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Range of Motion (ROM) Assessment

People with cerebral palsy are more likely to have a decreased range of motion (ROM) because of reduced mobility and the presence of spasticity1 and dystonia. ROM can also be affected by a person’s age, gender, pain levels, illness, injuries, and levels and types of physical activity.

Having adequate muscle and joint movement allows a person to move freely and efficiently and is an important part of completing everyday activities for everyone, including people with cerebral palsy. Reduced range of motion can affect a person’s ability to carry out everyday activities and can lead to secondary problems such as strain and discomfort, contractures, and hip displacement and dislocation2.

A ROM assessment is most commonly used to measure movement of the ankles, knees, hips, shoulders, elbows, wrists and fingers. Measures are taken on consecutive occasions to assess any change over time. They are used to determine whether an individual’s ROM is within the expected range. If needed, an intervention can then be carried out to prevent a further reduction in ROM. Measuring ROM is also used to identify if an intervention to increase ROM has been effective. ROM assessment is only one part of the musculoskeletal assessment commonly carried out with people with cerebral palsy.
ROM assessments can be used for any person with cerebral palsy – from infants through to adults, and across all levels of severity and types of cerebral palsy.
Initial screening and informal assessment of ROM occurs via observation during functional activity. To formally measure ROM, an occupational therapist or physiotherapist measures how much a person’s joint is able to move
The amount of time it takes to measure ROM may vary from five minutes to half an hour or more and will depend on the number of joints which need to be measured and how easy it is to take the measurements.

Fees will apply for a physiotherapist or occupational therapist to conduct the assessment. The cost will vary depending on the service provider. You should also check with your provider to confirm if there will be additional costs to develop a home program, travel to the sessions or prepare reports.

You can ask your health care provider if you are eligible for funding to assist with the assessment fees. People with disability living in Australia may also be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

Training

The assessment should be conducted by a qualified health professional with experience carrying out ROM assessments. Occupational therapists and physiotherapists typically conduct ROM assessments as part of a routine assessment.

Cost to administer

The only cost involved in conducting a ROM assessment is purchase of the goniometers or other equipment to measure joint angles.

Method

The therapist will usually measure passive range of motion (PROM), where the therapist moves the limb, without assistance from the client, to identify the maximum possible movement around a joint. Active range of motion (AROM) may also be measured by asking a client or person with cerebral palsy to move their own limbs. PROM is usually larger than AROM3.

The resulting angle is most commonly measured with a handheld device called a goniometer. Other tools used to measure range of motion can include computerised goniometry, smartphone applications, X-rays and photographs4.

Things to note

  • Having adequate muscle and joint movement is important for all people, including people with cerebral palsy. It allows us to move freely and efficiently and is an important part of completing everyday activities
  • Reduced range of motion can lead to secondary problems such as strain and discomfort, contractures, and hip displacement and dislocation4.

Psychometric properties reviewed

Passive ROM

Interrater reliability – ranges from poor to excellent (intra-class correlation coefficient (ICC) 0.198-0.929)5, 6, 7, 8, 9
Test retest reliability - ranges from fair to excellent (ICC 0.55-0.97)5, 6, 9, 10, 11
Intra-rater reliability – ranges from poor to excellent (ICC 0.198-0.954)8, 10, 11, 12, 13

Active ROM

There were no studies located evaluating the psychometric properties of the active ROM assessment for people with cerebral palsy.

Reliability depends on the joint or movement being measured

Lower extremity. Assessments involving ankle dorsiflexion5, 6, 10, 12, dorsiflexion with knee flexion11 and hip external rotation10 present the highest reliability with good to excellent ranges across inter-rater, test-retest and intra-rater reliability. Hip extension with knee extension and the hamstring shift test have the lowest inter-rater reliability7, 8.

Upper extremity. Fewer studies have evaluated ROM assessment for the upper extremity. The results from the available research show moderate to excellent reliability for passive elbow extension, forearm supination and wrist extension with finger extension(ICC=0.48-0.94)9.

