Transcript Goniometry
The term goniometer ir derived from greek words Gonia meaning angle and metron meaning measure. Goniometer refers to the measurement of angles created at human joints by the bones of the body. Goniometer is used to measure and document the amount of active and passive joint motion as well as abnormal fixed joint positions. The technique of quantifying human joint position or range of motion 1. 2. 3. 4. 5. 6. 7. 8. Determining the presence or absence of impairement Establishing a diagnosis Developing a prognosis ,treatment goals and plan of care. Evaluating progress or lack of progress toward rehabilitative goals Modifying treatment Motivating the subject Research the effectiveness of therapeutic techniques or regimens Fabricating orthoses and adaptive equipement. Arthrokinematics -is the term used to refer to the movement of joint surfaces. These movements are described as slides(glides),spins, and rolls. Slide : is a translatory motion with sliding of one surface over the other.(skidding of braked wheels) Spin: is a rotary motion where all points on the moving joint surface rotate around a fixed axis of motion.( spinning of toy top) Roll: is a rotary motion similar to the rolling of bottom of rocking chair on the floor. The direction of the rolling and sliding components of a roll-slide will vary depending on the shape of the moving joint surface. If a convex joint surface is moving, the convex surface will roll in the same direction as the angular motion of the shaft of the bone but will slide in the opposite direction. If a concave joint surface is moving ,the concave surface will roll and slide in the same direction as the angular motion of the shaft of the bone. Refers to the gross movement of the shafts of bones rather than the movement of joint surfaces. The movement of the shafts of the bones are usually described in terms of rotary or angular motion produced as if the movement occurs around a fixed axis of motion. Goniometry measures the angles created by the rotary motion of the shafts of the bones. Osteokinematic motions take place in one of the three cardinal planes of the body and three corresponding axes. Planes/Axis - Sagittal plane/ medial-lateral axis - Frontal plane / anterior-posterior axis - Transverse plane / vertical axis Movements at these planes and axes Sagittal plane/M-L axis: Flexion Extension Frontal plane/A-P axis: Abduction Adduction Transverse plane/vert axis: Rotations Rom is the arc of motion that occurs at a joint or a series of joints. The starting position for measuring all ROM is the anatomical position except for rotations which is done in the transverse plane. Three notation systems have been used to define ROM. - 0-180° system - 180-0° system - 360° system 1. 0 to 180 degree system - The upper extremity and lower extremity joints are at 0 degrees for flexion-extension and abductionadduction when the body is in anatomical position. - This system is also called as the neutral zero method - Used widely throughout 2.180 to 0 degrees system - Defines anatomical system as 180 degrees. - Rom begins at 180 degrees and preceeds in an arc towards 0 degrees. 3. 360 degrees system - Also defines anatomical position as 180 degrees. - The motions of flexion and abduction begin at 180 degrees and proceed in an arc toward 0 degrees. - The motions of extension and adduction begin at 180 degrees and proceed in an arc towards 360 degrees. - This system is more difficult to intepret - Not used frequently It is the arc of motion attained by the subject during unassisted voluntary joint motion. Active ROM provides information about the subjects willingness to move, coordination,muscle strength, and joint ROM Is a good screening technique to help focus a physical examination Passive ROM - Is the arc of motion attained by an examiner without the assistance from the subject. - The subject remains relaxed and plays no active role in producing the motion - Normally rom is greater than active rom - Additional rom is due to stretch of tissues surrounding the joint and the reduced bulk of contracting muscles. - Testing this rom provides examiner with information about the integrity of the joint surfaces and the extensibility of the joint capsule and other structures. - Passive ROM rather than active ROM should be tested in goniometry The feeling experienced or felt by the examiner as a barrier to further motion at the end of passive ROM is called End-feel. Normal end-feels 1. Soft : due to soft tissue approximation. Eg: knee flexion 2. Firm: muscular stretch,capsular stretch,ligamentous stretch.eg: hip flexion with knee straight, extension of MCP jt,Forearm supination. 3. Hard: bone contacting bone. Eg: elbow extension 1. 2. 3. 4. Boggy : soft tissue edema,synovitis Firm: occurs in a joint that normally has a soft /hard end-feel. Due to increased muscular tone,capsular/lig/muscular/facial shortening. Hard: occurs in ajoint that normally has a soft or firm end-feel. Bony block/grating is felt. Due to OA, MO,fracture, Chondromalacia, loose bodies in joint. Empty: no real end-feel because pain prevents movement. Due to acute jt inflammation, bursitis, abscess, fracture, psychogenic disorder. Refers to a decrease in passive ROM that is substantially less than normal values for that joint,given subjects age and gender. May occur due to abnormalities of joint surfaces, passive shortening of joint capsules, ligaments, muscles, fascia, and skin Conditions where hypomobility is seen are OA,RA,spinal disorders, stroke,head injury,CP,diabetes etc. Pathological conditions involving the entire joint capsule cause a particular pattern of restriction involving all or most of the passive motions of the joint.this pattern of restriction is called a capsular pattern. Noncapsular patterns of restriction - A limitation of passive motion that is not proportioned similarly to a capsular pattern is called a noncapsular pattern of restriction. - Usually caused by a condition involving structures other than joint capsule - Due to internal joint derangement,adhesion ,lig shortening, muscle strain,muscle contractures. Refers to an increase in passive RPOM that exceeds normal values for that joint,given the subjects age and gender. Hypermobility is due to the laxity of soft tissue structures such as ligs, capsules, and muscles that normally prevent excessive motion at a joint. Age Gender: females more than males Active/passive ROM BMI Occupational activities Recreational activities Testing position Universal Goniometer plastic or metal protractor like device with moveable and stationary arms of varying lengths Gravity Dependent Goniometers – Inclinometers -Pendulum – Fluid (bubble) • report position of distal or proximal segment relative to the line of gravity requiring the adjacent segments to be positioned vertically or Horizontally Electrogoniometers – potentiometer detects changes in position of two segments Positioning - Is an important part of goniometry because it is used to place the joints in a zero starting position and helps to stabilise the proximal joint segment. - Affects the tension in soft tissue structures surrounding the joint. - Testing positions refer to the positions of the body that we recommend for obtaining goniometric measurements. - The testing positions are designed to do the following - A. place the joint in a starting position of 0 degrees - B. permit a complete ROM - Provide stabilization for the proximal joint segment - Testing positions involve position like supine,prone,sitting and standing. Expose landmarks Position Axis or “fulcrum” – Convex pivot point – Axis may move with motion – prioritize arm alignment over axis alignment Align Proximal Arm – stationary arm parallel to the long axis of the segment Align Distal Arm – moving arm parallel to the long axis of the segment Failure to read at eye level causing parallax distortion • Incorrect landmark identification • Failure to read proper scale • Lack of patient cooperation Measurement is consistent, repeatable and reproducible Goniometric reliability is maximized by standardized: 1) measuring device 2) positioning and landmarks 3) procedure 4) examiner