Range of movement

Range of movement

What is range of movement (ROM)?

The function of a joint is to allow full range, friction free movement between its segments. The full range of movement (FROM) of a joint incorporates both the accessory movement (which cannot be produced in isolation by an individual) and the physiological movement.

Active physiological movement

The physiological movement of a joint is the active voluntary movement that a person can perform themselves. When performing an active physiological movement (AROM) there is combined involvement of the joint, muscle and motor control. Therefore these are all potential sources of dysfunction. The more common presentation is that of a reduced ROM, however instability, loss of proprioception and poor control could lead to an excessive ROM. In a neurologically impaired patient the potential causes of altered AROM include:

• Altered muscle tone (S3.21)

• Altered sensation (especially proprioception) (S3.23)

• Altered motor control (S2.7)

• Incoordination/ataxia (S3.26)

• Pain (S3.29)

• Cognitive/perceptual deficit (S3.33)

• Lack of confidence

• Soft tissue contracture

• Weakness (S3.30).

Clinical hints and tips

Remember that AROM may also be influenced by factors such as age, gender, occupation, handedness, time of day, temperature, emotional status and other pathology.

Passive physiological movement

A passive physiological movement (PROM) is defined as a movement within the unrestricted ROM for a segment, which is produced entirely by an external force. In the spinal joints this is referred to as a ‘passive physiological intervertebral movement’ (PPIVM). Although not actively involved in producing the movement, muscles and other soft tissue around the joint may still reduce the PROM. Excessive PROM is common in neurologically impaired patients particularly related to hypotonia, e.g. subluxation of the shoulder. Of course motor control does not have any influence in this case.

Accessory movement

The passive accessory range of movement is vital for FROM to be achieved in all joints. In the spinal joints this is termed a ‘passive accessory intervertebral movement’ (PAIVM).

Why do I need to assess range of movement?

A dysfunction of the neural or musculoskeletal systems may lead to joint hypermobility (excessive movement) or hypomobility (reduced movement) either of which may conclude in soft tissue damage, pain and loss of function. Assessment of ROM allows the therapist to identify a potential limitation to functional ability and when combining the findings of AROM and PROM allows the therapist to begin hypothesizing the structures that may be implicated (differential diagnosis).

How do I assess range of movement?

AROM

AROM should be assessed before the PROM is explored.

Patient

The patient’s position will alter depending upon the joint being tested because where possible, the position must allow for FROM. For example, full ROM of hip flexion (hip extension to hip flexion) is only possible in standing. In circumstances where this is not practical, such as an immobile patient, the movement will need to be assessed in two halves.

Therapist

The therapist will already have observed the patient’s general AROM during the performance of functional activities (S3.18). However, as function involves the combined movement of many joints, a more specific assessment of the individual segments involved may

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Tags: Neurological Assessment A Clinicians Guide

Jun 4, 2016 | Posted by admin in NEUROLOGY | Comments Off

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