The variability of these results indicate that several factors can affect the reliability of the ROM assessment such as the level of experience and training of the individual assessor, the type of device used, the joint being measured and the severity and type of cerebral palsy12. To increase the reliability of this assessment, it is recommended that materials and methods are standardised and subsequent measurements are performed, where possible, by the same assessor who is blinded to previous assessment results2, 9. Results should be interpreted with caution where this has not occurred7.

Date of literature searches: August 2016

  1. Graham, H., Selber, P. (2003). Musculoskeletal aspects of cerebral palsy. The Journal of Bone and Joint Surgery, 85-B(2), 157-166.
  2. Darrah, J., Wiart, L., & Gorter, J. W. (2014). Stability of serial range-of-motion measurements of the lower extremities in children with cerebral palsy: Can we do better? Physical Therapy, 97 (7), 987-995.
  3. Norkin, C. C., & White, D. J. (2009). Measurement of joint motion: A guide to goniometry (4th Edition), Philadelphia: F. A. David Company.
  4. Clarkson, H. M. (2000). Musculoskeletal assessment; joint range of motion and manual muscle strength (2nd Edition), Baltimore, Maryland and Philadelphia, Pennsylvania: Lippincott Williams & Wilkins.
  5. Fosang, A. L., Galea, M. P., McCoy, A. T., Reddihough, D. S., & Story, I. (2003). Measures of muscle and joint performance in the lower limb of children with cerebral palsy. Developmental Medicine & Child Neurology, 45(10), 664-70.
  6. McWhirk, L. B., & Glanzman, A. M. (2006). Within-session inter-rater reliability of goniometric measures in patients with spastic cerebral palsy. Pediatric Physical Therapy, 18(4), 262-265.
  7. Herrero, P., Carrera, P., García, E., Gómez-Trullén, E. M., & Oliván-Blázquez, B. (2011). Reliability of goniometric measurements in children with cerebral palsy: A comparative analysis of universal goniometer and electronic inclinometer. A pilot study. BMC Musculoskeletal Disorders, 12(1), 155-162.
  8. Lee, K. M., Chung, C. Y., Kwon, D. G., Han, H. S., Choi, I. H.,…Park, Moon Seok. (2011). Reliability of physical examination in the measurement of hip flexion contracture and correlation with gait parameters in cerebral palsy. Journal of Bone & Joint Surgery, American Volume, 93-A(2), 150-158. See abstract
  9. Klingels, K., De Cock, P., Molenaers, G., Desloovere, K., Huenaerts, C., Jaspers, E., & Feys, H. (2010). Upper limb motor and sensory impairments in children with hemiplegic cerebral palsy. Can they be measured reliably? Disability & Rehabilitation, 32(5), 409-416. See abstract
  10. Mutlu, A., Livanelioglu, A., & Gunel, M. K. (2007). Reliability of goniometric measurements in children with spastic cerebral palsy. Medical Science Monitor, 13(7), pg 323-9. See abstract
  11. Kilgour, G., McNair, P., & Stott, N. S. (2003). Intrarater reliability of lower limb sagittal range-of-motion measures in children with spastic diplegia. Developmental Medicine & Child Neurology, 45(6), 391-399.
  12. Glanzman, A. M., Swenson, A. E., & Kim, H. (2008). Intrarater range of motion reliability in cerebral palsy: a comparison of assessment methods. Pediatric Physical Therapy, 20(4), 369-372. See abstract
  13. Ten Berge, S. R., Halbertsma, J. P. K., Maathuis, P. G. M., Verheij, N. P., Dijkstra, P. U., & Maathuis, K. G. B. (2007). Reliability of popliteal angle measurement: A study in cerebral palsy patients and healthy controls. Journal of Pediatric Orthopaedics, 27(6), 648-652. See abstract
Find out about CP Check-Up™

Cerebral Palsy Alliance offers a service called CP Check-Up™ which provides ongoing surveillance of the health and well-being of our clients aged 0-18 years.
The information on this page was developed using the best research evidence combined with the expertise of clinicians and people with cerebral palsy and their families. It is provided to help people with cerebral palsy, their families and caregivers, clinicians and service providers make decisions about suitable interventions. This information is intended to support, but not replace, information exchanged, and decisions made, between people with cerebral palsy, their families and health professionals.