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Range of Motion
Irman Somantri, S.Kp. M.Kep.

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definisi
The maximum movement that is possible for that joint Is the extent of movement that a joint is normally capable of Joint range of motion varies from individual Determined by genetic makeup, developmental pattern, the presence or absence of disease and the amount of physical activity in which person normally engages

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Gerakan Sendi
ROM

Mundur Bedrest

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Types of Joint Movement

Flexion X Extension X Hyperextension Abduction X Adduction Rotation X Circumduction Eversion X Inversion Pronation X Supination

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Fleksi : menurunkan sudut antara dua tulang Ekstensi : meningkatkan sudut antara dua tulang Hyperekstensi : Ekstensi lebih lanjut antara dua tulang atau peregangan keluar dari sendi Abduksi : pergerakan tulang menjauhi dari garis tengah tubuh Adduksi : Pergerakan tulang mendekati garis tengah tubuh Rotasi : Pergerakan dari tulang memutar dari porosnya (Gerakan kepala melihat bahu)
Rotasi Internal : gerakan ke arah garis tengah tubuh Rotasi Eksternal : gerakan menjaui garis tengah tubuh.

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Sirkumduksi : gerakan dari bagian distal tulang mengelilingi ujung proksimal Eversi : gerakan telapak kaki keluar dengan menggerakan sendi mata kaki infersi : gerakan dari telapak kaki kedalam dengan menggerakan sendi mata kaki Pronasi : gerakan telapak tangan sehingga telapak tangan bergerak dari anterior menjadi posterior dalam posisi anatomik atau perputaran telapak tangan menghadap ke bawah. Supinasi : kebalikan dari pronasi

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Extension

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Flexion

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PEMERIKSAAN FISIK : ROM sendi

Alat : goniometer

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Assessing Joint Mobility

Size, shape, color & symmetry of opposite joints. Note masses, deformities or muscle atrophy.

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Assessing Joint Mobility

The ROM is appropriate to each joint and equal to its opposite joint.

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Temporomandibular Joint
Buka mulut lebar-lebar dan kemudian tutup, pada saat memuka dan menutup palpasi temporomandibular joint dengan telunjuk dan jari tengah

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ROM : Cervical Spine

450 Fleksi : sentuhkan dagu ke dada 550 Ekstensi - hyperekstensi : lihat ke arah langit-langit 400 Fleksi Lateral : Sentuhkan telinga ke masing-masing bahu 700 Rotasi : Sentuhkan dagu ke masing-masing bahu

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ROM : Lumbar Spine

750 - 900 Fleksi : Sentuh kaki dengan jari-jari tangan 300 Ekstensi - hyperekstensi : Rentangkan ke arah belakang dengan lambat 300 Fleksi lateral : Rentangkan ke arah kiri dan kanan 300 Rotasi : Putar bahu ke arah kanan dan kiri

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ROM : Bahu
1800 Fleksi : lengan lurus dengan badan gerakan ke atas 500 Hyperekstensi : lengan lurus digerakkan ke arah belakang 900 Rotasi internal eksternal 1800 Abduksi : Gerakkan tangan kondisi lurus ke atas ke arah luar 500 Adduksi : Gerakkan tangan kondisi lurus ke badan

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ROM : Siku
1600 Fleksi : sentuhkan tangan ke bahu 1800 Ekstensi : luruskan siku 900 Pronasi 900 Suppinasi

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ROM : Tangan
900 Fleksi : Bengkokan tangan ke arah bawah 700 Ekstensi : Bengkokan tangan ke arah atas 550 Ulnar deviasi : Bengkokan tangan ke arah luar (kelingking) 200 Radial deviasi : Bengkokan tangan ke arah dalam (ibu jari)

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ROM : Panggul
Saat Klien berbaring 1200 Fleksi : tekuk lutut gerakkan ke arah dada 450 Abduksi : pertahankan kaki lurus, gerakkan menjauhi badan 400 Rotasi internal 450 Rotasi eksternal 300 Hyperekstensi : Tengkurap, kaki diangkat

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ROM : Lutut
1300 Fleksi : Bengkokan lutut 1800 Ekstensi : Luruskan lutut

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ROM : Ankles
200 Dorso Fleksi : Gerakan kaki ke atas 450 Plantar Fleksi : Gerakkan kaki menuju lantai 300 Inversi : Berjalan dengan sisi luar kaki 200 Eversi Jari kaki : 900 Fleksi (berjalan dengan jari-jari kaki)

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Setelah ROM selesai

Ukur panjang ekstremitas Kaki dari SIAS menyilang ke Tulang Malleus Medial Selanjutnya ukur kekuatan otot dengan Lovets Scale (Syarat tidak ada kekakuan sendi, nyeri ekstremitas)

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SKALA KEKUATAN OTOT

KEKUATA ISTILA TANDA N H 0 Zero Tidak terlihat adanya kontraksi otot

1
2 3 4 5

Trace
Poor Fair Good

Tidak ada pergerakan sendi dan hanya tampak adanya kontraksi otot
ROM lengkap dengan gravitasi dieliminir (hanya menggeser) ROM lengkap melawan gravitasi ROM lengkap dengan sedikit tahanan

Normal ROM lengkap melawan gravitasi dengan tahanan penuh

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Limitations

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Limited ROM in Neck of Sable

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Walking Sables

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ROM of Motion changes with age

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Swelling, tenderness & pain are among factors that limit ROM.

