Self-Assisted Range of Motion Techniques for Rehabilitation

 

Self-Assisted ROM

As soon as a patient is able to comprehend and learn how to take care of themselves, they should start participating in self-care. The patient can learn how to move the affected area and be taught the value of moving within safe bounds even if they are paralyzed or feeble. When more intense muscular contraction is not recommended following surgery or a traumatic injury, self-assisted range of motion, or S-AROM, is utilized to protect the healing tissues. The objectives of PROM or A-AROM can thus be met with a range of devices in addition to using a normal extremity. S-AROM integration then becomes a component of the at-home workout regimen.

Manual Assistance

Patients who experience unilateral weakness or paralysis, or who are recovering from trauma or surgery, can be trained to manipulate the implicated extremity through its range of motion using the unaffected extremity. You can perform these exercises sitting, standing, or in a supine position. Since the location of the patient affects the effects of gravity, help is needed for the prime mover while raising a part against gravity since gravity acts as a resistive force. Gravity is the force behind the extremity's downward motion, which the antagonists must help control eccentrically.

Arm and Forearm

Give the patient instructions to extend their unaffected (or supporting) extremity across their body to hold the afflicted extremity around the wrist, supporting their hand and wrist.

Shoulder flexion and extension

The affected extremity is raised above the head and then lowered to the side by the patient.

Shoulder horizontal abduction and adduction

The patient drags the extremity across the chest and back to the side, starting with the arm 90° abducted.

Shoulder rotation

The patient rotates the forearm "like a spoke on a wheel" with the uninvolved extremity, starting with the arm at the patient's side in minor abduction and the elbow resting on a small pillow to elevate it or abducted 90° and elbow flexed 90°. The focus should be on rotating the humerus rather than just flexing and extending the elbow.

Elbow flexion and extension

The hand is moved down toward the side of the leg by the patient after bending the elbow until it is close to the shoulder.

Pronation and supination of the forearm

The patient rotates the radius around the ulna starting with the forearm resting across the body. Remind the patient not to turn their hand around at the wrist.

Wrist and Hand

The patient places the thumb in the hand's palm and the unaffected fingers on the hand's dorsum.

Ulnar and radial deviation, as well as wrist flexion and extension

The patient does not apply pressure to the fingers while they move their wrist in all directions.

Finger flexion and extension

The patient flexes the affected fingers by cupping the normal fingers over their dorsum and extends the involved fingers with the uninvolved thumb.

Thumb flexion with opposition and extension with reposition

The patient inserts the uninvolved thumb along the palmar surface of the involved thumb to expand it, and cups the uninvolved fingers along the radial border of the narrower eminence of the affected thumb. The patient cups the normal hand around the dorsal surface of the affected hand, presses the first metacarpal toward the little finger, and flexes and opposes the thumb.

Hip and Knee

Hip and knee flexion

While the patient is in a supine position, direct them to elevate the affected knee by putting their usual foot below it or by placing a strap or belt underneath it. After that, the patient can finish the range of motion by bringing the knee up toward the chest with one or both hands gripping it. The patient can flex their knee to the limit of its range while sitting and raise their thigh with their hands.

Hip abduction and adduction

Due to the weight of the leg and the friction of the bed surface, it is challenging for a weak patient to assist the lower extremities into abduction and adduction when supine. However, for bed mobility, the person must be able to move a weak lower extremity from side to side. As an exercise, have the patient slide the normal foot from the knee to the ankle and then move the affected extremity side to side to perform this functional action. S-AROM can be done while seated by supporting the movement of the thigh inward and outward with the hands.

Combined hip abduction with external rotation

With the foot lying on the surface, the patient's hips and knees flexed, their back supported, they sit on the floor or a bed. With help from the upper extremities, the knee is pushed inside and outward (toward the table or bed).

Ankle and Toes

The distal leg rests on the normal knee as the patient sits with the involved extremity crossed over the uninvolved one. The involved ankle can move into dorsiflexion, plantarflexion, inversion, eversion, and toe flexion and extension with the uninvolved hand.

Wand (T-Bar) Exercises

A wand (dowel rod, cane, wooden stick, T-bar, or similar instrument) can be used to aid a patient who can control their voluntary muscles in an affected upper extremity but needs direction or encouragement to finish range of motion in the shoulder or elbow. The degree of function of the patient determines the best position. If utmost protection is required, the majority of the techniques can be executed while supine. Standing or sitting demands more self-control. The influence of gravity on the weak muscles influences the choice of position as well. To make sure the patient doesn't employ alternate motions, first lead him or her through each activity's correct motion. The normal extremity directs and regulates the movements while the patient holds the wand with both hands.

Shoulder flexion and return

Holding the wand, place your hands shoulder-width apart. Elbows extended if at all possible, the wand is raised forward and upward through the range of motion. Allowing alternative motions, including scapular elevation or trunk movement, is not appropriate for smooth scapulohumeral movement.

