LEARNING OUTCOMES
At the end of this lecture students will be able to:
- Demonstrate how to zero a range of motion measurement tool.
- Compare and explain the difference between an absolute zero start position versus a relative zero start position.
- Demonstrate the planes of movement for an inclinometer.
- Explain where to place the ROM measurement tool of consistency.
- Analyze ROM data and compare it to population norms.
- Explain the term impairment.
- Demonstrate how to perform full body ROM measurements.
- Give examples of how to adapt a ROM test based on the subject's ability.
- Give examples of when to stop a range of motion test.
- Describe how to perform a two point measurement of the lumbar spine.
- Document signs of discomfort.
- Report clinical observations.
How to zero inclinometer
Cervical
Flexion and Extension -
· Plane: Sagittal, Position: Seated, Neutral: Horizontal -0-, Landmarks: Sensor 1 - Calvaria, Sensor 2 - T1
Flexion: Use the horizontal ZERO method: Place inclinometer on flat surface and press ZERO. While individual is in the neutral position place the inclinometer on the top of the head. Ask the individual to FLEX forward completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Extension: With individual in neutral position, press HOLD. Then ask the individual to EXTEND backward completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Rotation Left and Right -
Plane: Rotation, Position: Supine, Neutral: Horizontal -0-, Landmarks: Place the inclinometer on the forehead
Rotation (left) : While individual is in the neutral supine position on a flat exam table, place the inclinometer on the occiput. Ask the individual to ROTATE his or her head to the LEFT completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score. Measuring cervical rotation requires stabilization of the trunk in the supine position with the shoulders on the table.
Rotation (right) : While individual is in the neutral supine position on a flat exam table, place the inclinometer on the occiput. Ask the individual to ROTATE his or her head to the RIGHT completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score. Measuring cervical rotation requires stabilization of the trunk in the supine position with the shoulders on the table.
Lateral Flexion -
Plane: Coronal, Position: Seated, Neutral: Horizontal -0-, Landmarks: Place the inclinometer on the Calvarium (skullcap)
Place the inclinometer on the top of the client's head and ask them to bend their head to the left. When the individual reaches their maximum range of motion press the HOLD button. Record the measurement before having the client return to neutral position and press the HOLD button to reset the inclinometer to reset. Repeat this process for the right side.
Thoracic
Thoracic Lateral Flexion -
Plane: Coronal, Position: Standing, Neutral: Horizontal -0-, Landmarks: Sensor 2 – S1, palpate the PSIS which are just caudal to the skin dimples. The PSIS are at the S2 level.
Lateral Flexion (Left): Place inclinometer on flat surface and press ZERO. While individual is in the neutral position place the main unit on the T12 spinous process. Ask the individual to FLEX to the LEFT completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Lateral Flexion (Right): Place inclinometer on flat surface and press ZERO. While individual is in the neutral position place the main unit on the T12 spinous process. Ask the individual to FLEX to the RIGHT completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Lumbar
Lumbar Flexion -
Plane: Saggital, Position: Standing, Neutral: Horizontal -0-, Landmarks: Sensor 1 – T12, palpate the lower scapular angle, which is at the T8 level, then count down 4 levels. Sensor 2 - S1, palpate the PSIS which are close to the skin dimples. The PSIS are at the S2 level.
T12 Flexion: While individual is in the neutral position place the inclinometer on the T12 spinous process. Press the ZERO button and then ask the individual to FLEX forward completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
S2 Flexion: While individual is in the neutral position place the inclinometer on the S2 spinous process. Press the ZERO button and then ask the individual to FLEX forward completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Lumbar Extension -
Plane: Saggital , Position: Standing, Neutral: Relative -0-, Landmarks: Sensor 1 – T12, palpate the lower scapular angle, which is at the T8 level, then count down 4 levels. Sensor 2 – palpate the posterior superior iliac spines (PSIS) which are just caudal to the skin dimples. The PSIS are at the S2 level.
T12 Extension: While individual is in the neutral position place the inclinometer on the T12 spinous process. Press the ZERO button and then ask the individual to EXTEND backward completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score
S2 Extension: While individual is in the neutral position place the inclinometer on the S2 spinous process. Press the ZERO button and then ask the individual to EXTEND backward completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Shoulder
Shoulder Flexion -
Plane: Sagittal, Position: Standing, Landmark: Set the goniometer to the vertical gravity -0- position aligned with the long axis of the forearm.
While individual is in the neutral position, place the inclinometer on the LEFT humorous. Ask the individual to FLEX their LEFT SHOULDER completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Shoulder Extension -
Plane: Sagittal, Position: Standing, Landmark: Set the goniometer to the vertical gravity -0- position aligned with the long axis of the upper arm.
While individual is in the neutral position, place the main unit on the LEFT humorous. Ask the individual to EXTEND their LEFT SHOULDER completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Shoulder Adduction -
Plane: Rotation, Position: Standing, Landmark: Set the goniometer to the vertical -0- position. Position the forearm midway between supination and pronation (thumb up, palm facing the midline of the body), and elbow flexed at 90 °.
While individual is in the neutral position, place the main unit on the LEFT humerous. Ask the individual to ADDUCT their LEFT SHOULDER completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Shoulder Abduction -
Plane: Frontal, Position: Standing, Landmark: Set the goniometer to the vertical position aligned with the long axis of the arm.
While individual is in the neutral position, place the inclinometer on the LEFT humerous. Ask the individual to ABDUCT their LEFT SHOULDER completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Shoulder Rotation
External Rotation -
Plane: Rotation, Position: Standing, Landmarks: Set the goniometer to the horizontal position aligned with the long axis of the arm.
