Demonstration of Functional Approach in ROM Rehabilitation


Demonstration of Functional Approach in ROM Rehabilitation


This chapter explores the use of functional range of movement (ROM) rehabilitation within a clinical setting. The demonstration will focus on the ROM rehabilitation of the upper limb (shoulder and elbow) and trunk. The management approach described for these areas can be applied elsewhere in the body. The book is accompanied by a video demonstration of the ROM challengers, which can be viewed online at: www.therapeuticstretch.com.





13.1 Demonstration of principles







13.1.5 Mixing ranges and planes


Normal functional movement is highly variable and often involves multiple planes. Generalization of training may occur more readily when end-ranges are mixed with the whole-range challenges, as well as performing the same task in different planes (this is better demonstrated in the accompanying video).


Patients who are unable to perform a movement in a particular range can be still challenged in that range (primary challenge) but with movements in another plane (secondary challenge). This principle of primary and secondary challenges is demonstrated in this section.



Fig. 13.9A–C: Imagine a clinical situation in which the patient is unable to elevate the arm in abduction above shoulder height. In this situation they are instructed to raise the arm to their end-range (primary challenge). While in that range they can be instructed to perform a movement challenge (secondary challenge). In this example, internal–external rotation (secondary challenge) is imposed on the abducted shoulder (primary challenge).



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Fig. 13.10A–C: In this example, the primary challenge is external rotation with superimposed secondary abduction–adduction challenges.



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Fig. 13.11A–D: In this example, the primary challenge is internal rotation. The patient is instructed to imagine that they are “washing their back”. This task produces secondary abduction–adduction cycles (superimposed on internal rotation).



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Fig. 3.12A,B: Primary and secondary challenges exemplified in the elbow. Imagine a patient who has a flexion contracture in the elbow. They are encouraged to extend to their end-range (primary challenge). They are then instructed to perform a task such as “closing and opening a lid”, imposing a secondary pronation–supination challenge on the elbow.



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Mar 20, 2017 | Posted by in MANUAL THERAPIST | Comments Off on Demonstration of Functional Approach in ROM Rehabilitation
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