The following information has changed since the original video was produced.
Please note:
1. The current version of the Range of Motion page does
not include the normal ranges as a point of reference.
2. The definition of a target joint as portrayed on screen and in
the Joint Range of Motion Reference Guide (Pg 2) is incorrect.
The correct definition of target joint is a joint which
has sustained four or more bleeds in the past six months.
You'll find measuring ranges of motion is a basic skill
and, like most skills, it becomes easier
and requires less time to do after repeated practice.
Let's look at the Annual Visit form.
Turn to the last page of the form,
where the end points of each range of motion measurement
will be recorded.
Also, refer to your Range of Motion Reference Guide
for the definitions you'll be using
to complete the other columns.
You will measure five different joints --
the hip, the knee, the shoulder, the elbow, and the ankle.
The measurements taken on the left side of the body
will be recorded in the left column.
Those taken on the right side
will be recorded in the right column.
The normal ranges are included as a point of reference.
In the next two sections of the form,
the format is different.
The information related
to the joints on the patient's left side are recorded
above the information for the right side.
The middle column is checked
for any joints that qualify as target joints.
A "target joint" is any joint which has bled 4 or more times
in the most recent 6-month period
or a total of 20 times ever.
You will obtain this information from the patient's history.
The next column is used to indicate
why a joint is not being measured.
Circle the appropriate letter based on the codes listed
at the top of the form.
These are -- A. for an Acute Bleed.
This means there has been bleeding into the joint
within 24 to 48 hours prior
to the time you're taking the measurement.
B is for Postoperative Restrictions.
These are doctors' guidelines
that the patient must follow after surgery
which require limiting joint use.
As a result, you cannot obtain an accurate measurement.
C. Other Medical Reason.
For example, a patient has an IV or a port
restricting access to the joint.
If a joint range is not being measured,
be sure to leave the range end point box
blank for that joint.
The next column is for you to note if a patient has used
any type of orthopedic appliance since the last annual visit.
Circle the appropriate letter,
based on the codes listed at the top of the form.
Again, the complete definitions
are located in the Reference Guide.
Let's review what these codes mean
and the devices they represent.
Circle a D in the box if the patient has had a Cast --
a rigid plaster or fiberglass dressing used
to immobilize a body part.
Circle E if the patient has used a Splint
since his last annual visit.
These are usually temporary, made of lightweight plastic,
to limit motion and rest a joint during an acute injury or bleed.
Circle F for Orthosis.
These are usually custom-made, of durable plastics,
to provide long-term support to a joint.
Patients usually wear them at all times,
except during sleep.
This includes ankle-foot othoses, or AFOs,
and orthotics.
Circle G for Braces, which are generally prefabricated
and used intermittently,
often during recreational or work activities,
to provide extra stability and support to a joint.
They often have metal or plastic stays.
This includes ACE wraps, air splints,
and neoprene sleeves.
In the final column, circle the appropriate letters
for any invasive procedures that have been done on a joint
since the last annual visit.
The codes for these letters are listed at the top of the form
and the definitions are in the Reference Guide.
Let's review the definitions.
H. Arthrodesis -- a surgical fusion of the joint.
I. Joint Replacement --
a total or partial replacement of the joint.
J. Arthroscopic Synovectomy --
removal of synovial tissue using arthroscopic techniques
through two to three small incisions.
K. Open Synovectomy --
removal of synovial tissue by fully opening the joint
using a large incision or incisions.
L. Radioisotopic Synovectomy -- removal of synovial tissue
by injecting a radioactive substance into the joint.
M. Other Invasive Procedure.
For example, artificial joint revision or removal.
Note -- for the orthopedic appliances
or invasive procedures, if more than one
has been used or occurred since the last annual visit,
circle the appropriate letter for each one that applies.
That's it for the form, except one last thing.
A space is provided to check whether the measurements
were taken by a physical therapist
or other health care provider, such as a nurse or a physician.