, resulting in joint movement. Active range of motion is usually less than the passive range of motion.

Range of motion therapy is beneficial in recovery from soft-tissue and joint lesions, maintaining existing joint and soft-tissue mobility, minimizing the effects of contracture formation, assisting neuromuscular re-education, and enhancing synovial movement. Measurement of range of motion can be used to evaluate available motion, determine joint stability, and determine soft-tissue elasticity as well as response to therapy over time. The evaluation of a joint's end feel, which is the quality of the resistance of the joint as the endpoint of a passive movement of the joint, will provide information about the complete range of motion for that joint (Table 21-1).

Active Range of Motion

Active ROM is the motion of a joint that may be achieved by active muscle contraction. In addition to increasing strength, coordination between muscle groups is necessary because the guidance of assisting the patient through ROM is no longer provided. The active ROM may be performed during a regular gait cycle, in which the excursion of joint motion is relatively limited, or under special conditions designed to expand motion and encourage more complete use of the full available ROM. Examples of these activities include swimming; walking in water, tall grass, snow, or sand; climbing stairs; crawling through a tunnel; and negotiating cavaletti rails.

As the patient improves ROM of a joint, it is helpful to continue to perform passive ROM and stretching to achieve as complete ROM as possible, and then perform active ROM through this increased motion to emphasize more complete use of the limb. Greater strength is required for patients to perform active ROM, and some of the special conditions require more muscle strength than normal ambulation during walking or trotting. Therefore for those exercises, a transition between active assisted and active ROM may be necessary. Active ROM exercises may be a prelude to other strengthening activities. Owners may also be involved with active ROM exercises in helping with a home care program for their pet.

Range of Motion/Joint Mobility.

Passive ROM (PROM) and active ROM (AROM) at the involved joint and joints above and below should be measured. The clinician should look for the quality and quantity of motion, as well as end-feel. ROM should be noted for both the affected and unaffected side. Joint precautions, as well as ROM restrictions, should be respected, as noted by the physician. For the knee, close attention should be paid to the mobility of the patella because restrictions in its mobility may result in restrictions of knee ROM and function.

Passive Range of Motion

PROM is the ability of a joint to be moved through its normal arc of motion while relaxed, with motion being performed by an outside source, such as the therapist’s hand, the client’s opposite hand, or gravity. Limitations in PROM indicate a problem within the joint (for example, stiffness caused by capsular or ligamentous tightness, decreased joint space, or bone spur). PROM also may be limited by tightness of the muscle/tendon group opposing the passive motion (for example, a tight or adherent extensor muscle/tendon will prevent full passive or active flexion).

Precaution. Traumatic injuries to the bone or joint in the acute phase of healing, or as determined by the physician, are limited to AROM, with no PROM allowed. PROM by an outside source may be performed too strongly, reinjuring the healing bone or ligament. Following a tendon repair in the early phase of tendon healing, PROM in the direction that would stretch the tendon is not allowed.

Range of Motion and Muscle Performance.

ROM and muscle performance (see Chapter 5) should be examined when the systems review or history suggests these could be impaired. In patients with poor standing balance, ROM and muscle performance at the ankles should be tested; in those with poor sitting balance, hip ROM and trunk strength should be tested. Ankle ROM has been shown to have moderately high correlation with the ability to accomplish gait and reaching balance tasks in standing and moderate, although significant, correlation with standing up and turning balance tasks in older women.34 Loss of strength in one or both lower limbs is a significant fall risk factor for hospitalized older adults.36 Neck ROM must also be checked before performing any of the head-moving vestibular tests.

Therapeutic Exercises

ROM is essential in preventing loss of mobility and in optimizing return of function for patients. It is essential for patients to perform ROM exercises early to prevent development of contractures. Due to the fragile nature of healing burn tissue, patients begin with AROM using their own muscle power and then progress to assisted AROM, with physical help provided by another person (Figs. 4.11.17A and 4.11.17B). These stretches to the joints and wound surface help to prevent joint stiffness, shortening of tendons and ligaments, scar adherence, and contractures. In post-surgical releases, the skin quality may be less fragile and can tolerate earlier passive range of motion (PROM) exercises. In some cases when a patient is unable to participate actively (i.e., a person in coma or a young child), PROM and AROM may be initiated early. PROM and AROM should also be done for adjacent unaffected joints to prevent stiffness from decreased mobility. As a scar matures, PROM may be more aggressive to mobilize joints (Fig. 4.11.18).

As mobility returns, therapeutic activities may be introduced to improve gross and fine motor coordination and to encourage return to normal use and ADLs. Gross motor activities may include stacking cups or wringing a towel; fine-motor activities may include grasping or picking up small pegs or coins (Fig. 4.11.19). Treatment should be tailored for each individual through evaluating limitations in movements and using age and culturally appropriate activities toward enhancing function.

Passive Range-of-Motion Exercise

Passive range-of-motion (PROM) exercises are passive movements of a joint through its available range. PROM movement incorporates an external force to move the joint and therefore does not involve active muscle contraction.5 Performed regularly, PROM exercises may help prevent joint contracture as well as soft tissue shortening. PROM exercises can also maintain movement across fascial planes and augment lymphatic flow. PROM sessions should be incorporated early in the course of treatment for any animal that is unable or not permitted to actively move its joints on its own. Since PROM exercises do not involve active muscle contraction, they do not prevent muscle atrophy or increase muscle strength. Guidelines for safe, effective administration of PROM exercises and stretching are listed in Box 145-2.

Generally, PROM exercises are performed three to five times per day for all peripheral joints, including the digits. Each movement is repeated 10 to 15 times.

Range of Motion Exercise.

ROM exercises can alleviate stiffness, increase or maintain joint mobility, and increase the flexibility and elasticity of periarticular structures. Active and active-assisted exercise is recommended in patients with inflammatory arthritis, avoiding overstretching inflamed tissues. During periods of acute inflammation, joint ROM may be maintained by performing at least one to two repetitions through the full ROM daily.155 The number of repetitions may be gradually increased as the acute joint symptoms subside and become subacute or chronic. Active ROM exercise in combination with relaxation has also been shown to produce functional gains and pain reduction in patients with RA.156

Active Range of Motion

Active range of motion (AROM) may initially be performed in gravity-eliminated positions (e.g., tabletop flexion-extension) before transition to antigravity positions (e.g., sagittal plane flexion-extension). The benefits of AROM parallel those of AAROM, with the added benefit that AROM voluntarily activates the elbow muscles, thus stimulating NMC. AROM is performed within safe flexion-extension and pronation-supination motion arcs while monitoring loads placed on the elbow due to upper limb positioning (e.g., effect of forearm pronation on humeroradial compression force,56 effect of shoulder abduction on elbow varus force).64