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range of motion:
Recreating normal, intended joint and muscle movements.
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What factors influence a client's ROM?
- Tissue constraints
- Joint type
- Movements permitted by joint
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What are the benefits of performing ROM ?
- 1. Opportunity to evaluate joint and muscle flexibility
- 2. Improves flexibility of joints and muscles
- 3. Produces a virtual pumping motion that improves the circulation of blood and lymph
- 4. Passive version is a relaxation practice
- 5. Creates a sense of self in space (i.e., proprioception).
- 6. May, unintentionally, correct subluxations
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subluxation:
- A partial dislocation
- A slight misalignment of the vertebrae
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What factors effect a client’s ROM?
- Flexibility
- Overuse/Lack of use
- Joint health
- Basal restrictions (fascia)
- Nervous system response
- Age
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passive range of motion:
The movement is created externally while the client receives.
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active range of motion:
- Client demonstrates ROM
- More often used with athletes
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What are the contraindications for performing ROM sequence?
Hypertension—either move forward with caution, or avoid
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What are the major divisions of the ROM Sequence?
- 1. Make Contact
- 2. Legs
- 3. Arms
- 4. Head/Neck
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What are the preliminary steps that need to be completed before proceeding with a ROM Sequence?
- 1. Health History review
- 2. Client signed Informed Consent
- 3. Clear, concise description of procedure
- 4. Client’s verbal consent to begin procedure
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What are the primary steps in the Leg phase of the ROM Sequence?
- Make Contact
- Ankle/Foot
- Diaper Drape
- Knee/Hip
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What are the steps of the Make Contact phase of the ROM Sequence?
- 1. Assist client into a comfortable supine position with their arms at their sides.
- 2. Position yourself at the feet and ask and recieve client’s consent to make contact
- 3. Undrape lower legs
- 4. Make contact with the crural surface of client’s legs and perform 2-3 light effleurage strokes.
- 5. Grasp both heals and pull light traction on client’s exhale
- 6. Stretches lower back
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What are the steps of the Ankle/Foot phase of the ROM Sequence?
- Move to the right side of the client’s right foot and fold sheet to make a triangle
- Support client’s heal from below and plantar flex/dorsi flex ankle
- Rotate ankle both directions
- Flex and extend toes, beginning w/5th digit (wiggle, wiggle, extend)
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What are the steps of the Diaper Drape phase of the ROM Sequence?
- 1. Take corner of blanket, fold into a triangle, and accordion fold to cover opposing leg
- 2. Take corner of sheet, fold into triangle ~ mid abdomen, bring tail back, and accordion fold to exposee leg to mid-thigh
- 3. Support arm and tuck/secure sheet under client’s lower back
- 4. Raise client’s knee just enough to push sheet corner through
- 5. Pull up to client’s side and tell them to pull it snugly
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What are the steps of the Knee/Hip phase of the ROM Sequence?
- 1. Support the leg from below at the knee and ankle
- 2. Flex knee/hip, then bring leg back to full extension (3 repetitions)
- 3. Flex knee/hip to 90° and move corresponding hand to top of knee
- 4. Rotate hip inward, then outward (3 rotations each)
- 5. Return leg to full extension
- 6. Undo diaper drape and drape leg to just below the knee
- 7. With leg fully extended, perform abduction/external rotation and adduction/internal rotation in a smooth rowing motion (3 repetitions)
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What are the primary steps in the Arm phase of the ROM Sequence?
- Undrape arm
- Fingers/Wrist
- Wrist/Elbow
- Shoulder
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What are the steps of the Undrape Arm phase of the ROM Sequence?
- 1. Place hand on shoulder to secure linens and roll them to expose client’s arm
- 2. Grasp and cradle arm as you slide linens under arm
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What are the steps of the Fingers/Wrist phase of the ROM Sequence?
- 1. Rest client’s upper arm on table as you pronate and flex their forearm to 90°
- 2. Flex and extend fingers (wiggle, wiggle, extend) begining with 5th digit
- 3. Flex and rotate thumb
- 4. Flex, Extend and rotate wrist
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What are the steps of the Wrist/Elbow phase of the ROM Sequence?
Suppunate forearm and flex/extend elbow and wrist in a snaking motion
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What are the steps of the Shoulder phase of the ROM Sequence?
- 1. Supporting the elbow and wrist abduct the arm out to the side and move the shoulder through a full circumduction rotation in both directions
- 2. Supporting the wrist and elbow, horizontaly adduct and abduct the shoulder
- 3. Supporting the wrist and elbow, extend/flex the shouder overhead
- 4. Redrape the arm
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What are the primary steps in the Head/Neck phase of the ROM Sequence?
- Neck Flextion/Extention
- Neck Roatation
- Lateral Neck Flection
- In-Line Traction
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What are the steps of the Neck Flextion/Extentsion phase of the ROM Sequence?
- 1. Move to the head of the table and assume a shallow squating position that allows you to adequately support and manipulate the client’s head and neck.
- 2. Place one hand on the back of the client’s head with fingers making contact with the occiput.
- 3. Place the other hand on top of the head with fingers making contact with the orbits.
- 4. Slowly lift and gently flex and extend the client’s neck (repeat 3 times).
- 5. Gently return client’s head to the table.
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What are the steps of the Neck Rotation phase of the ROM Sequence?
- 1. Support client’s head from below with the 4th and 5th digits making contact with the occiput region.
- 2. Gently rotate the head to one side, and then back to the neutral postion.
- 3. Then rotate to the other side, and back to the neutral position
- 4. Repeat cycle 3 times.
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What are the steps of the Lateral Neck Flextion phase of the ROM Sequence?
- 1. Laterally flex the client’s head to one side.
- 2. Place your other hand on top of client’s shoulder and prepare to gently apply a downward pressure
- 3. Instruct client to take a deep breath and time the downward pressure with client’s exhale.
- 4. Repeat 3 times each side
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What are the steps of the In-Line Neck Stretch phase of the ROM Sequence?
- 1. Gently but firmly support client’s head from below and above making contact with the occiput and orbits respectively.
- 2. Slowly and gently pull light, in-line traction, hold, and release.
- 3. Repeat 3 times
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