OTA assessments

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Answer

Shoulder flexion norm

0 - 170 degrees

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Shoulder extension norm

0 - 60 degrees

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Shoulder Abduction norm

0 - 170 degrees

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Shoulder Horizontal Abduction norm

0 - 40 degrees

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Shoulder Horizontal Adduction Norm

0 - 130 degrees

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Shoulder Internal rotation norm

0 - 70 degrees

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Shoulder External rotation norm

0 -90 degrees

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Elbow Flexion - Extension norm

0 - 135 - 150 degrees

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Forearm pronation norm

0 - 80 - 90 degrees

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Forearm supination norm

0 - 80 - 90 degrees

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Wrist flexion norm

0 - 80 degrees

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Wrist extension norm

0 - 70 degrees

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Wrist radial deviation norm

0 - 20 degrees

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Wrist ulnar deviation norm

0 - 30 degrees

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Thumb IP Flexion norm

0 - 80 degrees

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Thumb MP flexion norm

0 - 50 degrees

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Thumb Radial abduction norm

0 - 50 degrees

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Thumb palmar abduction norm

0 - 50 degrees

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Thumb opposition norm

measured in centimeters

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Digit MCP flexion norm

0 - 90 degrees

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Digit PIP flexion norm

0 - 110 degrees

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Digit DIP flexion norm

0 - 80 degrees

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client factor that describes the extent of movement that occurs at a joint

Range of motion (ROM)

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arc of motion through which the joint passe when voluntarily moved by muscles acting on the joint

Active Range of motion (AROM)

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arc of motion through which the joint passes when moved by an outside force (another person, yourself, object)

Passive Range of motion (PROM)

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disease processes, trauma, periarticular changes, and age

Factors that can decrease joint movement

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normal joint movement and muscular strength

required for effortless movement in occupation

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part of assessment of client factors in individuals (CVA, arthritis, fx, and general debility) also motivation

Purpose of measuring joint ROM

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Improvements in ROM not significant unless

person has gained in performance skills to enhance participation in occupation

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Role of COTA based on

competency level, legislation and restrictions

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degree and type of motion (occurs at specific jt.), average normal ROM, positioning of self and client during measurement.

before doing goniometry the therapist must understand;

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always establish rapport with patient

before beginning goniometry

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ask patient to move extremity through comfortable ROM noting

amount of movement, noise, or discomfort

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predisposition to joint limitations (RA, old fx, fused joints, etc.)

Always check medical record for

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uninvolved extremity

some patients do not have full ROM check _________ for an idea of what is 'normal' for your patient

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anatomic position

most measurements are performed in

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3 cardinal planes of movement (sagittal, frontal, horizontal)

motions occur in

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angle

goni =

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a measure

metron =

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stationary arm

-Small protractor or half/full circle -Degree numbers are on this bar

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movable arm

-Attached to center of axis -Acts as the dial -Read the degree

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axis

1) Rivet that acts as the fulcrum is placed over the axis of the joint 2) Makes a semi circle of movement 3) Tight enough to hold the movable arm when being measured

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full circle-360 degree, 180, finger, small

various sizes of goniometer

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position of pt. (sitting, supine, etc.) and if pain, spasticity, or abnormal pathology is noted (unable to stand, etc.)

examiner should note

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scapular mobility

glenohumeral mobility depends greatly on

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5 degree increments you will round down or up (unless 1 degree)

ROM is measured in

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Sitting or standing

Shoulder Flexion patient position

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Side of patient

Shoulder Flexion Therapist Position

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enter of humerus just distal to acromion process on lateral aspect of humerus

Shoulder Flexion Axis Location

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Forearm and wrist in neutral

Shoulder Flexion Starting Position

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Client’s arm is raised in front of body in a sagittal plane of movement (Palm facing head)

Shoulder Flexion Ending position

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parallel to trunk

Shoulder Flexion Stationary arm

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parallel to humerus

Shoulder Flexion Mobile Arm

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Trunk bending

Things to watch for measuring Shoulder Flexion

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Sitting or standing

Shoulder Extension patient position

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Side of patient

Shoulder Extension Therapist Position

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Located center on the head of the humerus (just distal to acromion process)

Shoulder Extension Axis Location

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Forearm and wrist in neutral.

