A clinician has a distal radius fracture and the OT requests focusing on pain-free motion within functional ROM. How should the COTA assist in determining functional ROM?

• A. Assist the client in identifying activities the client wants or needs to be able to accomplish with the affected extremity and incorporate practice of these specific activities
• B. Measure passive ROM to determine the available range of the affected extremity and then focus on place and hold exercises within that available range
• C. Review the evidence to determine specific measurements that correspond to functional ROM and then formulate functional ROM goals for the client
• D. Use goniometric measurements of the unaffected extremity to create ROM goals for the affected extremity

Answer: (A)

Functional ROM is defined by the amount of motion a person actually needs and can safely use to perform meaningful tasks, with motion that remains within pain-free limits. The best way for the COTA to assist is to work with the client to identify activities they want or need to accomplish with the affected hand and then practice those specific tasks within the client’s current pain-free range. By tailoring practice to real-life tasks, the clinician can observe how much ROM is sufficient for daily activities, set practical goals, and gradually progress tasks as tolerance improves. This approach emphasizes the client's priorities, supports motivation, and yields a functional target rather than relying on abstract ROM numbers.

Focusing only on passive ROM measures defines what motion could be achieved with the joint but not how it translates to function, and place-and-hold exercises within that range may not reflect how the hand is used in real activities. Looking to literature for preset functional ROM measurements can miss the individual’s daily-life needs, and using the unaffected side to set goals may misrepresent what’s achievable or necessary on the injured side.