ROM

Description:	ROM, MMT
Category:	Occupational Therapy
Created by:	natkat on 2005-03-13

Body Assessing
POSTURE	alignment of the body	relative disposition of joints	in any motion the placement of one joint effects another	when in correct posture you put minimal stress on joints
Plumb line lateral aspect	EAM--> acromion process	greater trochanter--->lat epicondial of femur--->lat maleolus	bodies of lumb--->Posterior to hip	ant to knee--->ant to lat maleolus	lat epicondyle of knee	and of knee
Anterior plumb line	nose	sternum	belly button	pubic symphysis	right between legs
Sitting posture	neutral to slight anterior pelvic tilt	hamstring tight=post pelvic tilt
ROM	degree of mvmnt in joint
ROM limitation	tight tissue	shortend muscles	burn scar and swelling	AROM- muscle weakness
PROM affected by	CVA (spastic)	tight ligament, burn scar(joint contracture and abnormqal bone mvmnt)	hand trauma	dislocation of joint/ disaligned surface	foreign bodies in the joint( calcification)
Why measure ROM	may effect occupations	choose modalities	how much range to compensate for	assistive devices	baseline ( see if pt is progressing)(effectiveness of treatment
Asessment of ROM	screening- for adequate rom for occup performance	AROM ( for muscle strength)	measure PROM (for joint deficits)	look for symmetrt/compen./quality/post/color/facial expressions	can always observe coordination and pain	if there is a limitation in AROM do PROM
End feel	soft ( knee/ elbow flex)	hard ( elbow ext) bone to bone	firm ( hip exten/ shoulder mvmnt)- joint capsule or ligament
Abnormal pathology	swelling soft instead of hard	spacticity firm- when occurse sonner than expect (full rom not reached)	bone protrusion- hard instead of soft or firm	empty- no end feel because of pain ( prevents full rom)
Precautions for ROM	never do with our written orders	don't do it on a dislocated joint	don't do it on a non healed fracture	don't do immediately post op of tissue around joint	myositis ossifications ( disease calcified)osteoperosis- (easily fracture) inflamation- (joint is unstable)	hypermobility/ subluxation( partial dislocation)/ and if person is taking pain meds
MMT	muscles strength	ability to move against gravity with resistance (to maintain posture/ perform movement)
Causes of muscle strangth limitations	direct disease (MD, myas grav)	an injury to muscle itself	lmn issues ( perph nerve injury, periph neurophathy( disease processin pns distalmuscles not recieve sensation),guillian barre, spinal chord injury effects nerev roots even through cns injury)	indirect/misuse imobilization (amputations, arthritis, fracture)
Why do we do MMT	need to assess individuals meaningful occupations and decide if deficit interferes with performance
DO not perform MMT	on disorders related to tone	CNS- message from brain arent being transmitted so they willnot be able to control and isolate movmnt
Types of muscle contractions	Isometric ( no joint motionocurse and muscle length stays the same)	Isotonic (joint movement and change in length of muscle)
ISOTONIC movement	concentric ( muscle gets shorter)	eccentric (muscle is lengthend)
When do we test strength?	when we do a quick ROM asessment - they have grade of 3 bec no resistance applied	1/2 of AROM againts gravity w/ no resistance is 2+	add resistance/ you can test strength with their available ROM
Endurance	When testing strength we are NOT testing endurance	measure of fatige	measure of muscle strength over time	if you are weak coordination and endurance will be effected (effects functional ability)
Functional Muscle test	getting an estimate of person's strength tx planning and progress eval	asess external rotators/ not supraspinatus	saves time/ position change/ energy	not precise mmt but can be used as screening toolIn spinal chord injury we use MMT ( need to know specifics)
Contraindications for FMT/mmt	post op/ after surgery	broken bones	pain	mobility issue ( weight bearing?)	osteoperosis and pain medication	high BP- no isometric contraction