VALIDITY AND RELIABILITY

VALIDITY:
Validity refers to how well a test measures what it is purposed to measure.

Types of Validity:
 Face Validity
 Construct Validity
 Criterion-based Validity
 Formative Validity
 Sampling Validity

RELIABILITY:
Reliability is the degree to which an assessment tool produces stable
and consistent results.

Types of Reliability:
 Test-retest reliability
 Parallel forms reliability
 Inter-rater reliability
 Internal consistency reliability
GONIOMETRY AND ITS INTRODUCTION
Goniometer:
A goniometer is an instrument that either measures an
angle or allows an object to be rotated to a precise angular position.
A goniometer is a device used in physical therapy to
measure the range of motion around a joint in the body.

Goniometry:
Goniometry is an evaluating tool to make a record at
ground level and to access the patient functioning.
It is a measurement of JROM (Joint range of motion)
which is evaluative and which we can use to progn0se or anticipate
treatment protocol.
It is an accurate record of joint motion which provides
information that is necessary for determining the extent of disability.

Effective rehabilitation program:

Effective rehabilitation program includes:
MMT
ROM Assessment
Cognition Assessment
 PARTS OF A GONIOMETER
A Goniometer consists of three parts:
 Fulcrum
 Mobile Arm
 Immobile Arm
TYPES OF GONIOMETER
SYSTEMS USED IN GONIOMETRY
Three notation systems have been used to define range of motion:
0°-180°
180°-0°
360°
 0°-180°:
Upper extremity and lower extremity joints are at 0
degrees for flexion/extension and abduction/adduction when the
body is in anatomical position.
 0° is at ground level
 180° is at the level of head
 180°-0°:
ROM begins at 180° and proceeds towards 0°.
 180° is at ground level

 0° is at the level of head

 360°:
360° involves further two measurement systems:
 Flexion and abduction 180°-0°
 Extension and adduction 180°-360°
PROCEDURES USED IN GONIOMETRY
The procedure is as follows:
o Ask the patient to adopt recommended measurement position
o Place the joint in neutral position
o Now palpate bony landmarks
o Align the goniometer as:
-Fulcrum: At the joint whose range is to be measured
-Mobile arm: Along distal bone
-Immobile arm: Along proximal bone
o Measure and record the range of motion
o Repeat the process three times and take average

MEASUREMENT OF RANGE OF MOTION

Goniometer can be used to measure both active and passive joint range
of motion.

Joint Range of Motion:

It refers to movement of joint surfaces
Arthrokinematics
Osteokinematics

Active Joint Range of Motion:

 Active joint range of motion is the arc of motion attained by a
subject during unassisted voluntary joint motion
  It is the performance of measurement by the patient voluntarily
and actively
 It provides the therapist with information about the subject’s
willingness to move, coordinate, muscle strength and joint range
of motion.

Passive Joint Range of Motion:

 PROM is the arc of motion attained by an examiner without
assistance from the subject
 Normally PROM is slightly greater than AROM
 This provides the examiner with information about the integrity
of the articular surfaces and extensibility of soft tissues around
the joint

Active ranges of motion of the larger joints

JOINT ACTION DEGREES OF MOTION
Shoulder Flexion 0°-180°
Extension 0°-40°
Abduction 0°-180°
Internal rotation 0°-80°
External rotation 0°-90°
Elbow Flexion 0°-150°
Forearm Pronation 0°-80°
Supination 0°-80°
Wrist Flexion 0°-60°
Extension 0°-60°
Radial deviation 0°-20°
Ulnar deviation 0°-30°
Hip Flexion 0°-100°
Extension 0°-30°
Abduction 0°-40°
Adduction 0°-20°
Internal rotation 0°-40°
External rotation 0°-50°
Knee Flexion 0°-150°
Ankle Plantarflexion 0°-40°
Dorsiflexion 0°-20°
Foot Inversion 0°-30°
Eversion 0°-20°

Active range of motion norms for the hand and fingers

Motion Degrees
Finger flexion MCP:85°-90°; PIP: 100°-115°; DIP: 80°-90°
Finger extension MCP:30°-45°; PIP: 0°; DIP: 20°
Finger abduction 20°-30°
Finger adduction 0°
Thumb flexion CMC: 45°-50°; MCP: 50°-55°; IP: 85°-90°
Thumb extension MCP: 0°; IP: 0°-5°
Thumb adduction 30°
Thumb abduction 60°-70°