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TEST DIAGNOSTIK
Radiologi Blood Test
Serum Calcium Serum Phosphat

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ROM and ADLs

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Counter indication of ROM

1. Dislocated or unhealed fracture (fx). 2. Immediately after surgery (sx) on tendons, ligaments, muscles, joint capsules or skin.

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Precautions with ROM

1. 2. 3. 4. Infection or inflammation around a joint. Pain medication Osteoporosis Arthritis

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Age and sex affect ROM

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The effect of ROM on ADLs

Movement in bed i.e. sitting in bed, rising from bed and turning over.

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Transfers: Seat-to-Seat, Toilet to Bed, etc.

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Locomotion: walking on level ground or gentle slope

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Dressing
What affects would not being able to dress yourself have on you? On your client?

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Personal Hygiene

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Eating

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Body Alignment

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Keep Your Back Straight

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The Correct Way to Lift

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When turning, rotate your whole body, not just your back.

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When sitting keep your back straight.

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Balance: Keep Your Feet 12 apart

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Coordinated Body Movement

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Factors That Affect Body Alignment and Mobility

1. Developmental---Age of Client 2. Physical HealthChornic or Acute Disease 3. Musculoskeletal: Congenital or acquired abnormalities 4. Nervous System: CVA 5. Cardiovascular: orthostatic hypotension, increased cardiac workload, thrombosis

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Factors Affecting (cont)

6. Pulmonary: Atelectasis, Pneumonia 7. Metabolic: Immobility Affects Normal Metabolic Functioning 8. Integumentary: Impaired Skin Integrity 9. Urinary: Urinary stasis, renal calculi, UTI 10. Mental Health: Physical Processes Slow With Depression All of These Effect.

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LIFESTYLE

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Normal Body Alignment

While Standing While Sitting While Lying In Bed

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Clients in Bed
Evaluate Comfort After Positioning for Alignment Reposition q2h Use Repositioning for effective ROM Use Supportive Devises for Positioning

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DIAGNOSA KEPERAWATAN
Kerusakan Mobilitas Fisik

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PERENCANAAN
TUJUAN UMUM 1. Mencegah Deformitas 2. Mencegah Ketegangan otot & Kelemahan 3. Mencegah Luka Tekanan

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PERENCANAAN
Atur posisi tidur Latihan & Ambulasi Dini Medikamentosa

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Positioning Clients

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Pengaturan Posisi Tidur

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Fowlers Positions
Close to High Fowlers Semi-Fowlers

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Supine position

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Side-lying/Dorsal Recumbent Position

Major weight on dependant hip and shoulder. Use supportive foam blocks or pillows for support

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Sims Position
Weight supported by anterior aspects of humerus, clavicle and ileum. These pressure points are different from other positions, i.e. supine, thereby preserving skin integrity.

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Prone Position
This prone position can be used to prevent contractures in knees and hips. Prone position counter indicated with spinal cord clients.

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Positioning/Moving a Client Up in Bed

Allow patient to move himself if he can. HOB down---dont move up hill. Position height of bed for nurses comfort. Have patient flex knees, chin to chest, arms folded across chest Nurses tightens abdominal girdles, flex knees. Nurses shift weight, moving patient. Reposition HOB, bed in low position.

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Use Mechanical Devises

Lifts will save backs, yours included.

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Turning a Patient
Determine what patient can do, find assistance if it is needed. Position height of bed for nurses comfort. Position patient supine on far side of bed. Patient arms across chest, far leg over near one. Tighten girdles, flex knees.

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Turning Patient (cont)

Place one hand on patient shoulder, other on hip. Roll patient toward you. Position patient for comfort, support with pillows if need be. Raise side rails, lower bed.

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Jenis Latihan ROM

1. Latihan Aktif
Pasien dengan paralisis ekstremitas sebagian Pasien bedrest tanpa kontra indikasi

2. Latihan Pasif
Pasien Pasien Pasien Pasien semikoma atau tidak sadar usia lanjut dengan mobilitas terbatas bedrest total dengan paralisis ekstremitas total

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Jenis
3. Latihan Aktif-Assistif : diberikan dengan jalan pasien menggerakan sendiri bagian tubuhnya, dan perawat membantu pada bagian yang tidak mampu pasien lakukan. 4. Latihan Isometrik / Statik : tidak ada sendi yang bergerak dan panjang dari otot tidak berubah. Pasien secara sadar meningkatkan tekanan pada otot tanpa menggerakan sendi. 5. Latihan Resistif : tdd kontraksi dari otot melawan tekanan yang berlawanan. Latihan Resistif dapat meningkatkan ukuran otot, kekuatan dan tenaga.

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Care Plan
ROM should be included in the patients care plan unless counter indicated. Move each joint to the point of resistance, NOT pain. Use good body mechanics as you do ROM with your patients.

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