When performing range of motion exercises each movement should be repeated?

Range of motion exercises

Range of motion (ROM) exercises may target the oral and/or pharyngeal and laryngeal structures involved in swallowing. Although extensive research on the effectiveness and underlying biological parameters of these exercises is limited, their use has been found to be effective in some types of patient (Logemann, 1998). ROM lingual exercises, such as tongue elevation, lateralization, pretending to gargle, and lingual retraction repeated 5−10 times a day, have been found to be effective in improving swallowing performance and speech intelligibility in oral cancer patients (Logemann et al., 1997). Other ROM exercises may involve laryngeal or pharyngeal structures, such as vocal fold adduction exercises, or the falsetto exercise that requires patients to elevate vocal pitch as much as they can, thus practicing elevating their larynx. Efficacy data on these ROM exercises are not yet available (Logemann, 1998).

Phase II: intermediate phase (weeks 7-12)

Goals:

Full nonpainful range of motion at week 8

Normalize arthrokinematics

Increase strength

Improve neuromuscular control

Range of Motion

ROM testing is important to help to identify soft tissue restrictions, functionally limiting deficits in ROM and hypermobility and laxity that may be a risk factor for specific injuries. Active ROM is that brought about by the patient’s own effort, whereas passive ROM is generated by the examiner moving a body part through its arc of motion. The possibilities of ROM depend on the body location or joint. For example, in the shoulder the movements include flexion, extension, abduction, adduction, and external and internal rotation. The ROM for each possible movement is described in terms of maximum degrees of movement through which the body part was moved either actively or passively and the reported reason for any limitations. Alternatively, when arcs are not formally measured it may be helpful to classify ROM as increased, full, or mildly, moderately, or severely restricted. It is important to be aware that ROM may also be greater than expected. Joint, connective tissue, or ligamentous laxity can result in supranormal ROM, whereas pain and structural abnormalities (strictures, arthritis) can limit ROM.

Tone, the sensation of resistance felt as one manipulates a joint through its expected ROM with the patient relaxed, is described in terms of hypotonia and hypertonia. Hypotonia, a decrease in the normal expected muscular resistance to passive manipulation, is due to a depression of alpha or gamma motor unit activity either centrally or peripherally. Hypotonia can be seen in polyneuropathy, myopathy, and certain spinal cord lesions. Hypertonia, a greater-than-expected normal resistance to passive joint manipulation, is divided into spasticity and rigidity. Spasticity is defined as a velocity-dependent increase in tone with joint movement. Spasticity is seen with excitation of spinal reflex arcs or with loss of descending inhibitory control in the reticulospinal or rubrospinal tracts. Spasticity is commonly seen after brain and spinal cord injury and stroke and in multiple sclerosis. It is commonly assessed using the Modified Ashworth Scale (Table 4.3). Rigidity, a generalized increase in muscle tone, is characteristic of extrapyramidal diseases, and is due to lesions in the nigrostriatal system.

In the head, when testing the TMJ, it is important to note any crepitus during active or ROM testing. In the neck, normal cervical active ROMs are flexion of 0–60 degrees; extension of 0–25 degrees; bilateral lateral flexion of 0–25 degrees; and bilateral lateral rotation of 0–80 degrees.4 Any reduction in active ROM should be documented with the reported reason for limitation.

The normal lumbar spine ROMs are flexion of 0–90 degrees; extension of 0–30 degrees; bilateral lateral flexion of 0–25 degrees; and bilateral lateral rotation of 0–60 degrees.4,6 Chapter 24 provides a review of the possible causes of limitation of ROM and pain. In general, pain on flexion hints at a possible disc lesion, whereas pain on extension can indicate spinal stenosis, spondylosis, or a myofascial pain generator.