Normal ranges of motion, and end feels, for the toes[2, 3]

Motion Normal Range (Degrees)

Toe flexion Great toe: MTP, 45º; IP, 90º
Lateral four toes: MTP, 40º; PIP, 35º; DIP, 60º
Toe extension Great toe: MTP, 70º; IP, 0º
Lateral four toes: MTP, 40º; PIP, 0º; DIP, 30º

Factors Affecting Range of Motion

 Age:
Flexibility and laxity in early decades of life are more and
decrease with aging due to degeneration of joints
 Gender Difference:
Females have more laxity due to release of hormones prolactin
and Relaxin hormones which make ligaments more flexible
 Diseases:
-Hypermobility: Increased abnormal laxity
-Hypomobility: Decreased JROM i.e. in Arthritis
 Muscular factors:
-Lacerations
-Sprain/Strain
 Nervous system
 Bony structure of the joint
 Arthroplasty
RECORDINGS
Recordings are done in a well-controlled environment, the room
being airy, well-lighted, having enough space to provide
evaluation process
Instruments should follow the measurement procedure
The patient should be aware of the procedure to gain cooperation
Lack of cooperation leads to incomplete JROM and improper
measurements
Joint to be assessed should be uncovered along respective limb
Starting position of the patient should be stable i.e. mostly lying
to avoid substitution
Before performance patient should be instructed verbally or be
given demo to avoid any mishap
If possible then passive demonstration should be given to patient
Readings should be done quickly to avoid fatigue
CAPSULAR PATTERNS OF JROM

When certain soft-tissue pathologies are present, many joints have a

characteristic pattern of limited movement. Each pattern of movement
limitation is unique to a particular joint. This movement restriction is
caused by dysfunction in the joint capsule. Consequently it’s called the
joint capsular pattern.

Capsular Patterns of Joints Throughout the Body:

JOINT CAPSULAR PATTERN

Temporomandibular Opening

Extension & side flexion equally

Occipitoatlanto
Limite
d
 Side flexion & rotations equally

Cervical Spine limited,

Extension

Lateral rotation, abduction, medial

Glenohumeral
rotation

Sternoclavicular Pain at extreme range of movement

Acromioclavicular Pain at extreme range of movement

Humeroulnar Flexion, extension

Flexion, extension, supination,

Radiohumeral
pronation

Proximal Radioulnar Supination, pronation

Distal Radioulnar Pain at extremes of rotation

Wrist Flexion & extension equally limited

Trapeziometacarpal Abduction, extension

MCP and IP Flexion, extension

Side flexion & rotation equally

Thoracic Spine limited,

Extension

Side flexion & rotation equally

Lumbar Spine limited,

Extension

SI, Symphysis Pubis, &

Pain when joints stressed
Sacrococcygeal
 Flexion, Abduction, medial rotation
Hip
(order varies)

Knee Flexion, extension

Tibiofibular Pain when joint stressed

Talocrural Plantar flexion, dorsiflexion

Limitation of varus range of

Subtalar (Talocalcaneal)
movement

Dorsiflexion, plantar flexion,

Midtarsal adduction, medial

rotation

First MTP Extension, flexion

Second to Fifth MTP Variable

IP Flexion, extension
NON-CAPSULAR PATTERNS OF JROM

When no capsule is involved, specific movements are limited and

restricted due to specific intra-articular or extra-articular tissue damage
over a local area. It is specifically:
“Limitation of passive motion that is not proportional similarly to a
capsular pattern”

Limitation of Movements:
Only one or two movements are limited over the affected
area.