Shoulder Extension Starting Position

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Client’s arm is to be brought in back of the body in a sagittal plane of movement

Shoulder Extension Ending position

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Also parallel to trunk

Shoulder Extension Stationary arm

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Also parallel to humerus

Shoulder Extension Mobile Arm

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excessive scapular motion, spinal flexion

Things to watch for measuring Shoulder Extension

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Sitting or Standing

Shoulder Abduction patient position

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Behind patient

Shoulder Abduction Therapist Position

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on acromion process on posterior surface of shoulder

Shoulder Abduction Axis Location

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Palm up with shoulder in adduction with external rotation to prevent impingement

Shoulder Abduction Starting Position

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Client’s arm is raised to side of body in a frontal plane of movement

Shoulder Abduction Ending position

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parallel to trunk

Shoulder Abduction Stationary arm

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parallel to humerus

Shoulder Abduction Mobile Arm

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watch for lateral trunk bending

Things to watch for measuring Shoulder Abduction

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Sitting

Horizontal Shoulder Abduction Patient Position

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Standing behind patient

Horizontal Shoulder Abduction Therapist Position

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over acromion process

Horizontal Shoulder Abduction Axis Location

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shoulder in 90 degrees of abduction, palm down moving the shoulder into abduction.

Horizontal Shoulder Abduction Starting Position

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Move arm toward back of body patient's arm is raised to side of body in frontal plane of movement.

Horizontal Shoulder Abduction Ending position

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parallel over shoulder toward the neck

Horizontal Shoulder Abduction Stationary arm

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Parallel to the humerus on the superior aspect

Horizontal Shoulder Abduction Mobile Arm

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trunk bending

Things to watch for measuring Horizontal Shoulder Abduction

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Sitting

Horizontal Shoulder Adduction Patient Position

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Standing behind patient

Horizontal Shoulder Adduction Therapist Position

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Also on acromion process

Horizontal Shoulder Adduction Axis Location

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Shoulder in 90 degrees of abduction, palm down moving the shoulder into adduction

Horizontal Shoulder Adduction Starting Position

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Arm reaching in front and across body to opposite side patient's arm is moved in front of the body in horizontal plane of movement

Horizontal Shoulder Adduction Ending position

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Also parallel over shoulder toward the neck

Horizontal Shoulder Adduction Stationary arm

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Also Parallel to the humerus on the superior aspect

Horizontal Shoulder Adduction Mobile Arm

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trunk bending

Things to watch for measuring Horizontal Shoulder Adduction

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sitting or standing

Shoulder Internal Rotation Patient Position

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Beside patient

Shoulder Internal Rotation Therapist Position

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on olecranon process of elbow (point of elbow)

Shoulder Internal Rotation Axis Location

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Shoulder in 90 degrees of abduction, elbow in 90 degrees of flexion. Move into External rotation (like resting on an arm rest that is at shoulder height)

Shoulder Internal Rotation Starting Position

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Client’s forearm is swung down gently, keeping humerus parallel to floor

Shoulder Internal Rotation Ending position

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parallel to where forearm started

Shoulder Internal Rotation Stationary arm

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parallel to where forearm is at

Shoulder Internal Rotation Mobile Arm

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trunk bending, arm is straight

Things to watch for measuring Shoulder Internal Rotation

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sitting or standing

Shoulder External Rotation Patient Position

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Beside patient

Shoulder external Rotation Therapist Position

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Also on olecranon process of elbow (point of elbow)

Shoulder external Rotation Axis Location

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Also Shoulder in 90 degrees of abduction, elbow in 90 degrees of flexion. Move into External rotation (like resting on an arm rest that is at shoulder height)

Shoulder external Rotation Starting Position

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Client’s forearm is lifted gently, keeping humerus parallel to floor

Shoulder external Rotation Ending position

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Also parallel to where forearm started

Shoulder external Rotation Stationary arm

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Also parallel to where forearm is at

Shoulder external Rotation Mobile Arm

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trunk bending arm is sraight

Things to watch for measuring Shoulder external Rotation

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sitting or standing

Elbow Extension to Flexion Patient Position

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On side of patient

Elbow Extension to Flexion Therapist Position

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placed over lateral epicondyle of humerus at end of elbow crease

Elbow Extension to Flexion Axis Location

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Forearm supination with palm up (straighten as much as possible)

Elbow Extension to Flexion Starting Position

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Client bring palm towards shoulder Client’s forearm begins in extended position and is raised in a sagittal plane of movement.

