Basic concept:

• Goniometry

• Joint Motion

• Arthrokinematics

• Osteokinematics

• 5Planes and Axes

• Range of Motion

• Active Range of Motion

• Passive Range of Motion

• Hypomobility,

• Hypermobility

• Factors Affecting Range of Motion

• Muscle Length Testing

What is Goniometry

• The term goniometry is derived from two Greek words, gonia meaning angle and metron, meaning measure.

• goniometry refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body

• Goniometry may be used to determine both a particular joint position and the total amount of motion available at a joint.

Importance of Goniometry

• Determining the presence or absence of impairment Establishing a diagnosis Developing a prognosis, treatment goals, and plan of care Evaluating progress or lack of progress toward rehabilitative goals

• Modifying treatment

• Motivating the subject

• Researching the effectiveness of therapeutic techniques or regimens (for example, measuring outcomes following exercises, medications, and surgical procedures)

• Fabricating orthoses and adaptive equipment

Arthrokinematics

• term used to refer to the movement of joint surfaces.

• The movements of joint surfaces are described as

1. slides for glides),

2. spins, and

3. rolls.

Slide (glide)

is a translatory motion, is the sliding of one Joint surface over another as when a baked wheel or

A slide is a translatory motion in which the Same point on the moving joint surface comes in contact with new points on the opposing surface, and all the points on the moving surface travel the same amount of distance

Spin

A spin is a rotary motion, similar to the spinning of a toy top. All points on the moving Joint surface rotate around a fixed axis of motion or

A spin is a rotary motion in which all the points the moving surface rotate around a fixed central axis. The points on the moving joint surface that are closer to the axis of motion will travel a smaller distance than the points further from the axis.

Roll

A roll is a rotary motion similar to the rolling of the bottom of a racking chair on the floor or the rolling of a tire on the road

Or

A roll is a rotary motion in which new points on the moving joint surface come in contact with new points on the opposing surface. The axis of rotation has also moved in this case to the right

Concave convex rule

Osteokinematics

• Osteokinematics refers to the gross movement of the shafts of bones rather than the movement of joint surfaces. The movements of the shafts of bones are usually described in terms of the rotary or angular motion produced, as if the movement occurs around a fixed axis of motion.

Goniometry measures the angles created by the rotary motion of the shafts of the bones 

• Some translatory shifting of the axis of motion usually occurs during movement: however, most clinicians find the description of osteokinematic movement in terms of just rotary motion to be sufficiently accurate and use goniometry to measure osteokinematic movements.

Planes and Axes

Osteokinematic motions are classically described as taking place in one of the three cardinal planes of the body (sagittal, frontal, transverse) around three corresponding axes (medial- lateral, anterior-posterior, vertical). The three planes lie at right angles to one another, whereas the three axes lie at right angles both to one another and to their corresponding planes.

• The plane: is the surface on which the movement occurs or take place

• axes: is the line around which the movement take place. Axis is the singular and axes are the plural noun. Any movement occur in plane around an axis. axis of same plane make an angle

CARDINAL PLANES OF BODY

Frontal (Coronal) Plane: is vertical and extends from one side of the body to the other. It divides the body into front and back sections.

2. Sagittal (Medial) Plane: is vertical and extends from the front of the body to the back. It divides the body into right and left sections.

3 Transverse (Horizontal) Plane: is horizontal and divides the

Primary Axes of Rotation

Horizontal Medio Latetal Axis:

Runs from side to side

* Perpendicularto Sagittal Plane

• Typically flexion/extension

Antero-Pester Sagittal Axis

• Runs from front to back
• Perpendicular to the Coronal Plane
• Typically abduction/adduction movements

3. Longitudinal (Vertical) Axis:
   • Runs straight through the top of the head down between the feet
   • Perpendicular to the Transverse Plane
   • Typically a rotation type of movement

Range of Motion:

• Range of motion (ROM) is the arc of motion that occurs at a joint or a series of joints. The starting
position for measuring all ROM, except rotations in the transverse plane, is anatomical position.
• Three notation systems have been used to define ROM:
o the 0 to 180 degree system,
o the 180 to 0 degree system, and
o the 360 degree system.
• Each specific joint has a normal range of motion that is expressed in degrees.
• Joint ranges are divided into

1. 1. Active range of motion AROM
2. 2. Passive range of motion PROM
   • The structure involved with movement of the bones as well as the bony arrangements are factors in limiting motion.

Capsular Patterns of Restricted Motion

Cyriax18 has proposed that pathological conditions involving the entire joint capsule cause a particular pattern of restriction involving all or most of the passive motions of the joint. This pattern of restriction is called a capsular pattern.

The restrictions do not involve a fixed number of degrees for each motion, but rather a fixed proportion of one motion relative to another motion

Noncapsular Patterns of Restricted Motion

– A limitation of passive motion that is not proportioned similarly to a capsular pattern is called a Noncapsular pattern of restricted motion.

• A Noncapsular pattern is usually caused by a condition involving structures other than the entire joint capsule. Internal joint derangement, adhesion of a part of a joint capsule, ligament shortening, muscle strains, and muscle contractures are examples of conditions that typically result in Noncapsular patterns of restriction

• Noncapsular patterns usually Involve only one or two motions of a joint, in contrast to capsular patterns, which involve all or most motions of a joint.

