Keeping moving to promote greater health

Presented by: Rachel Davie Kinesiologist pt Healthcare Solutions

The amount of movement a person has at each joint

Every joint has a normal range of motion

The type of movement or activity that aims to preserve flexibility & mobility of the joints on which it is performed

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 assistance with movement here, AAROM of hip and only need partial assistance with movement, AROM of their neck.

Chronological age alone may affect ROM less than several age-related conditions

Stroke Osteoporosis Parkinsons disease Fracture Muscle overuse injuries (sprains & strains)

Muscle disuse injuries (bed bound clients)

Dementia Arthritis Contractures And many more.

Lack of use can be caused by pain, stiffness, fatigue, and fear of harming oneself This often leads people to avoid exercise or movement of these joints

Ironically this makes the problem worse!

Joints are filled with synovial fluid. Fluid acts to lubricate the joint. Additionally this fluid contains essential nutrients and oxygen which it brings to tissues of the joint (such as cartilage). Synovial fluid also contains natural pain relieving analgesic components. Fluid is spread throughout the joint whenever the joint is moved.

Less fluid is produced Fluid becomes less viscose/thinner Joint surfaces become more worn or jagged

If the joint is not regularly moved this fluid is unable to spread to all areas and surfaces of the joint where it is needed. This translates to:
Little or no joint lubrication Collection or pooling of joint fluid in one specific area of joint i.e. swelling Drying out of joint surfaces

Stiffening and subsequent structural change in joint Increased pain on movement of 1 or more joints 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

Additional emotional stress

Sedentary or immobile clients show loss of ROM

Creates further decline in functional abilities

Generates emotional stress re:loss Client withdraws from activities or becomes less active

May make IADLs or ADLs more difficult or impossible

Trouble dressing Trouble bathing Trouble grooming Trouble feeding oneself independently Trouble accessing or participating in social situations or activities

Changes in joint mechanics or joint function related to stiffness or presence of pain can lead to changes in gait or transfer patterns Improper mechanics can increase risk for damage to other body tissues (ligaments, tendons, muscles)

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

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 retirement or long term care facilities prematurely

Increased need for staff assistance with ADLs Greater difficulty carrying out assistance with ADLs
those who use to be independent may become dependent with respect to care

Difficulty engaging client in activities

may be due to physical or behavioral causes those already receiving assistance may require more assistance feel they cant participate sadness about loss of function Aggression or lashing out due to loss (real or perceived) of independence or control

Promote active movement as much as possible to maintain or improve independent range of motion
Incorporate ROM exercises into daily programming

Assist residents with range of motion movements or exercises (AAROM) Put joints passively through range of motion gently in those clients who cannot independently do so (PROM)

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Tell client what you are going to do and why Place resident in a comfortable position which allows full movement of joint All movement should be done slowly and smoothly Do not move beyond the comfortable end range for that particular joint

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If movement requires assistance (either partial or full) use one hand as the working hand & the other as the stabilizing hand

ROM is about movement not stretching

Provide only as much assistance as necessary to promote and encourage independence Encourage feedback from client
How is this feeling?, Are you in any pain?

Encourage an increase to overall range (when safe to do so) as repetitions progress

Do you think you can go a little further?

Encourage participation Reward with praise

Effects of a range-of-motion exercise programme

Tseng CN, Chen CCH, Wu SC, & Lin LC. Journal of Advanced Nursing 57(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 group supervised by an RN Group C: 4 week, twice per day, 6-days a week ROM exercise group where an RN physically assisted participants to achieve maximum ROM

Each intervention session lasted 10-20 minutes and included PROM of 6 joints (shoulder, elbow, wrist, hip, knee, and ankle)

Both intervention groups showed statistically significant improvement in:

Joint angle:
Usual care group- lost movement; average of -5.85 in upper extremities and -3.88 in lower extremities Intervention group- gained movement; average of +5.42 in upper extremities & +2.14 in lower extremities (group B) AND +12.8 in upper extremities & +7.92 in lower extremities Usual care group- showed lower ADL scores than before study Invention group- showed higher ADL scores than before study 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 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)

Activity function (functional independence ADL scale)

Perception of pain (pain scoring scale)

Depressive symptoms (GDS score)

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 around them Reduce depressive symptoms and anxiety Enhance self esteem and body image