range of motion presentation

7/28/2019 Range of Motion Presentation

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Keeping moving to promote greater healthPresented by: Rachel Davie

Kinesiologistpt Healthcare Solutions


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The amount of movement a person has at each joint Every joint has a normal range of motion


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The type of movement or activity that aims to

preserve flexibility & mobility of the joints onwhich it is performed


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Passive Range of Motion (PROM) Joint movement caused by external assistance (not gravity)

Active-Assisted Range of Motion (AAROM) Joint movement caused by voluntary effort combined with

external assistance (not gravity) Active Range of Motion (AROM)

Joint movement caused by voluntary effort

A person can have all three of these types of movement:

i.e. Stroke resident may have PROM of shoulder and needs total assistancewith movement here, AAROM of hip and only need partial assistance withmovement, AROM of their neck.


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Chronological age alone may affect ROM less thanseveral age-related conditions


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Stroke

Osteoporosis

Parkinsons disease

Fracture

Muscle overuse injuries (sprains & strains)

Muscle disuse injuries (bed bound clients)

Dementia

Arthritis

Contractures

And many more.


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Lack of use can be caused by pain, stiffness,fatigue, and fear of harming oneself

This often leads people to avoid exercise ormovement of these joints

Ironically this makes the problem worse!


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Joints are filled with synovial fluid. Fluid acts to lubricate the joint.

Additionally this fluid contains essential

nutrients and oxygen which it brings totissues of the joint (such as cartilage).

Synovial fluid also contains natural painrelieving analgesic components.

Fluid is spread throughout the joint wheneverthe joint is moved.


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Less fluid is produced

Fluid becomes less viscose/thinnerJoint surfaces become more worn or jagged


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If the joint is not regularly moved this fluid isunable to spread to all areas and surfaces ofthe joint where it is needed.

This translates to: Little or no joint lubrication

Collection or pooling of joint fluid in one specificarea of joint i.e. swelling

Drying out of joint surfaces


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Stiffening and subsequent structural change injoint

Increased pain on movement of 1 or morejoints

Loss of function (related to pain, stiffness, etc)

Increased risk for falls of other injuries

Difficulty with positioning

Onset or continued severity of contractures Loss or perceived loss of independence


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Sedentary or

immobile

clients show

loss of ROM

Generates

emotional

stress re:loss

Clientwithdraws

from

activities or

becomes less

active

Creates

further

decline in

functional

abilities

Additionalemotional

stress


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May make IADLs or ADLs more difficult orimpossible

Trouble dressing

Trouble bathing

Trouble grooming Trouble feeding oneself independently

Trouble accessing or participating in social situationsor activities


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Changes in joint mechanics or joint functionrelated to stiffness or presence of pain canlead to changes in gait or transfer patterns

Improper mechanics can increase risk fordamage to other body tissues (ligaments,tendons, muscles)


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Creates increased risk for skin breakdown Pressure areas

Unequal weight distribution when sitting

Shearing or pulling on skin when attempts made to

position correctly Risk of affecting other joints d/t improper

positioning


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Can affect behaviors Increased irritability

Increased feelings of anger or aggression

Increased feelings of hopelessness or helplessness

Increased incidences of depression Withdrawal or avoidance of social situations or

activities

Places increased burden on client (or

caregivers) forcing them to enter retirementor long term care facilities prematurely


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Increased need for staff assistance with ADLs those who use to be independent may become

dependent with respect to care

Greater difficulty carrying out assistance withADLs may be due to physical or behavioral causes those already receiving assistance may require more

assistance

Difficulty engaging client in activities

feel they cant participate sadness about loss of function Aggression or lashing out due to loss (real or perceived)

of independence or control


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Promote active movement as much aspossible to maintain or improve independentrange of motion Incorporate ROM exercises into daily programming

Assist residents with range of motionmovements or exercises (AAROM)

Put joints passively through range of motiongently in those clients who cannotindependently do so (PROM)


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1. Tell client what you are going to do and why2. Place resident in a comfortable position

which allows full movement of joint3. All movement should be done slowly and

smoothly4. Do not move beyond the comfortable end

range for that particular joint ROM is about movement not stretching

5. If movement requires assistance (eitherpartial or full) use one hand as the workinghand & the other as the stabilizing hand


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Provide only as much assistance as necessaryto promote and encourage independence

Encourage feedback from client How is this feeling?, Are you in any pain?

Encourage an increase to overall range (whensafe to do so) as repetitions progress Do you think you can go a little further?

Encourage participation Reward with praise


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Effects of a range-of-motion exercise programme

Tseng CN, Chen CCH, Wu SC, & Lin LC.Journal of Advanced Nursing57(2), 181-191.

Study looked at 59 bedridden older stroke survivors

Participants randomly assigned to 3 groups Group A: usual care (control group)

Group B: 4 week, twice per day, 6-days a week ROM exercise groupsupervised by an RN

Group C: 4 week, twice per day, 6-days a week ROM exercise groupwhere an RN physically assisted participants to achieve maximumROM

Each intervention session lasted 10-20 minutes andincluded PROM of 6 joints (shoulder, elbow, wrist, hip,knee, and ankle)


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Both intervention groups showedstatistically significant improvement in: Joint angle:

Usual care group- lost movement; average of -5.85 in upperextremities and -3.88 in lower extremities

Intervention group- gained movement; average of +5.42 in upperextremities & +2.14 in lower extremities (group B) AND +12.8 in upperextremities & +7.92 in lower extremities

Activity function (functional independence ADL scale) Usual care group- showed lower ADL scores than before study

Invention group- showed higher ADL scores than before study

Perception of pain (pain scoring scale) Usual care group- showed increase of 5.41 in pain reporting

Intervention group- showed drop of 7.62 (group B) and 10.00 (group C)in pain reporting

Depressive symptoms (GDS score) Usual care group- were more depressed; showed 2.35 point increase

Intervention group- were less depressed; showed 4.76 decrease(group B) and 4.77 decrease (group C)


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Improve or maintain normal ROM of joints and surrounding soft tissue

Decrease risk of injury to joint or surround tissues Decrease in pain in those with joint mobility deficits

Prevent of limit the impact of contractures

Combat effects of prolonged immobilization (open areas, pressure sores,skin breakdown, etc)

Decrease risk of falls

Maintain bone strength If people do fall we decrease the risk of fracture

Promote and maintain levels of independence through movement

Keep people as able as they are for as long as they can be able

Maximize ADL function

Promote mental well being through independent movement

Feel more in control of their health and by extension the world aroundthem

Reduce depressive symptoms and anxiety

Enhance self esteem and body image


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range of motion presentation

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