Use the horizontal ZERO method: Place inclinometer on a flat surface and press ZERO. While individual is in the neutral position, place the inclinometer on the LEFT forearm. Ask the individual to EXTERNALLY ROTATE their LEFT SHOULDER completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Internal Rotation -
Plane - Rotation, Position: Standing, Landmarks: Set the goniometer to the horizontal position aligned with the long axis of the arm.
While individual is in the neutral position place, the main unit on the LEFT forearm. Ask the individual to INTERNALLY ROTATE their LEFT SHOULDER completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Elbow
Elbow Flexion -
Plane: Sagittal, Position: Standing, Landmark: Set the goniometer to the vertical gravity -0- position aligned with the long axis of the forearm
While individual is in the neutral position, place the inclinometer on the LEFT forearm. Ask the individual to FLEX their LEFT ELBOW completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Elbow Extension -
Plane: Sagittal, Position: Standing, Landmark: Set the goniometer to the vertical gravity -0- position aligned with the long axis of the forearm
While individual is in the neutral position, place the main unit on the LEFT forearm. Ask the individual to EXTEND their LEFT ELBOW completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Supination -
Plane: Rotation, Position: Standing, Landmark: Set the goniometer to the vertical -0- position. Position the forearm midway between supination and pronation (thumb up, palm facing the midline of the body), and elbow flexed at 90 °.
While individual is in the neutral position, have them hold the extender. Ask the individual to SUPINATE their LEFT ARM completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Pronation -
Plane: Rotation, Position: Standing, Landmark: Set the goniometer to the vertical -0- position. Position the forearm midway between supination and pronation (thumb up, palm facing the midline of the body), and elbow flexed at 90 °.
While individual is in the neutral position, have them hold the extender. Ask the individual to SUPINATE their LEFT ARM completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Wrist
Wrist Flexion -
Plane: Horizontal, Position: Seated, Landmarks: Set the goniometer on the carpal bones - about an inch beyond the wrist - with the hand facing palm down.
Use the horizontal ZERO method: Place inclinometer on a flat surface and press ZERO. While individual is in the neutral position, place the inclinometer on the LEFT hand. Ask the individual to FLEX their LEFT WRIST completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Wrist Extension -
Plane: Horizontal, Position: Seated, Landmarks: Set the goniometer on the carpal bones - about an inch beyond the wrist - with the hand facing palm down.
While individual is in the neutral position, place the main unit on the LEFT hand. Ask the individual to EXTEND their LEFT WRIST completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Radial deviation -
Plane: Horizontal, Position: Seated, Landmarks: Place the goniometer on the proximal phalange of the index finger with the thumb pointed up.
While individual is in the neutral position, place the inclinometer along the middle of the LEFT HAND. Ask the individual to ULNAR DEVIATE their LEFT WRIST completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Ulnar deviation -
Plane: Horizontal, Position: Seated, Landmarks: Place the goniometer on the proximal phalange of the index finger with the thumb pointed up.
Use the horizontal ZERO method: Place inclinometer against on a flat surface and press ZERO. While individual is in the neutral position, have them hold the extender. Ask the individual to SUPINATE their LEFT ARM completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score
Hip
Hip Flexion -
While individual is in the neutral position, place the inclinometer on the LEFT thigh. Ask the individual to FLEX their LEFT HIP completely. When the individual has reached the maximum range of motion, press the HOLD button.
Extension: While individual is in the neutral position, place the main unit on the LEFT thigh. Ask the individual to EXTEND their LEFT HIP completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Abduction: While individual is in the neutral position, place the inclinometer on the LEFT thigh. Ask the individual to ABDUCT their LEFT HIP completely. When the individual has reached the maximum range of motion, press the HOLD button.
Adduction: While individual is in the neutral position, place the main unit on the LEFT thigh. Ask the individual to ADDUCT their LEFT HIP completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
External Rotation: Use the vertical ZERO method: Place inclinometer on against a flat surface and press ZERO. While individual is in the neutral position, place the inclinometer on the LEFT leg Ask the individual to EXTERNALLY ROTATE their LEFT HIP completely. When the individual has reached the maximum range of motion, press the HOLD button
Internal Rotation: While individual is in the neutral position, place the inclinometer on the LEFT leg. Ask the individual to INTERNALLY ROTATE their LEFT HIP completely. When the individual has reached the maximum range of motion, press the HOLD button
Knee
Flexion: While individual is in the neutral position, place the inclinometer on the posterior leg. Ask the individual to flex their knee completely. When the individual has reached the maximum range of motion, press the HOLD button.
Extension: Ask the patient/client to extend the knee as far as possible. If the patient/client cannot fully extend the knee, measure the number of degrees away from the horizontal zero position. Return to starting position. Complete a total of three trials.
Ankle
Client: (prone lying on plinth)
Dorsiflexion: While individual is in the neutral position, place the inclinometer on the LEFT foot Ask the individual to FLEX their LEFT ANKLE completely. When the individual has reached the maximum range of motion, press the HOLD button.
Plantar Flexion: While individual is in the neutral position, place the main unit on the LEFT foot. Ask the individual to EXTEND their LEFT ANKLE completely. When the individual has reached the maximum range of motion, press the HOLD button. RECORD the score.
Eversion: Ask the patient/client to evert the ankle maximally (put the heel into a valgus position by moving it away from the midline of the body). Return to starting position. Complete a total of three trials.
Inversion: Ask the patient/client to invert the ankle maximally (put the heel into a varus position by moving it towards the midline of the body).R eturn to starting position. Complete a total of three trials.