To the Patient:
Range of motion is the amount of free movement available at any particular joint. When joints are not moved, they become stiff and painful. Repetitive movement through the fullest possible range prevents these problems. You can make sure your joints move freely, even if your arm or hand is weak, by following the exercises in this booklet and repeating them as instructed by your physical therapist.
Principles of Range of Motion Exercises
Establish a daily routine for performing exercises. Your therapist or physician will advise you as to how many times per day you should exercise and how many repetitions per session. If you have no other guidelines, you should exercise 3 sessions per day; start with 5 repetitions of each movement (holding each position for a count of 5) and work up to 10 repetitions.
Move the joint as far as possible without forcing the joint beyond its range.
Always stretch gently. Stretches should be long and slow. DO NOT BOUNCE! You should feel a stretch but not pain.
Remember to breathe while exercising.
Relax between exercises.
For your protection, review these exercises with your therapist or physician prior to use. It is imperative that they are performed correctly and under professional supervision.
If you exercises produce pain or swelling later in the day, consult your therapist or physician immediately.
INSERT 29 PAGES OF EXERCISES FROM MASTER MANUAL HERE!
PROGRESSIVE RESISTIVE EXERCISE
1. DeLorme Technique
Originally called Heavy Resistive Exercise.
High repetition with maximum exertion to point of fatigue.
Use of 10 RM (repetition maximum). Determine the maximum weight the individual could lift 10 times. Revise weekly.
Oxford Technique
Reverse the usual 3 bout PRE system.
Diminish resistance as muscle fatigue develops.
Method: determine 10 RM (repetition maximum).
10 repetitions at 10 RM
10 repetitions at 3/4 10 RM
10 repetitions at ½ 10 RM
This sequence attempts to reduce the detrimental effects of fatigue.
Brief Maximal Exercise:
Determine 1RM: Maximum weight muscle can lift through complete range for 1 repetition.
Have person hold contraction at end of range for 6 seconds.
Progress with unit of standard increment daily until maximum reached or patient plateaus.
Brief Maximal Exercise
Contraction of muscle against a fixed resistance; hold 5-6 seconds; relax.
If performed repetitively, knows as Brief Repetitive Maximal Isometric Exercise (BRIME).
Load Assisting (also form of PRE):
An assistive form of exercise.
Method:
Determine the 10 RM (repetition Minimum): the amount of weight needed to counterbalance the weight of the extremity so that muscle contraction will move segment through the full range of motion.
10 repetitions 2 x 10 RM
10 repetitions 1 ½ x 10 RM
10 repetitions 10 RM
Determine the new 10 RM as resident improves by reducing the weight used for the 10 RM.
Gradually reduce the amount of weight needed for assistance and progress to active free then resistive exercises as tolerate.
PROGRAM: MANUAL MUSCLE TEST PROCEDURES
Fill in all blanks.
Fill in blanks describing muscle strength for each muscle group, using the key provided. The form allows for one evaluation and three reassessments.
Complete the evaluation and sign and date the document. If a different therapist administers the reassessment, he or she should date the column and sign initials.
For visual illustration of manual resistance, refer to Trombly and Scott.
Refer to physical therapy notes for lower extremity manual muscle test results.
DEPARTMENT OF OCCUPATIONAL THERAPY REPORT
MANUAL MUSCLE TEST FOR THE UPPER EXTREMITY
Name:_________________________________________ Diagnosis:_______________________________________
MUSCLE POWER
LEFT RIGHT
MUSCULAR ACTION
|
PRIME MOVERS
|
SPINAL CORD LEVEL
|
PERIPHERAL
NERVE
|
Date
|
|
|
|
|
|
|
|
SCAPULA
abduction & upward rotation
|
serratus
anterior
|
C5-7
|
long thoracic
|
|
|
|
|
|
|
|
|
adduction & downward rotation
|
middle trapezius
rhomboids
|
C2-5
C5
|
spinal accessory
dorsal scapular
|
|
|
|
|
|
|
|
|
elevation
|
levator scapulae
upper trapezius
|
C3,4
C2-4
|
dorsal scapular
spinal accessory
|
|
|
|
|
|
|
|
|
depression
|
lower trapezius
|
C2-4
|
spinal accessory
|
|
|
|
|
|
|
|
|
SHOULDER
flexion to 90
|
anterior deltoid
coracobrachialis
|
C5,6
C6.7
|
Axillary
musculocutaneous
|
|
|
|
|
|
|
|
|
exten sion/hyperextensi on
|
latissimus dorsi
teres major
posterior deltoid
|
C5,6
C5,6
C5,6
|
thoracodorsal
lower subscapular
axillary
|
|
|
|
|
|
|
|
|
abduction 90
|
middle deltoid
supraspinatus
|
C5,6
C5,6
|
axillary
suprascapular
|
|
|
|
|
|
|
|
|
adduction
|
pectoralis major
latissimus dorsi
|
C5-T1
C6-8
|
medial & lateral pectoral
thoracodorsal
|
|
|
|
|
|
|
|
|
horizontal abduction
|
posterior deltoid
|
C5,6
|
axillary
|
|
|
|
|
|
|
|
|
horizontal adduction
|
pectoralis major
anterior deltoid
teres major
|
C5-T1
C5,6
C5,6
|
medial & lateral pectoral
axillary
lower subscapular
|
|
|
|
|
|
|
|
|
internal rotation
|
subscapularis
pectoralis major
latissimus dorsi
teres major
|
C5,6
C5-T1
C6-8
C5,6
|
upper & lower subscapular
medial & lateral pectoral
thoracodorsal
lower subscapular
|
|
|
|
|
|
|
|
|
external rotation
|
infraspinatus
teres minor
|
C5,6
C5
|
suprascapular
axiliary
|
|
|
|
|
|
|
|
|
ELBOW
flexion with supination
|
biceps
brachialis
|
C5,6
C5,6
|
musculocutaneous
|
|
|
|
|
|
|
|
|
flexion with forearm in mid-position
|
brachioradialis
|
C5,6
|
radial
|
|
|
|
|
|
|
|
|
extension
|
triceps
|
C6-8
|
radial
|
|
|
|
|
|
|
|
|
Key: N (5) Complete ROM, gravity with full resistance.