Hypermobility

The term hypermobility refers to an increase in passive HOM that exceeds normal values for that joint, given the Subject’s age and gender  

Factors Affecting Range of Motion

• Determinants of Normal joint ROM
 Age
 Gender
 Others such as ADL, right vs left, body physique, active vs passive ROM
• Abnormal
 Tight soft tissues around the joint
 Muscle insufficiency
 Adhesion
 Foreign body

Muscle Length Testing

Maximal muscle length is the greatest extensibility of a muscle tendon unit. It is the maximal distance between the proximal and the distal attachments of a muscle to bone

Clinically, muscle length is not measured directly; instead, it is measured indirectly by determining the maximal passive ROM of the joint(s) crossed by the muscle.

Muscle length, in addition to the integrity of the joint surfaces and the extensibility of the capsule, ligaments, fascia, and skin, affects the amount of passive ROM of a joint.

The purpose of testing muscle length is to ascertain whether hypomobility or hypermobility is caused by the length of the inactive antagonist muscle or other structures.

Muscles can be categarized by the number of joints they cross from their proximal to their distal attachments.

One joint muscles cross and therefore influence the motion of only one joint,

Two joint muscles cross and influence the motion of two joints, whereas multi-joint muscles cross and influence multiple joints.

Procedures

The examiner must have knowledge of the following for each joint and motion

1. Joint structure and function

Z. Normal end-feels

3. Testing positions

4 Stabilization required

5. Anatomical bony landmarks

6. Instrument alignment

Cont…..

The examiner must have the skill to perform the following for each joint and motion:

1. Position and abilize correctly

2. Move a body part through the appropriate range of motion (ROM) 3. Determine the end of the ROM and end-feel

4. Palpate the appropriate bony landmarks

5. Align the measuring instrument with landmarks

6. Read the measuring instrument

7. Record measurements correctly

Types of Goniometry

Universal goniometry

Gravity-Dependent Goniometers Inclinometers)

• Bubble goniometer

Pendulum inclinometer

• Double inclinometer (used for spine goniometry)

Electro goniometers Visual Estimation

• Single and twin axis goniometer • Digital goniometer

• Smartphone soft wares

• Arthrodial protractor

Universal goniometry

The universal goniometer is the instrument most commonly used to measure joint position and motion in the clinical setting.

• Moore designated this type of goniometer as universal because of Its versatility

• It can be used to measure joint position and ROM at almost all joints of the body

• Universal goniometers made plastic or metal and are produced in many sizes

• It has three parts

1 A body

2 Fulcrum

3. Stationary arms

4 Moving arms

• The body of the goniometer is designed like a protractor and may form a full or half circle; and on it is a scale from 0 to 180 or 360 degree

• The fulcrum is a rivet or screw-like device at the center of the body that allows the moving arm to 7 move freely on the body of the device

• The fulcrum and body is placed over the joint being measured

• The stationary arm will be aligned with the inactive part of the joint measured while the moving arm is placed on the part of the limb which is moved in the joint’s motion

1. fluid (bubble) goniometer

The fluid (bubble) goniometer, which was developed by Schenkar14. in 1956, has a fluid-filled circular chamber containing an air bubble

can be used for flexion and extension, abduction and adduction, rotation in the neck shoulder elbow wrist knee ankle and the spine

2. Pendulum Goniometer

The pendulum goniometer consists of a 360-degree protractor with a weighted pointer hanging from the center of the protractor

This device was first described by Fox and Van Breeme in 1934

Electro goniometer

Electro goniometers are devices that convert joint to a voltage. The voltage can be sampled continuously, making electro goniometers ideal for measuring dynamic movement. There are basically two deigns, both of which fall under the category of resistive transducer. These devices namely potentiometers and strain gauges, output a voltage related to the angular position of the joint. The voltage is converted to an angle by using a manufacturer supplied scale factor specific to each transducer. The joint angle can be displayed in real time and/or stored on a computer equipped with an analog- to digital data acquisition card  

use of electro goniometer

Rehabilitation engineering is the systemic application of emerging sciences to design, develop, adapt, test, evaluate, apply and distribute technological solutions to problems confronted by Individual with disabilities. Determining precise joint angles is extremely important to rehabilitation and biomedical engineers as well as physiotherapists and ergonomic specialties. The angle data is essential for identifying abnormal patterns and characterizing impairments, disabilities and handicaps.

Disabled patients, such as those suffering hemiplegia (half the body is paralyzed) or hemiparesis (half the body is weakened but not paralyzed), may experience limited speed and amplitude in some body movement. For such cases, an electro goniometer is useful tool for measuring joint angles, such as those for elbow or knees to determine the extent of he disability, The electro goniometer is an electronic device that uses angle sensors, such as potentiometer, strain gauges and more recently, accelerometers to records such measurement

Twin Axis Electro-goniometer

The inter-rater and intra-rater reliability of the electrogoniometer is higher as compared to universal goniometer but challenging to apply in the clinical evaluation of patients hence used more often for research purposes.

Software/Smartphone-based Goniometer

The use of a smartphone as a digital goniometer has several benefits like availability, ease of measurement, application-based tracking of measurements, and also one hand use. These applications use the accelerometers in phones to calculate the joint angles

Arthrodial Goniometer

It is ideal for measuring cervical rotation, anteroposterior flexion, and lateral flexion of the cervical spine.

Digital Goniometer

As a Digital Goniometer, it allows to measure flexion, extension and rotation. As a digital inclinometer it allows to measure cervical, thoracic extension, and lumbar flexion, rotation and side bending Can also measure the cobb angle on a scoliosis