Dr Faiza Sharif

DPT, MSOMPT
 Precautions and contraindications to ROM
 Principles and procedures for applying ROM
techniques
 ROM techniques
 PRINCIPLES AND PROCEDURES FOR APPLYING
ROM TECHNIQUES
 Examine and evaluate the patient’s
impairments and level of function, determine
any precautions and prognosis,and plan the
intervention.
 Determine the ability of the patient to
participate in the ROM activity and whether
PROM, A-AROM, or AROM can meet the
immediate goals.
 Determine the amount of motion that can be
safely applied for the condition of the tissues
and health of the individual.
 Decide what patterns can best meet the goals.
ROM techniques may be performed in the
a. Anatomic planes of motion: frontal, sagittal,
transverse
b. Muscle range of elongation: antagonistic to the
line of pull of the muscle
c. Combined patterns: diagonal motions or
movements that incorporate several planes of
motion
d. Functional patterns: motions used in activities of
daily living (ADL)
 Monitor the patient’s general condition and
responses during and after the examination and
intervention; note any change in vital signs, any
change in the warmth and color of the segment,
and any change in the ROM, pain, or quality of
movement.
 Document and communicate findings and
intervention.
 Re-evaluate and modify the intervention as
necessary.
 Communicate with the patient. Describe the plan
and method of intervention to meet the goals.
 Free the region from restrictive clothing, linen,
splints, and dressings. Drape the patient as
necessary.
 Position the patient in a comfortable position
with proper body alignment and stabilization but
that also allows you to move the segment
through the available ROM.
 Position yourself so proper body mechanics can
be used.
 To control movement, grasp the extremity
around the joints. If the joints are painful,
modify the grip, still providing support
necessary for control.
 Support areas of poor structural integrity,
such as a hypermobile joint, recent fracture
site, or paralyzed limb segment.
 Move the segment through its complete pain-
free range to the point of tissue resistance. Do
not force beyond the available range. If you force
motion, it becomes a stretching technique.
 Perform the motions smoothly and rhythmically,
with 5 to 10 repetitions. The number of
repetitions depends on the objectives of the
program and the patient’s condition and
response to the treatment.
 During PROM the force for movement is
external, being provided by a therapist or
mechanical device. When appropriate, a
patient may provide the force and be taught
to move the part with a normal extremity.
 No active resistance or assistance is given by
the patient’s muscles that cross the joint. If
the muscles contract, it becomes an active
exercise.
 The motion is carried out within the free
ROM, that is, the range that is available
without forced motion or pain.
 Demonstrate the motion desired using PROM; then
ask the patient to perform the motion. Have your
hands in position to assist or guide the patient if
needed.
 Provide assistance only as needed for smooth motion.
 When there is weakness, assistance may be required
only at the beginning or the end of the ROM, or when
the effect of gravity has the greatest moment
arm(torque).
 The motion is performed within the available ROM