G+ Complete ROM, gravity with full resistance but cannot maintain motion, i.e., “breaks’
G (4) Complete ROM, gravity with moderate resistance.
Complete ROM, gravity with minimal resistance.
F+ Slight resistance at end of ROM.
F (3) Complete ROM vs. gravity with no resistance.
More than ½ A/ROM against gravity with no resistance, but not a full A/ROM.
P+ Less than ½ A/ROM against gravity with no resistance.
P(2) Complete ROM with gravity eliminated.
Less than ½ A/ROM with gravity eliminated, but not full A/ROM.
T+ Evidence of slight A/ROM with gravity eliminated
T (1) Evidence of slight contractility, No joint return.
0 (0) No evidence of contractility
MUSCLE POWER
LEFT RIGHT
MUSCULAR ACTION
|
PRIME MOVERS
|
SPINAL CORD LEVEL
|
PERIPHERAL
NERVE
|
Date
|
|
|
|
|
|
|
|
FOREARM
supination
|
biceps
supinator
|
C5,6
C5-7
|
musculocutaneous
radial
|
|
|
|
|
|
|
|
|
pronation
|
pronator teres
pronator quadratus
|
C6,7
C7-T1
|
median
median
|
|
|
|
|
|
|
|
|
WRIST
flexion
|
flexor carpi radialis
flexor carpi ulnaris
|
C6
C8-T1
|
median
ulnar
|
|
|
|
|
|
|
|
|
extension
|
extensor carpi radialis
longus & brevis
extensor carpi ulnaris
|
C6,7
C7
|
radial
radial
|
|
|
|
|
|
|
|
|
FINGERS
flexion PIP
|
flexor digitorum
superficialis
|
C7-T1
|
median
|
|
|
|
|
|
|
|
|
flexion DIP
index & long
|
flexor digitorum
profundus
|
C8-T1
|
median
|
|
|
|
|
|
|
|
|
ring & small
|
flexor digitorum
profundus
|
C8, T1
|
ulnar
|
|
|
|
|
|
|
|
|
flexion MP & extension IP index & long
|
lumbricales
|
C7,8
|
median
|
|
|
|
|
|
|
|
|
ring & small
|
lumbricales
|
C8
|
ulnar
|
|
|
|
|
|
|
|
|
extension MP
|
extensor digitorum
communis
|
C6,7
|
radial
|
|
|
|
|
|
|
|
|
abduction index, long, ring
|
dorsal interossei
|
C8
|
ulnar
|
|
|
|
|
|
|
|
|
abduction
small
|
abductor digiti minimi
|
C8, T1
|
ulnar
|
|
|
|
|
|
|
|
|
adduction
|
palmar interossei
|
C8
|
ulnar
|
|
|
|
|
|
|
|
|
opposition small finger
|
opponens digital minimi, flexor digiti minimi
|
C8,T1
|
ulnar
|
|
|
|
|
|
|
|
|
THUMB flexion MP
|
flexor pollicis brevis
|
C6-8
|
median & ulnar
|
|
|
|
|
|
|
|
|
flexion IP
|
flexor pollicis longus
|
C8,T1
|
median
|
|
|
|
|
|
|
|
|
extension MP
|
extensor pollicis brevis
|
C7
|
radial
|
|
|
|
|
|
|
|
|
palmar abduction
|
abductor pollicis brevis
|
C6,7
|
median
|
|
|
|
|
|
|
|
|
radial abduction
|
abductor pollicis longus
|
C7
|
radial
|
|
|
|
|
|
|
|
|
adduction
|
adductor pollicis
|
C8
|
ulnar
|
|
|
|
|
|
|
|
|
opposition
|
opponens pollicis
|
C8,T1
|
median
|
|
|
|
|
|
|
|
|
_________________________________________________________________ ___________________________________________________ __
Therapist’s Signature Date
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