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Keeping moving to promote greater healthPresented by: Rachel Davie
Kinesiologistpt Healthcare Solutions
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The amount of movement a person has at each joint Every joint has a normal range of motion
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The type of movement or activity that aims to
preserve flexibility & mobility of the joints onwhich it is performed
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Passive Range of Motion (PROM) Joint movement caused by external assistance (not gravity)
Active-Assisted Range of Motion (AAROM) Joint movement caused by voluntary effort combined with
external assistance (not gravity) Active Range of Motion (AROM)
Joint movement caused by voluntary effort
A person can have all three of these types of movement:
i.e. Stroke resident may have PROM of shoulder and needs total assistancewith movement here, AAROM of hip and only need partial assistance withmovement, AROM of their neck.
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Chronological age alone may affect ROM less thanseveral age-related conditions
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Stroke
Osteoporosis
Parkinsons disease
Fracture
Muscle overuse injuries (sprains & strains)
Muscle disuse injuries (bed bound clients)
Dementia
Arthritis
Contractures
And many more.
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Lack of use can be caused by pain, stiffness,fatigue, and fear of harming oneself
This often leads people to avoid exercise ormovement of these joints
Ironically this makes the problem worse!
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Joints are filled with synovial fluid. Fluid acts to lubricate the joint.
Additionally this fluid contains essential
nutrients and oxygen which it brings totissues of the joint (such as cartilage).
Synovial fluid also contains natural painrelieving analgesic components.
Fluid is spread throughout the joint wheneverthe joint is moved.
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Less fluid is produced
Fluid becomes less viscose/thinnerJoint surfaces become more worn or jagged
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If the joint is not regularly moved this fluid isunable to spread to all areas and surfaces ofthe joint where it is needed.
This translates to: Little or no joint lubrication
Collection or pooling of joint fluid in one specificarea of joint i.e. swelling
Drying out of joint surfaces
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Stiffening and subsequent structural change injoint
Increased pain on movement of 1 or morejoints
Loss of function (related to pain, stiffness, etc)
Increased risk for falls of other injuries
Difficulty with positioning
Onset or continued severity of contractures Loss or perceived loss of independence
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Sedentary or
immobile
clients show
loss of ROM
Generates
emotional
stress re:loss
Clientwithdraws
from
activities or
becomes less
active
Creates
further
decline in
functional
abilities
Additionalemotional
stress
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May make IADLs or ADLs more difficult orimpossible
Trouble dressing
Trouble bathing
Trouble grooming Trouble feeding oneself independently
Trouble accessing or participating in social situationsor activities
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Changes in joint mechanics or joint functionrelated to stiffness or presence of pain canlead to changes in gait or transfer patterns
Improper mechanics can increase risk fordamage to other body tissues (ligaments,tendons, muscles)
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Creates increased risk for skin breakdown Pressure areas
Unequal weight distribution when sitting
Shearing or pulling on skin when attempts made to
position correctly Risk of affecting other joints d/t improper
positioning
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Can affect behaviors Increased irritability
Increased feelings of anger or aggression
Increased feelings of hopelessness or helplessness
Increased incidences of depression Withdrawal or avoidance of social situations or
activities
Places increased burden on client (or
caregivers) forcing them to enter retirementor long term care facilities prematurely
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Increased need for staff assistance with ADLs those who use to be independent may become
dependent with respect to care
Greater difficulty carrying out assistance withADLs may be due to physical or behavioral causes those already receiving assistance may require more
assistance
Difficulty engaging client in activities
feel they cant participate sadness about loss of function Aggression or lashing out due to loss (real or perceived)
of independence or control
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Promote active movement as much aspossible to maintain or improve independentrange of motion Incorporate ROM exercises into daily programming
Assist residents with range of motionmovements or exercises (AAROM)
Put joints passively through range of motiongently in those clients who cannotindependently do so (PROM)
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1. Tell client what you are going to do and why2. Place resident in a comfortable position
which allows full movement of joint3. All movement should be done slowly and
smoothly4. Do not move beyond the comfortable end
range for that particular joint ROM is about movement not stretching
5. If movement requires assistance (eitherpartial or full) use one hand as the workinghand & the other as the stabilizing hand
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Provide only as much assistance as necessaryto promote and encourage independence
Encourage feedback from client How is this feeling?, Are you in any pain?
Encourage an increase to overall range (whensafe to do so) as repetitions progress Do you think you can go a little further?
Encourage participation Reward with praise
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Effects of a range-of-motion exercise programme
Tseng CN, Chen CCH, Wu SC, & Lin LC.Journal of Advanced Nursing57(2), 181-191.
Study looked at 59 bedridden older stroke survivors
Participants randomly assigned to 3 groups Group A: usual care (control group)
Group B: 4 week, twice per day, 6-days a week ROM exercise groupsupervised by an RN
Group C: 4 week, twice per day, 6-days a week ROM exercise groupwhere an RN physically assisted participants to achieve maximumROM
Each intervention session lasted 10-20 minutes andincluded PROM of 6 joints (shoulder, elbow, wrist, hip,knee, and ankle)
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Both intervention groups showedstatistically significant improvement in: Joint angle:
Usual care group- lost movement; average of -5.85 in upperextremities and -3.88 in lower extremities
Intervention group- gained movement; average of +5.42 in upperextremities & +2.14 in lower extremities (group B) AND +12.8 in upperextremities & +7.92 in lower extremities
Activity function (functional independence ADL scale) Usual care group- showed lower ADL scores than before study
Invention group- showed higher ADL scores than before study
Perception of pain (pain scoring scale) Usual care group- showed increase of 5.41 in pain reporting
Intervention group- showed drop of 7.62 (group B) and 10.00 (group C)in pain reporting
Depressive symptoms (GDS score) Usual care group- were more depressed; showed 2.35 point increase
Intervention group- were less depressed; showed 4.76 decrease(group B) and 4.77 decrease (group C)
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Improve or maintain normal ROM of joints and surrounding soft tissue
Decrease risk of injury to joint or surround tissues Decrease in pain in those with joint mobility deficits
Prevent of limit the impact of contractures
Combat effects of prolonged immobilization (open areas, pressure sores,skin breakdown, etc)
Decrease risk of falls
Maintain bone strength If people do fall we decrease the risk of fracture
Promote and maintain levels of independence through movement
Keep people as able as they are for as long as they can be able
Maximize ADL function
Promote mental well being through independent movement
Feel more in control of their health and by extension the world aroundthem
Reduce depressive symptoms and anxiety
Enhance self esteem and body image
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