Anatomical Direction Worksheet - PowerPoint

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```					Goniometry
Classroom Application
Curriculum

• Students will apply Anatomical Positions, Movements &
Directional terms.
– Anatomical Terms Study Guide (Unit 2)

• Students will examine performance enhancement
philosophies.
– Importance of flexibility in fitness and athletic performance (Unit 4)

• Students will explain therapeutic modalities and rehabilitation
techniques.
– Discuss components and goals of a rehabilitation program (Unit 9)
What we will cover...
Content Objectives
• Students will be able to successfully use a goniometer to measure Joint
Angles and Range of Motion.

Language Objectives
• Students will be able to define basic anatomical terms and apply those
terms when using a goniometry.
• Students will be able to compare and contrast Math/Health Science terms
by categorizing them on a graphic organizer.
• Students will be able to identify and utilize key information from story
problems by solving mathematical equations.
Divide these key terms into two different lists…
Words you KNOW & Words you DON’T Know
Goniometer            Anatomical Position          Measure
Kinesiology           Directional Terms            Compass
Angle                 Movement                     Protractor
Right              Flexion / Extension          Joint
Acute              Hyperextension               Arm
Fulcrum               Rotation                     Deviation
Range of Motion       Internal Rotation            Ruler
Active ROM         External Rotation
Passive ROM
Words I know   Words I don’t Know   Math Terms     Medical Terms
Terminology (T-Chart)
Mathematics             Health Science
• Protractor           • Goniometer
• Kinesiology
• Compass              • “Joint” Angles
• Angles           Angle Anatomical Position
•
•
Acute Directional Terms
– Acute             • Movement
– Right         Degree Flexion / Extension
•
– Obtuse    Fulcrum •/ Arm
Hyperextension
• Ruler           Measure
• Rotation
Deviation
• Internal Rotation
• External Rotation
• Range of Motion
• Active ROM
• Passive ROM
SIOP – Sheltered Instruction Observation Protocol
• Building Background knowledge
• Content / Language Objectives
(KUD’s)

• Anatomical terms: (Cornell Notes)
– Movements
– ROM
• Documentation
• Careers
– Therapy / Rehab
– Ergonomics
• Mathematic equations
– Story problems
• Research
Goniometry is…
The act of measuring the available Range of Motion
(ROM) or the position of a joint.
– Typically this is either a measurement of ACTIVE or
PASSIVE motion.
• It is important to DOCUMENT wither you are measuring Active
ROM of Passive ROM.

Like a compass, the circular portion of a goniometer is
marked with degrees, from 0 to 360. Two arms
extend from this circle, one of which can pivot freely.
The arm that does not pivot is mounted at the zero-
degree point.
Goniometer’s are used in the medical field to
measure a joint's range of motion. This range
is expressed in angles and are listed as
degrees. They can be helpful in determining
if a patient is lacking in mobility due to an
injury, or how well he/she is recovering after
sustaining an injury.

The term "goniometer" comes from two
Greek words that mean "angle" and
"measure." This is essentially what you are
doing when you measure range of motion--
measuring an angle.
Range of Motion
The angle through which a joint moves from the anatomical position to
the extreme limit of its motion in a particular direction.

• Active ROM - exercises are when you do the exercises yourself.
• Active-assisted ROM - exercises are done by you and a helper.
• Passive ROM - exercises are when you cannot do the exercises by

• Resistive ROM - exercises are when you are actively performing
the exercises and you have someone resist the movement you are
performing.

10
Anatomical Terms Worksheet
Range of Motion
1.       _Abduction____________________
Hip _______________________
Hip _______________________
3.       _Flexion____________________
Hip ________________________
_Extension___________________
Knee ______________________
_Plantarflexion_______________
Ankle _____________________
_Extension__________________
4. Wrist _____________________
_Hyperextension_______________
(a) _______________________
_Flexion____________________
(b) _______________________
_Flexion______________________
5. Hip ________________________
_Flexion___________________
Knee _____________________
_Dorsiflexion_________________
Ankle _____________________
_Supination_____________
6. Forearm (a) ________________
_Pronation_____________
Forearm (b) ________________
_Circumduction____________
7. Shoulder __________________
_Elevation_______________
8. Shoulder __________________
_Protraction___________________
9. Jaw _______________________
_Rotation______________
10. Shoulder __________________
Joint Range Norms*
*May vary on
each individual,
always compare
to opposite side
when available.
Joint Range of
Motion Lab &
Write-up
How to use a Goniometer

Step 1 Place the goniometer over the fulcrum
of the joint. This will vary depending on
which joint you are measuring. Place the
stationary arm of the goniometer along the
stationary line of the body (again, this will
vary depending on which joint you are
measuring), and the movable arm on the
moving part of the body.

the desired direction. Have the patient
move to their fullest extent of motion,
following the movement with the movable
arm of the goniometer. Make sure the
stationary arm stays straight.
How to use a Goniometer
Step 3 Stabilize the stationary portion of the body. This is the part of the body
that is proximal (closer to the midline of the body) to the joint you are testing.
It is important that the patient does not move his body while moving the joint;
this step isolates the joint movement for a more accurate measurement.

