RANGE OF MOTION

1. Definition of ROM
Range Of otion (ROM) exercise is an exercise that can be done to maintain or
improve the level of perfection ability to move joints normally and complete to
increase muscle mass and muscle tone (Potter & Perry, 2005).
Range Of Motion (ROM) exercise is a standard term to define the limits of
normal joint movement and as a basis to determine abnormalitiess or to declare the
limit abnormal joint movement (Arif, M, 2008).
ROM is the degree to measure the ability of bones, muscles and joints to
perform movement.
ROM is a normal movement can be done by the respective joints (Suratun, et
al, 2008).
ROM is an exercise of muscle or joint that given to patients with limited joint
mobility because of disease, disability or trauma
ROM is the maximum movement that can be done by joint movement in one
of the three pieces of the body: sagittal (left - right), frontal (front - rear) and
transfersal (top - bottom).
ROM is joint exercise that allow the contraction joints and muscle movement,
where the client moves each joints based on normal joint either actively or passively
(Potter and Perry, 2006).

2. Kinds Of ROM
There are two kinds of ROM, such as :
a. Active ROM
Active ROM is movement that can be done by patient by using their own
energy. Nurses should give motivation, and guiding clients in implementing the
movement by their self with the normal joint movement (active clients). Muscle
strength 75%.
It is to train flexibility and muscle strength and joint by using the active
muscles. Joints can be moved in active ROM is joints throughout the body from
head to toe by client actively.
 b. Passive ROM
Passive ROM is the energy that expended to practice comes from another
person (nurse) or a mechanical device. Nurse does joint movement of client based
on normal movement. Muscle strength 50%.
Indication of passive exercise is semikoma and unconscious patients, patients
with limited mobility has not able to do some or all of the range of motion
exercises with independent, complete bed rest patients or patients with paralysis
total extremity (suratun, et al, 2008).
Passive range of motion is useful to maintain the flexibility of muscles and
joints to move the muscles passively, for example nurse lifts and moves the
patient's legs. The joints are driven in passive ROM is the whole joints of the body
or only in the affected limb and the client is not able to do it independently.

3. Basic Principles of ROM Exercise

a. ROM must be repeated about 8 times and done at least 2 times a day
b. ROM must be done slowly and carefully so that it will not exhausting the patient.
c. In planning the exercise of ROM, note the patient's age, diagnosis, vital signs and
duration of bed rest.
d. The parts of the body that can be done ROM exercise are neck, fingers, arms,
elbows, shoulders, ankles, feet, and ankles.
e. ROM can be done on all the joints or just the parts that the suspect suffered the
disease process.
f. Doing ROM should match the time. For example, after a bath or routine
maintenance has been done.

4. Purpose of ROM
a. Maintain the flexibility and muscle strength
b. Maintain joint mobility
c. Stimulates blood circulation
d. Prevent deformity, stiffness and contractures
e. Maintain cardiac and respiratory function

5. Benefits of ROM
a. Fixing muscle tone
 b. Improve joint mobilization
c. Repairing muscle tolerance to exercise
d. Increasing muscle mass
e. Reduce bone loss

6. Indications and Target of ROM

a. Active ROM:
1) Indications:
a) when patient can do active muscle contraction and move the joint sections
either with the help or not.
b) When the patient has weakness of muscle and can not move the joints
completely, use A-AROM (Active-Assistive ROM, is a type of active
ROM which help is provided by an outside force whether manually or
mechanically, because primary mover muscles needs help to complete the
movement).
c) Active ROM can be used for aerobic exercise program.
d) Active ROM is used to maintain the mobilization of segments above and
below the area that can not move.

2) Target:
a) If there is no inflammation and contraindications, target of Active ROM is
similar with Passive ROM.
b) Physiological advantage from active muscle contraction and learning
movement of control voluntary movement.

3) Specific Target
a) Maintain physiological elasticity and contractility of the muscles involved
b) Provide sensory feedback from muscle contraction
c) Provide a stimulus for bone and joint tissue integrity
d) Increase circulation
e) Develop coordination and motor skills

b. Passive ROM
1) Indications:
 a) In areas where there is acute tissue inflammation which, if active
movement is done would hinder the healing process
b) When the patient can not or not allowed to be active in the segment or the
entire body, such as coma, paralysis or total bed rest
2) Target :
a. Maintaining mobility of joints and connective tissue
b. Minimize the effect of the formation of contractures
c. Maintaining the mechanical elasticity of muscle
d. Helping the smooth circulation
e. Increase synovial movement for nutrition of cartilage and joints diffusion
f. Reduce or prevent pain
g. To help the healing process after injury and surgery
h. To help maintain awareness of the movement of the patient

7. Contra Indications and Things That Must Be Worried of ROM Exercise

a. ROM exercises should not be given if the movement can disturb the healing
process of the injury.
Controlled movement carefully in the limits of pain-free movement during the
early phase of healing will demonstrate the benefits of the healing and recovery
There are too much signs or wrong movements can increase pain and
inflammation
b. ROM should not be done if the patient's response or harmful condition (life
threatening)
PROM is done carefully in the large joints, while AROM at the ankle and foot
joints to minimize venous stasis and thrombus formation. After myocardial
infarction, coronary artery surgery, and others, AROM in the upper limb can be
given the strict supervision

