Prom Before Arom: Nerve Injury Treatment Explored

Passive Range of Motion (PROM) is a therapeutic exercise where a physical therapist or equipment moves a joint through a series of stretches without the patient's muscles being engaged. PROM is used to increase a patient's range of motion (ROM) without requiring muscle contraction or flexion. Active Range of Motion (AROM), on the other hand, is the patient's ability to voluntarily move a joint through a range of motion against gravity, relying on the muscles, tendons, and ligaments to control the movement. In the context of nerve injury, PROM is often recommended before AROM to prevent further damage and promote joint and tissue integrity. This is because, during the initial stages of healing, active motion can be detrimental to the recovery process, and PROM helps maintain joint mobility and prevent contractures.

PROM can be used to increase ROM or prevent contractures

Passive range of motion (PROM) is used when you want to increase range of motion (ROM) or prevent contractures. PROM is how far a joint can move with assistance, for example, pulling your leg up to your chest with your arms to stretch.

PROM can be used to prevent or treat contractures in neuromuscular diseases (NMD). A limb contracture is the lack of full passive ROM due to joint, muscle, or soft tissue limitations. Contractures develop due to intrinsic myotendinous structural changes and extrinsic factors. The most frequent factor contributing to the occurrence of fixed contractures is weakness and the inability to achieve active joint mobilisation throughout the full normal range. For example, less than antigravity knee extension strength places an individual at risk for knee flexion contractures, particularly if the patient is seated with the knee joint positioned in flexion.

To prevent or delay the development of lower limb contractures, physical therapy modalities such as daily standing and/or walking, passive stretching of muscles and joints, positioning of the limbs to promote extension and oppose flexion, and splinting are regularly carried out. PROM is also used to prevent or delay the development of upper limb contractures.

PROM can be used to treat shoulder stiffness

Passive range of motion (PROM) is a technique used to increase the range of motion in a joint without requiring muscle contraction or flexion. PROM can be used to treat shoulder stiffness by stretching and increasing the flexibility of the shoulder joint.

During PROM exercises, the patient does not actively move their joint; instead, a physical therapist or equipment moves the joint through a variety of stretches. This can be particularly useful for individuals with shoulder stiffness who are unable to actively move their shoulder due to pain or surgical precautions.

One example of a PROM exercise for the shoulder is the pendulum stretch. This involves moving the arm in a circular motion, side to side, and front to back, without activating the muscles. Other PROM exercises can be performed using a pulley system or a PVC pipe to achieve passive flexion, abduction, internal rotation, and external rotation of the shoulder.

It is important to note that individuals with shoulder stiffness should consult their doctor or physical therapist before performing PROM exercises, as the allowed range of motion may be restricted after surgery.

PROM is often used in conjunction with active range of motion (AROM) exercises, where the patient voluntarily moves their joint. AROM exercises can help strengthen the muscles and tendons surrounding the joint, while PROM exercises focus on increasing the joint's flexibility. Together, these approaches can effectively treat shoulder stiffness and improve overall shoulder function.

PROM can help preserve joint and tissue integrity

Passive range of motion (PROM) is a technique used by physical therapists to help patients with their rehabilitation. PROM is how far a joint can move with assistance. For example, if you pull your leg up to your chest with your arms to stretch, you can move it farther than it can move on its own. PROM is not limited by the strength of the muscles, unlike active range of motion (AROM).

By understanding the different types of end feels and treatment applications, clinicians can derive valuable information to guide treatment plans and effectively address their patients' pain and injury conditions. PROM can also be used to increase a patient's range of motion or prevent contractures. For example, if someone has shoulder stiffness or a flaccid UE due to a stroke, then PROM is recommended.

In summary, PROM can help preserve joint and tissue integrity by providing valuable information about joint and tissue health, guiding treatment plans, and increasing a patient's range of motion. PROM is an important tool for physical therapists to help their patients recover from injuries or conditions affecting their joints and soft tissues.

PROM can be used to treat flaccid UE due to stroke

Passive Range of Motion (PROM) exercises are an effective way to treat flaccid paralysis after a stroke. Flaccidity refers to a complete lack of voluntary movement in a limb, which can be caused by damage to the neural pathways between the brain and muscles. This can lead to the affected limb hanging loosely due to a lack of muscle function.

PROM exercises can help to maintain the range of motion and encourage muscle function in patients with flaccid paralysis. During these exercises, a therapist or caregiver moves the patient's muscles for them, or the patient can move them using their unaffected limb. This type of exercise can stimulate the brain and help to rekindle the neural networks responsible for movement. Additionally, PROM exercises can help to keep the joints mobile and prevent additional complications such as contractures.

When performing PROM exercises, it is important to ensure that the patient's limb is well-positioned and supported. Slings can be used, but they may cause poor positioning and alignment. Pillows or trays can also be used to support the weak arm. Caregivers should be careful not to pull on the flaccid arm and should always ensure that it is positioned correctly.

Other treatments that can be used in conjunction with PROM exercises include electrical stimulation, mental practice, and mirror therapy. Electrical stimulation involves sending electrical impulses directly to the affected muscles, causing them to contract. Mental practice involves visualizing oneself moving the flaccid muscles, which can help promote neuroplasticity. Mirror therapy uses a mirror box to create a reflection of the patient's unaffected arm, tricking the brain into thinking the affected limb is performing a task and activating neuroplasticity.

By utilizing PROM exercises and other treatments, patients can improve their range of motion, encourage muscle function, and work towards recovering from flaccid paralysis due to stroke.

PROM can be used to prevent muscle atrophy

Muscle atrophy is the loss or thinning of muscle tissue, resulting in decreased muscle mass and strength. It can be caused by the disuse of muscles or neurogenic conditions. Disuse atrophy occurs when muscles are not used enough, leading to the body breaking down muscles as it no longer needs to waste energy maintaining them. This can be due to a sedentary lifestyle, lack of exercise, or certain medical conditions.

Passive Range of Motion (PROM) can be used to prevent muscle atrophy by increasing the range of motion of a joint without requiring muscle contraction or flexion. PROM is often used in rehabilitation to improve joint flexibility and range of motion. By moving the joint through a variety of stretching exercises, PROM can help prevent muscle atrophy and maintain joint integrity. This is especially important in cases where Active Range of Motion (AROM) may cause further damage, such as in the case of a repaired or broken extremity.

In the case of nerve injuries, PROM can be used to prevent muscle atrophy by maintaining joint movement and flexibility without requiring active muscle contraction. This can help to preserve the range of motion and prevent contractures from forming. Additionally, PROM can be used to promote tissue integrity and reduce scarring, which is important in the case of tendon repairs.

Overall, PROM can be an effective tool to prevent muscle atrophy by maintaining joint flexibility and range of motion without putting excessive strain on the muscles or joints. This makes it a valuable technique in the rehabilitation of nerve injuries and other conditions where AROM may not be safe or appropriate.

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