range of motion

1. RANGE
OF
MOTION
LEC 2
BY: DR. KHAZIMA ASIF

12. HIP FLEXION WITH
KNEE BEND

13. HIP FLEXION IN SIDE
LYING

14. HIP ABDUCTION

15. INTERNAL ROTATION

16. DORSIFLEXION

17. Self assisted ROM
• After surgery or traumatic injury, self-assisted ROM (S-
AROM) is used to protect the healing tissues when more
intensive muscle contraction is contraindicated.
• 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 involved extremity through ranges of motion.

18. • These exercises may be done supine, sitting, or
standing. The effects of gravity change with patient
positioning, so when lifting the part against gravity,
gravity provides a resistive force against the prime
motion, and therefore, the prime mover requires
assistance. When the extremity moves downward,
gravity causes the motion, and the antagonists need
assistance to control the motion eccentrically.

19. • Forms of Self-Assisted ROM
• ■ Manual
• ■ Equipment
• ■ Wand or T-bar
• ■ Finger ladder, wall climbing, ball rolling
• ■ Pulleys
• ■ Skate board/powder board
• ■ Reciprocal exercise devices

20. • Guidelines for Teaching Self-Assisted ROM
• ■ Educate the patient on the value of the motion.
• ■ Teach the patient correct body alignment and stabilization.
• ■ Observe patient performance and correct any substitute or
unsafe motions.
• ■ If equipment is used, be sure all hazards are eliminated for
application to be safe.
• ■ Provide drawings and clear guidelines for number of
repetitions and frequency.
• Review the exercises at a follow-up session. Modify or
progress the exercise program based on the patient response
and treatment plan for meeting the outcome goals.

21. SHOULDER FLEXION

22. AND INTERNAL
ROTATION

23. WRIST FLEXION AND
EXTENSION

24. HIP FLEXION

25. HIP EXTERNAL AND
INTERNAL ROTATION

26. INVERSION AND
EVERSION

27. Wand (T-Bar) Exercises
• When a patient has voluntary muscle control in an involved upper
extremity but needs guidance or motivation to complete the ROM in
the shoulder or elbow, a wand (dowel rod, cane, wooden stick, T-
bar, or similar object) can be used to provide assistance .
• 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.
• Choice of position is also guided by the effects of gravity on the
weak muscles.
• Initially, guide the patient through the proper motion for each activity
to ensure that he or she does not use substitute motions.
• The patient grasps the wand with both hands, and the normal
extremity guides and controls the motions.

28. SHOULDER FLEXION

29. SHOULDER ABDUCTION
AND ADDUCTION

30. ROTATION

31. WALL CLIMBING FOR
SHOULDER ELEVATION

32. OVERHEAD PULLEYS TO ASSIST
SHOULDER ELEVATION

33. 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.
The mechanical devices that exist for nearly every joint
in the body.

34. USES OF CPM
• Total knee replacement
• ACL tear repair
• Tibial plateau fracture
• Patellar realignment

35. Benefits of CPM
• ■ 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

36. General Guidelines for
CPM
• 1. The device may be applied to the involved extremity
immediately after surgery while the patient is still under
anesthesia or as soon as possible if bulky dressings
prevent early motion.
• 2. 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 portion of the range
used initially is based on the range available and patient
tolerance.

37. • 3. The rate of motion is determined; usually 1 cycle/45
sec or 2 min is well tolerated.
• 4. 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.

38. • 5. Physical therapy treatments are usually initiated during
periods when the patient is not on CPM, including active
assistive and muscle-setting exercises. It is important that
patients learn to use and develop motor control of the ROM
as motion improves.
• 6. 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.

39. • 7. CPM machines are designed to be adjustable, easily
controlled, versatile, and portable. Some are battery
operated (with rechargeable batteries) to allow the
individual to wear the device for up to 8 hours while
functioning with daily activities.

40. CPM MACHINES

41. CPM MACHINES

42. ROM Through Functional
Patterns
Early ROM training for functional upper extremity and neck patterns may
include activities such as:
■ Grasping an eating utensil; utilizing finger extension and flexion
■ Eating (hand to mouth); utilizing elbow flexion and forearm supination
and some shoulder flexion, abduction, and lateral rotation.
■ Reaching to various shelf heights; utilizing shoulder flexion and elbow
extension.
■ Brushing or combing back of hair; utilizing shoulder abduction and lateral
rotation, elbow flexion, and cervical rotation.
■ Holding a phone to the ear; shoulder lateral rotation, forearm supination,
and cervical side bend.
■ Donning or doffing a shirt or jacket; utilizing shoulder extension, lateral
rotation, elbow flexion and extension.
■ Putting on socks and shoes; utilizing hip external rotation and abduction,
knee flexion and ankle dorsi and plantarflexion, and trunk flexion.