Step 4 Look at the reading on the goniometer before removing it from the
patient's body. Ensure that you take an accurate reading of the degree of
motion on the goniometer, and that you consistently use the same stationary
and movable landmarks on the body when measuring, to ensure consistency.
Be sure to record the range of motion for the joint.
Positioning & Assessing
POSITIONING
This is the reference point for the
measurement. If zero position
can't be achieved, this must be
documented.

ASSESSING
a. Permit complete range of motion
1)If you are assessing joint ROM, be sure
that some other structure (ie. tight
clothing) doesn't interfere.
2)If you are assessing some other structure
(ie. a tight clothing or pain limiting the
motion) document exactly what is
limiting the range of motion. (ie.
hamstring tightness at 65o of hip flexion)
Flexion / Extension / Hyperextension
Joint, Landmarks, Etc…
Who Uses Goniometers
A physical therapist uses a goniometer to measure
the amount range of motion possible at that joint.
Patients often have reduced range of motion at a joint
following an injury or surgery. Progress can be
charted by taking frequent measurements as
treatment continues. Because physical therapy often
progresses slowly, frequent goniometer
measurements on the affected joints can help the
patient visualize improvements. These changes may
be slight from one day to the next, but when charted,
seeing the steady increase in degree range can provide
motivation and daily goals.
Sample Problem
A 67 year old male pt is recovering from a total
knee replacement (TKA). In his Rx for PT the MD
Active ROM at the end of 6 weeks. On day one
the pt begins PT with a knee flexion of 63°
degrees and 6° degrees short of full extension.
In order to achieve the MD’s protocol, what
improvements need to be made on a weekly
basis?
What do we need to know?
• What is Information is Irrelevant and what is important?
• What would be a normal Active ROM for this Pt?
(give two examples)

• Draw his beginning ROM’s.
• Solve the problem.

A 67 year old male pt is recovering from a total knee
replacement (TKA). In his Rx for PT the MD protocol states
that the pt is to return to full Active ROM at the end of 6
weeks. On day one the pt begins PT with a knee flexion of 63°
degrees and 6° degrees short of full extension. In order to
achieve the MD’s protocol, what improvements need to be
Irrelevant / Important Information
A 67 year old male pt is recovering from a total knee
replacement (TKA). In his Rx for PT the MD protocol
states that the pt is to return to full Active ROM at the
end of 6 weeks. On day one the pt begins PT with a knee
flexion of 63° degrees and 6° degrees short of full
extension. In order to achieve the MD’s protocol, what
improvements need to be made on a weekly basis?
• Area / Body Part: Knee
• Goal: Full Active ROM at the end of 6 weeks
• Beginning ROM:
– knee flexion 63°
– 6° short of full extension
• What improvements need to be made on a weekly
basis?
Moving Forward
1. What will be a normal Active ROM for this Pt?
– Knee (two ways to analyze)
a. Normal values – Flexion - 135° , Extension - 0° .
b. Compare to opposite side, uninjured leg.

2. Draw his beginning ROM’s.
– knee flexion 63°
a.

– 6° short extension
b.
What do we Know?
• Average Knee
– Flexion is 135°
– Extension is 0°
• Week 1
– 63° Flexion
– 6° Short of Full Extension
• Time line
– 6 weeks

A 67 year old male pt is recovering from a total knee
replacement (TKA). In his Rx for PT the MD protocol states
that the patient is to return to full Active ROM at the end of 6
weeks. On day one the pt begins PT with a knee flexion of 63°
degrees and 6° degrees short of full extension. In order to
achieve the MD’s protocol, what improvements need to be
Solve
A 67 year old male pt is recovering from a total knee replacement
(TKA). In his Rx for PT the MD protocol states that the patient is to
return to full Active ROM at the end of 6 weeks. On day one the Pt
begins PT with a knee flexion of 63° degrees and 6° degrees short of
full extension. In order to achieve the MD’s protocol, what
improvements need to be made on a weekly basis?
135 – 63 = 72
1. How much knee flexion is lacking?

Flexion__135_°-          Flexion___63_            needed______°
Normal Knee Flexion______° - Current Flexion______° = Flexion needed___72_°

2. Based on Flexion needed, how much should be gained per week?                   72 ÷ 6 = 12

needed___72_°             weeks__6___               week___12_
Flexion needed______° ÷ Number of weeks______ = Flexion per week______°
6÷6=1
3. How short is the Extension from 0 and how much will be needed per week?