Elbow Extension to Flexion Ending position

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parallel to midline of humerus

Elbow Extension to Flexion Stationary arm

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parallel to radius

Elbow Extension to Flexion Mobile Arm

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Watch for shoulder flexion

Things to watch for measuring Elbow Extension to Flexion

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Sitting

Forearm supination Patient Position

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Sitting in front of patient

Forearm supination Therapist Position

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at volar aspect of wrist just proximal to ulnar styloid

Forearm supination Axis Location

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Shoulder Adducted, Elbow at 90 degrees flexion. start with forearm in mid position/neutral.

Forearm supination Starting Position

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move palm toward the ceiling Client’s forearm is rotated laterally around ulna.

Forearm supination Ending position

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pointing downward perpendicular to floor

Forearm supination Stationary arm

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resting against volar aspect of wrist

Forearm supination Mobile Arm

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Elbow in ribs, watch for shoulder abduction

Things to watch for measuring Forearm supination

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Sitting

Forearm pronation Patient Position

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Also Sitting in front of patient

Forearm pronation Therapist Position

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At the dorsal aspect of wrist, just proximal to ulnar styloid

Forearm pronation Axis Location

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Also Shoulder Adducted, Elbow at 90 degrees flexion . start with forearm in mid position/neutral.

Forearm pronation Starting Position

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Patient moves palm to face the ground Client’s forearm is rotated medially around ulna.

Forearm pronation Ending position

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Pointing downward perpendicular to floor

Forearm pronation Stationary arm

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resting against volar aspect of wrist

Forearm pronation Mobile Arm

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Elbow in ribs, watch for shoulder internal rotation

Things to watch for measuring Forearm pronation

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Sitting (table)

Wrist flexion patient position

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Sitting across patient

Wrist flexion therapist position

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Center of Dorsal aspect of wrist (RC joint)

Wrist flexion Axis location

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Seated with elbow on table fingers toward ceiling.

Wrist flexion Starting position

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Palm down toward the table

Wrist flexion Ending position

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Lies down the center of the arm between the radius and ulna

Wrist flexion stationary arm

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along the center of the 3rd metacarpal (there will be space at the wrist bend)

Wrist flexion Mobile arm

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Watch for pronation/supination

Things to watch for measuring Wrist flexion

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Sitting (table)

Wrist extension patient position

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Also Sitting across patient

Wrist extension therapist position

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center of the volar/palmar surface of the wrist (RC joint)

Wrist extension Axis location

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also Seated with elbow on table fingers toward ceiling

Wrist extension Starting position

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Palm toward ceiling

Wrist extension Ending position

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also lies down the center of the forearm between the radius and ulna

Wrist extension stationary arm

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also along the center of the 3rd metacarpal (there will be space at the wrist bend)

Wrist extension Mobile arm

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watch for pronation/supination

Things to watch for measuring Wrist extension

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Sitting (table)

Ulnar Deviation Patient position

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Sitting in front of table

Ulnar Deviation Therapist position

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the base of the 3rd metacarpal (capitate - RC joint)

Ulnar Deviation Axis location

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Seated with forearm pronated and palm flat on table

Ulnar Deviation Starting position

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Pinky moved towards patients wrist Client’s hand is laterally extended in a horizontal plane of movement

Ulnar Deviation Ending position

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Lies down the center of the forearm

Ulnar Deviation stationary arm

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along the 3rd metacarpal (stay in line of metacarpal and not fingers)

Ulnar Deviation Mobile arm

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Watch for pronation/supination

Things to watch for measuring Ulnar Deviation

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Sitting (table)

Radial Deviation Patient position

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Also Sitting in front of table

Radial Deviation Therapist position

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the base of the 3rd metacarpal (capitate - RC joint)

Radial Deviation Axis location

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Seated with forearm pronated and palm flat on table

Radial Deviation Starting position

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patients thumb toward wrist Client’s hand is medially extended in a horizontal plane of movement.

Radial Deviation Ending position

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Also Lies down the center of the forearm

Radial Deviation stationary arm

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also along 3rd metacarpal

Radial Deviation Mobile arm

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Watch for pronation/supination

Things to watch for measuring Radial Deviation

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Sitting (Table)

Digit MP Flexion Patient position

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in front of table

Digit MP Flexion Therapist position

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over lateral aspect of MP joint of index finger

Digit MP Flexion Axis location

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Elbow on table with hand elevated in front of patient.

