Antoine was admitted into acute care 3 days ago with a right middle cerebral artery stroke. During the first 48 hours after admission, his left arm and left leg exhibited decreased muscle tone, but since then Antoine's muscle tone in the left arm and left leg has increased. The overall rehabilitation prognosis for Antoine is good. What needs to be included in Antoine's intervention to maintain or improve the motions of all extremities? Under what circumstances would these interventions change from being considered “skilled” to “non skilled"? What progression of mobility would be appropriate?
The complex ability to move the body purposefully through space begins with the capacity for movement. Because the frame of the body is a skeleton made up of many bony segments, movement becomes possible anywhere two bones come together to form a nonfibrous joint. Range of motion (ROM) is the amount of movement available between any two of these bony levers and is commonly used as a measure of flexibility. Range of motion is also the name given to the patient-care technique of moving a joint through its available motion (see Box 9-1).
Box 9-1 ROM vs. Stretching
The technique of range of motion is different from that of stretching. Stretching is a specific technique designed to increase the available range of a joint's or muscle's movement, whereas ROM serves to monitor and maintain the capacity for motion that already exists.
Although ROM occurs between two bones, joint movement involves much more than just the bones or even the muscles. The cartilage of the joint capsule, where and how the muscles and ligaments attach, the shape of the articulating bony surfaces, and the soft tissue surrounding the joint help determine the direction and extent of joint movement. Any changes to the joint structure, therefore, may affect the amount of available ROM, creating range-of-motion impairments that limit a patient's functional activities. Trauma, systemic diseases, joint diseases, neurological impairments, musculoskeletal impairments, immobilization, and disuse are some of the possible causes of changes in joint ROM.
When a patient is at risk for such limitation, range-of-motion techniques are performed as part of an overall program addressing a patient's functional goals. Because of the inherent complexity of joint motion, ROM is a valuable assessment tool. The quantity and quality of a person's ROM can provide diagnostic and prognostic data and can serve as a marker for patient improvement or decline.
The Nature of Joint Motion
Osteokinematics and Arthrokinematics: A Review
Osteokinematics is the movement of one bone in relation to another, that is, a long bone moving around a joint axis, as occurs when the forearm is moved in elbow flexion. However, for that osteokinematic motion to occur normally, the bony surfaces involved in the joint have to move upon each other in specific coordinated patterns. ...