Extension___6__°             Weeks__6___                 week___1__°
Short of Extension______° ÷ Number of Weeks______ = Extension per week______°
Continuation
As our Pt continued PT he started to feel as if progress
was not being made. When the PT’s reviewed his chart
he noticed...
Weeks    Day 1   Day 2   Day 3   Day 4   Day 5   Day 6   Day 7
Week 1    63              67              71
Week 2    80              86              88
Week 3    96             104             106
Week 4   115             117             119
Week 5   121             124             127
Week 6   125                                             135

What conclusions could be made by this data?
At the current pace will our Pt react MD protocol by the
end of his rehab?
Other applications
Ergonomics
The study of workplace design; how a
workplace and the equipment used
there can best be designed for comfort,
efficiency, safety, and productivity.
Proper ergonomic design is necessary to
prevent repetitive strain injuries, which
can develop over time and can lead to
long-term disability.
– Proper desk alignment
– Specialized equipment
• Custom bike fit
How to get your seat height right
• Proper bicycle seat height has been proven to reduce over-
use injuries in cycling such as patellar tendonitis.
• A goniometer may be used to measure and determine the
proper angle of the knee joint at the bottom of the pedal
stroke.
How to get your seat height right
• Measure the angle of the knee joint at
the bottom of the pedal stroke.
– It is recommended that this angle of
between 25 and 35 degrees and closer
to 25 for those with a history of
patella tendonitis.
Research has shown that setting your seat height based
on a knee angle of 25 degrees outperforms all other
methods (including an angle of 35 degrees). Don’t rely
on simply feeling comfortable either. If you’ve been
pedaling at a much lower saddle height than is
optimal, it may feel awkward in the beginning,
weeks) the new position will not only feel comfortable,
but will improve performance in the long run.
Guess the ROM (Angle)
Based on what we learned today about Joint ROM Angles.

a.                                 b.           32°
68°

c.                                 d.
139°
86°
GONIOMETRY PROCEDURE
1. Position joint in zero position
2. Identify and palpate bony landmarks
3. Align goniometers arm with bony landmarks
4. Center the pivot point on the joint line
5. Move joint to end of range of motion
6. Determine end-feel at point where
measurement will be taken (at end of available
range of motion)
8. Record measurement (e.g. elbow flexion = 130o)
What we covered!
Content Objectives
 Students will be able to successfully use a goniometer to measure Joint
Angles and Range of Motion.

Language Objectives
 Students will be able to define basic anatomical terms and apply those
terms when using a goniometry.
 Students will be able to compare and contrast Math/Health Science terms
by categorizing them on a graphic organizer.
 Students will be able to identify and utilize key information from story
problems by solving mathematical equations.
Activity
Averages
An average is a number that is representative of a group or set of numbers.
There are different types of averages.

Arithmetic Mean – the most common type, calculated by adding all of the
numbers in the set and then dividing the sum by the number of units or
– Example, the average or arithmetic mean of six numbers is the sum of the
numbers divided by 6.

Median Average – a positional number where average represents the middle
number in a set of numbers.
– Example, in the set 20, 22, 24, 26, and 28, the median average is 24, the
number literally in the middle. All of the units averaged must be the same unit
of measure.

Mode Average – the number or numbers that occur most frequently is a set.
– Example, in the set 22, 28, 26, 22, and 24, the mode average is 22, the number
that occurs most frequently in the set. Some sets will not have a mode.
Measure the ROM of 10 people find the
average mean, median & mode.
Active
Name   Age   Sex   Joint Segment              Movement   Degree
/Passive
Stabilization, Validity & Reliability
STABILIZATION
• Poor stabilization is the most frequent cause of invalid measurements. (ie. observe a "normal"
ROM of elbow extension when movement of shoulder and arm masks a limitation - actually
measuring shoulder and arm movement)
• Usually stabilize proximal joint components
• Promote patient relaxation so voluntary muscle contraction doesn't interfere
VALIDITY
• Validity is a measurement concept that asks whether a measurement system actually
measures what it's supposed to (i.e., joint range of motion in the case of goniometry)
• Goniometric measurements can be invalid; usually because of poor stabilization.
RELIABILITY
• Reliability is a measurement concept that asks whether successive measurements are
consistent, repeatable or reproducible. Upper extremity measurements are more reliable than
lower extremity measurements.
1) intratester reliability (same tester on different occasions)- measurement error should be less than 5 degrees
2) intertester reliability (different testers) - measurement error probably greater than 5 degrees
• To maximize reliability always use the same:
1)   Goniometer
2)   Positioning
3)   Procedure
4)   Examiner
Articles

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