8. The Limitations on Exercise ROM

a. Active ROM
- For the strong muscles will not maintain or increase the strength.
- Will not develop skill or coordination except by using movement pattern.
b. Passive ROM
Passive ROM can not be:
 - Prevents muscle atrophy
- Increases strength and endurance
- Helps circulation

9. Kinds of ROM Movement

There are many kinds of ROM movements such as :
a. Flexion, is reduce the corner joints.
b. Extension, is increasing corner joints.
c. Hyperextension, is further extensions.
d. Abduction, is a movement far away from the midline of the body.
e. Adduction, is a movement near from the midline of the mody
f. Rotation, is the movement around the center of the bone.
g. Eversion, is rotation of the feet to the outside, into the corner joints.
h. Inversion, is rotation of the feet to the inside, into the corner joints.
i. Pronation, is the movement of the palm which the surface of the hand moves
down.
j. Supination, is the movement of the palm which the surface of the hand moves up
k. The opposition, is a movement of touching the thumb movement to the fingers on
the same hand.

10. Movement ROM Based on Body Parts

According to Potter & Perry, (2005), the ROM consists of motion in the joints such as
:
a. Neck

Flexion Moving the chin to the chest range of 45 °

Extension Returning the head to the upright position, the range of

45 °
Hiperextension Bend head backwards as far as possible, the range of 40-
45 °
Lateral Tilting the head as far as possible as far as possible in the
Flexion direction of each shoulder, range of 40-45 °
Rotation Rotate the head as far as possible in a circular motion,
 the range of 180 °

b. Shoulder

Flexion Raising the arm from the position next to the body
forward to a position above the head, the range of 180 °

Extension Restore the arm to a position on the side of the body,

the range of 180 °
Hiperextension Move the arm to the back of the body, elbows stay
straight, range 45-60 °
Abduction Raise the arms to the side position over the head with
the palms away from the head, the range of 180 °
Adduction Lower the arm to the side and cross body as far as
possible, the range of 320 °
Internal With elbow flexion , rotate the shoulders to move the
Rotation arm to the thumb facing inwards and backwards, range
of90 °
Eksternal With elbow flexion, thumb drive arm up to the top and
Rotation sides of the head, range of90 °

Sirkumduction Moving the arm with a full circle, the range of 360 °
c. Elbow

Flexion Move the elbow so that the arm moves forward

shoulder shoulder joint and shoulder parallel hand, the
range of 150 °
Extension Straighten the elbow by lowering the hand, the range of
150 °

d. Forearm
Supination Rotate the forearm and arm so that the palms facing
upward, the range of 70-90 °
Pronation Rotate the forearm to the palm facing down, the range
of 70-90 °

e. Wrist
Flexion Moving the hands to the sides of the inside of the
forearm, the range of 80-90 °
Extension Moving the fingers so that fingers, hands, forearms are
in the same direction, range of 80-90 °

Hiperextension Bringing the dorsal surfaces of the hands back as far as

possible, the range of 89-90 °
Abduction Bending the wrist tilt to thumb, range of 30 °

Adduction Bending the wrist tilt towards the five fingers, the range
of 30-50 °

f. Finger

Flexion Make grip, range of 90 °

Extension Straighten the fingers, range of 90 °

 Hiperextension Moving the fingers backwards as far as possible, range
of 30-60 °
Abduction Stretch the fingers of one hand with the other, the range
of 30 °
Adduction Pressed back fingers, range of 30 °

g. Thumb

Flexion Moving the thumb crossed palm surface, rangeof 90 °

Extension moving the thumb straight away from the hand, range
of 90 °
Abduction Distanced thumb sideways, range of 30 °

Adduction Moving the thumb to in front of the hand, the range of

h. Hips 30 °
Flexion Moving forward and upper limbs, the range of 90-120 °

Extension Moving back to the other side of the leg, the range of
90-120 °
Hiperxtension Moving the legs to the back of the body, the range of
30-50 °
Abduction Moving the legs to the side away from the body, the
range of30-50 °
Adduction Moving the legs back to the position of the media and
more than it if possible, the range of 30-50 °
i. Knee

Flexion Moving the heel to the back of the thigh, the range of
120-130 °
Extension Restore the leg to the floor, the range of 120-130 °
j. Ankle

Dorsiflexion Moving the foot so that the toes bend upward, range of
20-30°
Plantarflexion Moving the foot so that the toes bend upward, range of
45-50°

k. Foot

Inversion Rotate the feet to the side in, range of 10 °

Eversion Rotate the feet to the outer side, the range of 10 °

f. Toes

Flexion Bend the toes down, the range of 30-60 °

Extension Straighten the toes, the range of 30-60 °

Abduksi Moving toes with the other, range of 15 °

Adduksi Closed back together, the range of 15 °