The remainder of the examination of the face, cervical, and lumbar regions is based on motor, sensory, and reflex examinations, which are best reviewed in an integrated manner. A directed examination of the face is largely based on cranial nerve testing, for which a detailed strategy is presented in Table 4.4. Table 4.5 lists appropriate tests for the C4–T1 nerve roots and Table 4.6 provides an outline for the L2–S1 roots.4,6

Objectivity of Range-of-Motion and Flexibility Assessments

Range of motion and flexibility are measured in a number of different ways. Typically, the type of tissue being assessed will dictate the method of assessment, although some methods may be used for various tissues. The primary movements that are assessed are termed as being physiologic or accessory. Physiologic movement accounts for the major portion of the range and can be measured with a goniometer (see Chapter 5). Physiologic joint movements occur in the cardinal movement planes and include flexion-extension, abduction-adduction, and rotation.29 Accessory motion, also referred to as arthrokinematics, is necessary for normal physiologic range of motion; it occurs simultaneously with physiologic motion and cannot be measured precisely.

The ability to accurately assess and measure physiologic range of motion appears to be dependent on the joint.30-38 These findings are detailed in Chapter 5, and the reader is encouraged to be innovative in developing improved methods of measurement to enhance those that currently exist. Devices, such as a sit-and-reach tool, can be used to assess excursion of the hamstring muscles39-41 (Fig. 6-1).

Accessory range of motion is much more difficult to assess and measure because it is often measured in units of millimeters. Experience in assessing both normal and abnormal joint accessory movement plays a critical role in one's ability to accurately process such movement. Studies have shown a clear difference between novice and expert clinicians in determining accessory range of motion.42-45 Equipment can also be used to assess accessory joint motion, such as that seen when one is measuring the amount of anterior translation of the knee as a result of injury to the anterior cruciate ligament46-50 (Fig. 6-2).

5.2.1 Background

The kinematics of the native joints are critical design parameters from two very important perspectives: ROM and rotation axis.

ROM is simply the maximum rotation angle of a joint in a specified direction. There are three general measures of ROM: passive ROM, active ROM, and functional ROM. Passive ROM is defined by ligament constraints and articular geometry. Cadaveric studies permit the most accurate assessment of passive ROM. Active ROM is the motion with which a joint can be actively rotated via muscle contraction. The magnitude of active ROM of a joint is less than its passive ROM. Functional ROM, typically less in magnitude than both passive and active ROM, is the motion that is required to perform a task or an activity of daily living (ADL).

The axis of rotation of a joint has two characteristics that must be considered for implant design: location and orientation. Consider joint motion that is planar. By definition, the rotation axis is oriented perpendicular to the plane of motion. Importantly, the intersection of the rotation axis with the plane of motion is classically referred to as the ICR. When an implant's center of rotation is not aligned with the joint's native center, the lever arms of muscles acting about the joint may be altered (typically decreasing muscle function and strength), and more importantly, cause increasing stresses at the implant-bone interface because of the misalignment. The effects of kinematic alignment and misalignment have been primarily been examined in total knee arthroplasties (Abdel, 2015; Dossett et al., 2014; Howell et al., 2013).

The orientation of the rotation axis can also have substantial impact on joint kinematics. This parameter is difficult to measure and even more difficult to incorporate into an implant design. Again, consider simple planar motion. Assume a joint begins to rotate in flexion from a neutral position in a single plane. In a simple hinge joint the orientation of the rotation axis would be orthogonal to the plane of motion. In a more complex joint, as a joint approaches its terminal ROM, the ligaments and articular shape guide it through a different rotation, internal rotation for example, to a more stable terminal position. Passive rotation out of the primary plane of motion is referred to as a stabilizing “screw-home” mechanism, and has been well described in the knee (Blankevoort et al., 1988; McLeod et al., 1977; Moglo and Shirazi-Adl, 2005; Piazza and Cavanagh, 2000; Wilson et al., 2000

How many times should each range of motion exercise be repeated quizlet?

How many times did each range of motion exercise be performed for each body part?