28 chapter 4
In different children (and sometimes in the same child) you may need to check range
of motion and strength in the hips, knees, ankles, feet, toes, shoulders, elbows, wrists,
hands, fingers, back, shoulder blades, neck, and jaw. Some joints have 6 or more
movements to test: bending, straightening, opening, closing, twisting in, and twisting
out. See, for example, the different hip movements (range-of-motion exercises) on
p. 380 in Chapter 42.
To test both ‘range of motion’ and ‘strength’, first check ‘range of motion’. Then
you will know that when a child cannot straighten a joint, it is not just because of
weakness.
Range-of-motion testing: Example:
Knee
1. Ask the
child to
straighten
it as much
as she can.
2. If she cannot straighten
it all the way, gently see
how far you can straighten
it without forcing.
With your hands,
support the joint
on each side as
you straighten it.
3. If at first the
joint will not
straighten,
CP
keep trying with
gentle continuous
pressure for 2 or 3
minutes.
If it still does not straighten, the range of motion is
reduced. This is usually because of a contracture
(see Chapter 8).
If it gradually straightens, spasticity (muscle spasms)
may be what makes it difficult (see p. 79). (If it stops
before it straightens completely, contractures may
also be developing.)
4. If a joint will
not straighten
completely, try
with the child
in different
positions.
For example, a
knee often does
not straighten as
much with the
hips bent as with
the hips straight.
CP
Position affects how much certain joints straighten or bend. This is true in any child, but
especially in a child with spasticity (see pages 101 to 103).
For this reason, each
time you test range
of motion to measure
changes, be sure the
child is in the same
position.
5. In addition to
checking how
much a joint
straightens,
check how
much it bends.
If joints are kept straight and never bent, they
may stiffen or develop contractures that do not let
them bend. (This can happen with joint infection,
arthritis, and other conditions, or when a joint is
kept in a cast for a long time.)
6. Also check
for too much
range of
motion.
A child who walks on a weak leg often
‘locks’ her knee backward to keep from
falling. In time, the knee stretches back
more and more, like this.
The same thing can
happen to the child with
weak arms who uses
crutches (or crawls).
Usually the best positions for checking range of motion are the same as those for
doing range-of-motion and stretching exercises. These are shown in Chapter 42.
For methods of measuring and recording range of motion, see Chapter 5.
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