Shoulder horizontal abduction and adduction

To achieve 90° shoulder flexion, raise the wand. The patient pushes and pulls the wand back and forth over the chest within the permitted range while maintaining extended elbows. Don't permit the trunk to rotate.

Shoulder internal and external rotation

The patient's elbows are 90 degrees bent, and their arms are at their sides. By sliding the wand side to side across the trunk and keeping the elbows at the side, one can rotate their arms. Rotation of the humerus should occur; elbow flexion and extension should not be permitted. A small towel roll may be inserted into the axilla with instructions to "keep the roll in place" in order to avoid substitution motions and apply a modest distraction force to the glenohumeral joint.

Shoulder internal and external rotation-alternate position

The patient has a 90° flexion of the elbows and an abduction of the shoulders. The wand is moved in the direction of the patient's head for external rotation and toward the waist for internal rotation.

Elbow flexion and extension

The patient's hands hold the wand shoulder-width apart; their forearms may be supinated or pronated. Give the patient instructions to flex and extend their elbows.

Shoulder hyperextension

 The patient might be on their side or upright. The individual positions the wand behind the buttocks, spreads their hands shoulder-width apart to hold it, and then raises it backward, away from the trunk. Trunk motion should be avoided by the patient.

Variations and combinations of movements

For example, to accomplish scapular winging, shoulder internal rotation, and elbow flexion, the patient starts with the wand behind the buttocks and moves it up the back.

Wall Climbing

By using a tool like a finger ladder or wall climbing, the patient can receive objective reinforcement, which will increase their motivation to undertake shoulder range of motion exercises. Another option for giving visual feedback for the height achieved is to employ wall markers. It is possible to shift the arm into flexion or abduction. With the arm raised, the patient takes a step toward the wall.

Precaution:

The patient needs to be instructed in the correct motions and is not permitted to use shoulder shrugging, toe rising, or trunk side riding as substitutes.

Overhead Pulleys

Pulley systems can help an engaged extremity perform range of motion if they are taught properly. This sort of assistance should be employed only when desirable muscle activity is achieved, as the pulley has been shown to utilize much more muscular activity than continuous passive motion devices and therapist-assisted ROM. A door must be closed to secure a strap that has a single pulley fastened to it for use at home. A pulley can also be fastened to the ceiling or an overhead bar. The patient ought to be positioned such that the pulley is directly above the moving joint or such that the line of pull really moves the extremity rather than merely compressing the joint surfaces together. The patient might be laying down, sitting, or standing.

Shoulder ROM

Give each patient a handle to hold, and then instruct them to pull the rope with their usual hand to lift the affected extremity forward (flexion), out to the side (abduction), or into the scapula's plane (30 forward of the frontal plane) for relief. To ensure smooth movements, the patient should not lean their trunk or shrug their shoulders (scapular elevation). Instead, they should be guided and instructed.

PRECAUTIONS:

Patients have a tendency to abuse shoulder assistive pulley exercises, which can compress the humerus against the acromion process. Persistent compression causes discomfort and reduced functionality. This issue can be avoided with careful patient selection and suitable instruction. These exercises should not be done if the patient is unable to learn how to use the pulley with appropriate shoulder mechanics. If there is increasing pain or decreased mobility, stop doing this exercise.

Elbow Flexion

The patient raises their forearm and bends their elbow while keeping their arm stabilized along the side of their trunk.

Skate Board/Powder Board

Using a friction-free surface can promote motion without the hindrance of friction or gravity. A skate with rollers can be utilized if one is available. Other techniques include applying polish to the surface or supporting the extremities with a towel so it may glide over the board's smooth surface. Although any movement can be performed, the most popular ones are the horizontal abduction/adduction of the shoulder while seated and the abduction/adduction of the hip while supine.

Reciprocal Exercise Unit

A number of equipment can be configured to supply an affected extremity some flexion and extension utilizing the strength of the normal extremity. Examples of these devices include a bicycle, an upper or lower body ergometer, and a reciprocal exercise unit. There are movable devices that can be fastened to a wheelchair, regular chair, or a patient's bed. It is possible to modify both the range of motion and the extremities' excursion. By adjusting the exercise's parameters and tracking heart rate and tiredness, a reciprocal exercise unit can be utilized for strengthening, endurance training, and reciprocal patterning, among other workout benefits.

Continuous passive motion:

The term continuous passive motion (CPM) describes passive motion that is carried out by a mechanical apparatus that gradually and continuously moves a joint within a predetermined range of motion. Robert Salter's study showed that continuous passive motion has positive healing benefits on diseased or injured joint structures and soft tissues in animal and clinical tests, leading to the development of mechanical devices for almost every joint in the body. Numerous studies have been conducted since the inception of CPM to ascertain the parameters of applicability; however, due to the fact that the devices are utilized for a variety of conditions and the studies have employed a range of procedures and research methodologies, a clear boundary has not been established.