Goniometry the technique of quantifying human joint position or range of motion What do goniometers assess?

? Ans: impairment (goniometry assesses range of motion which is consider an impairment on Nagis disab ement mode !easurement too s "ni#ersa goniometer p astic or meta protractor i$e de#ice with mo#eab e and stationary arms of #arying engths %gra#ity dependent goniometers inc inometers &pendu um &f uid (bubb e' %report position of dista or pro(ima segment re ati#e to the ine of gra#ity requiring the adjacent segments to be positioned #ertica y or hori)onta y %e ectrogoiniometers *potentiometer detects changes in position of two segments %radiographs %photographs +these de#ices are genera y on y used in research app ications Goniometric procedure ,(p ain-demonstrate procedure .osition and drape appropriate y /bser#e or measure unin#o #ed and A0/! first !a$e #isua estimation of motion ,nsure pro(ima stabi i)ation .0/! with identification of end fee 1andmar$ identification through pa pation A ign measurement de#ice in neutra or )ero position !easure end range position 2ocument findings and compare to norma s or unin#o #ed .ositioning Not standardi)ed 3tart in reference 4)ero5 position * 2ocument if )ero position cant be achie#ed

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.ermit comp ete range of motion A#oid position that put biarticu ar musc es in position of passi#e insufficiency 6nee e(tensor f e(ibi ity #s7 6nee f e(ion range of motion ,nsure pro(ima segment stabi ity

2e#ice a ignment 87 ,(pose andmar$s 97 .osition a(is or fu crum * :on#e( pi#ot point * A(is may mo#e with motion * .rioriti)e arm a ignment o#er a(is a ignment ;7 A ign pro(ima arm * 3tationary arm para e to the ong a(is of the segment <7 A ign dista arm * !o#ing arm para e to the ong a(is of the segment 3tabi i)ation Are you assessing functiona abi ity or iso ated joint motion? "nre iab e measures if inconsistent monitoring of substitution !ust anticipate compensatory motions * 3ubta ar joint pronation to increase an$ e dorsif e(ion 0/! * 1umbar hypere(tension to increase shou der f e(ion * =aw opening to increase cer#ica f e(ion * >run$ atera f e(ion to increase hip rotation What wou d you rather $now? What is imiting the motion you ha#e? * ?rom an inter#ention standpoint it may be more important to $now what is imiting the motion as opposed to ha#e much you ha#e because that information wi he p you pic$ the appropriate inter#ention

,nd fee nature of the motion barrier that characteri)es the type of tissue imiting range 3oft ?irm @ard As goniometry error free? .otentia sources of error ?ai ure to read at eye e#e causing para a( distortion Ancorrect andmar$ identification ?ai ure to read proper sca e 1ac$ of patient cooperation 0equires consistent repeatab eB and reproducib e measurements ha#e: 0,1AACA1A>D 0e iabi ity !easurement is consistentB repeatab e and reproducib e Goniometric re iabi ity is ma(imi)ed by standardi)ed: 87 !easuring de#ice 97 .ositioning and andmar$s ;7 .rocedure <7 ,(aminer @igher re iabi ity in measuring a position than a motion ", measurements Ethan 1, measurementsE than spine measurements Antratester (FG degrees' better than intertester (EG degrees' Huestionab e rea iabi ity benefit to using mean of measurements

Goniometric #a ue actua y represents the angu ar re ationship of the two articu ating segments Ia idity assumes re iabi ity :riterion #a idity (using radiographs as the go d standard' has genera y been estab ished in the iterature

2ocumentation WN1 unacceptab e un ess referenced * AA/3B 6nda B @oppenfie dB A!A impairment :ompare in#o #ed to unin#o #ed sides compare to subjects of simi ar age and gender ,(amp es of imited range documentation J*8G9 degrees (0' pain free passi#e e bow f e(ion with soft tissue end fee K*J*LG degrees (1' passi#e $nee motion with capsu ar end fee and symptom reproduction at end range f e(ion A ways use a third #a ue to indicate neutra position if motion e(its on each side of the neutra position 1inear a ternati#es 3hou der * ?unctiona reach tests @and * >humb opposition * ?ingertip to pa m 6nee * .rone hee height :er#ica spine * ? e(ion e(tension (sterna notch' * :er#ica 1?-0otation (acromion' 1umbar spine * 3pinous process distraction * ?ingertip to f oor 3hou der ,(ce ent intratester re iabi ity 3uspect intertester re iabi ity (e(cept e(t7 0otation'

!easures that repreent the true #a ue are: IA1A2 Ia idity !easurement represents the true #a ue of the #ariab e ,(tent to which the measurement fu fi s its purpose

?unctiona reach tests good a ternati#e

, bow . us-minus 9*K degrees intratester #ariation for f e(ion* e(tension . us-minus L*8J degrees intratester #ariation for pronation supination .ro supination re iabi ity beswt with dista arm para e to forearm Acceptab e re iabi ity for both uni#ersa goniometers and f uid based inc inometers Wrist*hand . us minus G*L degrees intrateste;r #ariation for wrist f e(ion e(tension . us minus M*8J degrees intertester #ariation for wrist f e(ion e(tension 2orsa goniometer p acement genera y accepted as preferred method for finger A. f e(ion e(tension assessment 3pine 0e iabi ity and criterion #a idity has been estab ished for inc inometry and is the recogni)ed standard of motion assessment A ternati#e methodo ogies * "ni#ersa goniometer * ? e(ib e ru er * >ape measure attraction distraction * ?inger tip to f oor measurements @ip Coth inc inometers and goniometers ha#e acceptab e intratester re iabi ity but are not interchangeab e Antertester re iabi ity has not been estab ished 1owest coefficient of #ariance for f e(ion 0/!B e(tension 0/! the highest

>ibia rotation 0/! re iabi ity has not been estab ished An$ e foot ,(ce ent intratester re iabi ity for p antar dorsif e(ion ?air to good intertester re iabi ity for p antar dorsif e(ion ?air intratester re iabi ity for 3>= in#ersion e#ersion .oor intertester re iabi ity for 3>= in#ersion e#ersion

6nee ,(ce ent intra and intertester goniometric re iabi ity for $nee f e(ion range of motion