Digit MP Flexion Starting position

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patient making a fist

Digit MP Flexion Ending position

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on the digit you are measuring

Digit MP Flexion stationary arm

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Dorsum of the hand

Digit MP Flexion Mobile arm

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Thumb not in palm

Things to watch for measuring Digit MP Flexion

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Sitting (table)

Digit PIP Flexion Patient position

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In front of table

Digit PIP Flexion Therapist position

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centered on dorsal surface of PIP joint being measured.

Digit PIP Flexion Axis location

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Elbow on table with hand elevated in front of patient

Digit PIP Flexion Starting position

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making a fist

Digit PIP Flexion Ending position

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over proximal phalanx

Digit PIP Flexion stationary arm

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over distal phalanx

Digit PIP Flexion Mobile arm

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Thumb not in palm

Things to watch for measuring Digit PIP Flexion

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Sitting (Table)

Digit DIP Flexion Patient position

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In front of table

Digit DIP Flexion Therapist position

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dorsal surface of DIP joint

Digit DIP Flexion Axis location

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Elbow on table with hand elevated in front of patient

Digit DIP Flexion Starting position

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making a fist . Extend MP joint enough to fit moveable arm without hitting the palm

Digit DIP Flexion Ending position

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over middle phalanx

Digit DIP Flexion Stationary Arm

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over middle phalanx

Digit DIP Flexion Mobile arm

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Thumb not in palm

Things to watch for measuring Digit DIP Flexion

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Sitting (table)

Thumb MP Flexion Patient position

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in front of table

Thumb MP Flexion Therapist position

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dorsal surface of MP joint

Thumb MP Flexion Axis location

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Neutral wrist on the ulnar border (45 degrees forearm supination)

Thumb MP Flexion Starting position

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(Reach thumb to bottom of palm) Client’s thumb distal of MP joint is flexed down

Thumb MP Flexion Ending position

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over thumb metacarpal

Thumb MP Flexion Stationary Arm

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over thumb metacarpal

Thumb MP Flexion Mobile arm

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On metacarpal not tendon

Things to watch for measuring Thumb MP Flexion

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Sitting

Thumb IP Flexion Patient position

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in front of table

Thumb IP Flexion Therapist position

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dorsal surface of IP joint

Thumb IP Flexion Axis location

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Neutral wrist on the ulnar border. Measure when the MP is also flexed.

Thumb IP Flexion Starting position

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(Reach thumb to bottom of palm) Client’s thumb distal of IP joint is flexed down

Thumb IP Flexion Ending position

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over proximal phalanx

Thumb IP Flexion Stationary Arm

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over distal phalanx

Thumb IP Flexion Mobile arm

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May need to slightly elevate hand to not hit table, keeping forearm stabilized on table

Things to watch for measuring Thumb IP Flexion

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Sitting

Thumb CMC Radial Abduction Patient position

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Sitting across table

Thumb CMC Radial Abduction Therapist position

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over CMC joint at base of thumb

Thumb CMC Radial Abduction Axis location

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Palm flat on table

Thumb CMC Radial Abduction Starting position

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Move thumb away from side of fingers Client’s thumb is abducted in a horizontal plane of movement.

Thumb CMC Radial Abduction Ending position

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In line with 2nd metacarpal

Thumb CMC Radial Abduction Stationary Arm

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parallel to thumb metacarpal

Thumb CMC Radial Abduction Mobile arm

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on metacarpal not tendon

Things to watch for measuring Thumb CMC Radial Abduction

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Sitting

Thumb CMC Palmar Abduction Patient position

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Sitting across table

Thumb CMC Palmar Abduction Therapist position

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1st CMC joint (anatomical snuff box)

Thumb CMC Palmar Abduction Axis location

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Hand and wrist on ulnar border

Thumb CMC Palmar Abduction Starting position

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Thumb move away from index finger (in a plane perpendicular to palm)

Thumb CMC Palmar Abduction Ending position

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in line with 2nd metacarpal

Thumb CMC Palmar Abduction Stationary Arm

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in line with 1st metacarpal

Thumb CMC Palmar Abduction Mobile arm

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on metacarpal not tendon

Things to watch for measuring Thumb CMC Palmar Abduction

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measure with ruler part of goniometer between center of pulp of thumb and small finger

Thumb opposition.

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Created by: OTAbaddies