ROM, Test Positioning, and Gravity Elimination

When measuring a client of ROM with a goniometer, bony landmarks will be used to find the accurate goniometer placement before and after the client is measured. Once the landmarks are found and the goniometer is placed correctly, the occupational therapist can accurately measure the range of motion at that specific joint. Having the client in a proper position when measuring for ROM is important as well because depending on how much the muscles are stretched; you can get a different measure. For example, if a client is in a position where the muscles crossing on the joint being measured are stretched over multiple joints all at once, it can result in a smaller range of motion, so make sure you position the client in a way that you can get optimal range or motion at the joint being measured.

The purpose of the test position during the manual muscle test (MMT) is to provide consistency between the client and occupational therapist when the instructions are given, and the test is being administered. The therapist should have consistent instructions such as “don’t let me push you down” so the client will be able to complete it with little confusion. That consistent phrase will be dependent on the position of the client during MMT, that’s why the correct position to correlate with the phrase is so important. The client position during MMT can also be very important for the client’s safety. During MMT, the therapist needs to be stabilizing the proximal body segment and apply resistance on the distal end of the body segment that is moving, but this can depend on the client. For example, if a client is older or has osteoporosis the therapist should place their hand on the mid-shaft of the body segment, instead of the distal end to ensure that the bones will not be too weak and break against the force applied. The MMT can also be dangerous to the client if the therapist has the client in the wrong position and they are pushing down and causing the muscle to stretch beyond its limits, which can result in a muscle tear. Both the client’s position and the therapist’s position play critical roles to accurately and safely carry out manual muscle testing.

While trying to measure a client’s ROM, eliminating gravity will be relevant if the client is not physically able to perform that motion in a plane where gravity is present. In order to get into a gravity eliminated position the client will need to perform the desired motion on a flat surface, parallel with the floor.