Causes of Non-Capsular Patterns:

 Overlying structures
 Internal joint derangement
 Ligamentous injuries
 Bursitis
 Muscular strains
 Fasciitis
 END FEELS

End feel is the sensation felt at the joint at the end of range of motion.
o It is an evaluative process done to test normality or abnormality
o Detection is through hands of examiner
o It is performed passively
o It is a specific feel that requires practice to assess with perfection
o Skill requires practice and sensitivity
o Hearing and attitude of the examiner play major role
o Movements are performed gradually
Normal End Feels:
Normal end feels are:
 Soft End Feel
 Firm End Feel
 Hard End Feel
Soft End Feel:
Soft end feel is felt when soft tissues approximate. The muscle
belly, ligaments and tendons are not stretched.
e.g. Knee Flexion, Elbow Flexion
Firm End Feel:
Firm end feel is felt due to muscular, capsular, and
ligamentous stretch.

e.g. Hip Flexion

 Hard End Feel:
Hard end feel is felt due to bone to bone approximation.
e.g. Elbow Extension

Normal End Feels of Joints of Body

Hip Flexion
0°-120°; soft end-feel
Hip Extension
0°-20°; firm end-feel
Hip Abduction
0°-45°; firm end-feel
Hip Adduction
0°-30°; firm end-feel
Hip Internal Rotation
0°-45°; firm end-feel
Hip External Rotation
0°-45°; firm end-feel
Knee Flexion
0°-135°; soft (compression) end-feel
Knee extension
135°-0°; firm end-feel
Dorsiflexion
0°-20°; firm end-feel
Plantarflexion
0°-50°; firm end-feel
Ankle Inversion
0°-35°; firm end-feel
Ankle Eversion
0°-15°; firm or hard end-feel
Shoulder Flexion
0°-180°; firm end-feel
Shoulder Extension (Hyperextension)
0°-60°; firm end-feel
Shoulder Abduction
0°-180°; firm end-feel
Shoulder Adduction
0° (not typically measured; starting point for abduction)
Internal Rotation
0°-70°; firm end-feel
External Rotation
0°-90°; firm end-feel
Elbow Flexion
0°-150°°; Soft end-feel
Elbow Extension
150°-0°; hard end-feel
Forearm Pronation
0°-80°; hard or firm end-feel
Forearm Supination
0°-80°; firm end-feel
Wrist Flexion
0°-80°; firm end-feel
Wrist Extension
0°-70°; firm end-feel
Wrist UD
0°-30°; firm
Wrist RD
0°-20°; Hard or Firm
Thumb Flexion (CMC)
0°-15°; soft end-feel
Thumb Extension (CMC)
0°-20°; Firm end-feel
Thumb Abduction (CMC)
0°-70°; Firm end-feel
Thumb Adduction (CMC)
0°-70°; Firm end-feel
Thumb Flexion (MCP)
0°-50°; Firm end-feel
Thumb Extension (MCP)
0°
Thumb Flexion (IP)
0°-80°; firm (in some hard) end-feel
Thumb Extension (IP)
0°-20°; firm
Digits 2-5 Flexion (MCP)
0°-90°; hard end-feel
Digits 2-5 Extension (MCP)
0°-45°; Firm end-feel
Digits 2-5 Flexion (PIP)
0°-100°; hard end-feel
Digits 2-5 Flexion (DIP)
0°-90°; firm
Cervical Flexion
0°-45°; firm
Cervical Extension
0°-45°; Firm
Cervical Rotation
0°-60°; Firm
Cervical Side-Bending
0°-45°; Firm
Trunk Flexion
0°-80°; Firm
Trunk Extension
0°-25°; Firm

ABNORMAL END FEELS

Abnormal end feels are:
 Soft End Feel
 Firm End Feel
 Hard End Feel
 Springy End Feel
 Empty End Feel
Soft/Springy End Feel:
It is felt at place of hard or firm end feels. Its causes are:
 Tumor
 External Swelling
 Bursitis
 Synovitis
 Soft Tissue Edema
 Firm End Feel:
It is felt at place of soft and the movement stops before approximation
of soft tissues. Its causes are:
 Opposite Muscle Contractures
 Tightening of Muscles
 Increased Muscle Tonus
 Ligamentous Shortening
 Fascial Shortening
Hard End Feel:
Its causes are:
 Chondromalacia
 Loose Bodies in Joints
 Osteoarthritis
 Myositis Ossificans
Empty End Feel:
No movement occurs, no end of ROM and no resistance is felt. Hence
no real end feel is felt. Causes are:
 Fracture
 Bursitis
 Rheumatoid Arthritis
 Abscesses
 psychogenic