PROVIDING PASSIVE RANGE OF MOTION EXERCISE

Overview: Mobility is the ability to move freely and purposefully. Mobility is essential in order for people to meet their basic needs, maintain independence, and have a good self-concept. Normal movement and stability require intact musculoskeletal and nervous system and intact inner ear structures that control equilibrium. Body movement involves four basic elements: (1) posture (body alignment), (2) joint mobility, (3) balance (stability), and (4) coordination. Range of Motion Exercises Active ROM exercises are isotonic (muscle tension is constant and the muscle shortens to produce muscle contraction and active movement). ROM exercises increase muscle strength and endurance. The client moves each joint through its complete range of motion. In addition to preventing loss of joint movement, active The nurse instructs the client to Joints should be perform each exercise three times and to do the entire series twice a day. moved to the point of slight resistance, but not to the point of discomfort. Passive ROM exercises are those in which the nurse or therapist moves each of the clients joints through its complete range of motion. Passive ROM will maintain joint flexibility but is of no value in maintaining muscle strength. Therefore, it should be used only for movements that the client cannot achieve independently. Active-assistive ROM exercises are those in which the client uses a stronger, opposite arm or leg to move of the joints of an immobile limb. The client moves the joint as much as he or she is able and the nurse then continues the movement passively to its maximal degree. Guidelines for Passive ROM Exercises Explain to the clients the reasons for the ROM exercises Dress the client in a loose gown and cover with a bath blanket Use proper body mechanics to avoid injury to self and client Position the bed at a comfortable height Expose only the limb being exercised While exercising a limb, support it above or below the joint to prevent muscle strain Move the body parts slowly and smoothly. Jerky movements can cause discomfort and injury. Fast movements may cause muscle spasms. Do not force a joint beyond its comfortable range of motion ROM should not be painful If muscle spasms occur, stop the exercise temporarily, but continue to apply gentle pressure on the part until muscle relaxes

Considerations: For elderly clients it is not essential to achieve full range of motion in all joints. Instead, emphasize achieving sufficient range of motion to carry out ADL, such as walking, dressing, combing hair, showering, and preparing a meal Equipment: Hospital bed Bath blanket as needed

PROCEDURE 1. Obtain the physicians or physiotherapists order before beginning the exercises.

The

nurse

RATIONALE should consider

any

medical The type

contraindications for each client. physician or the physical therapist.

and amount of exercises are approved by the

2. Do handwashing.

To

remove

transient

microorganisms

that

might be transmitted to the client. 3. Explain the rational for the procedure to the client. 4. Determine the clients physical ability to perform exercise, degree of ROM of joints needed to ambulate, or perform essential ADLs, presence of contracture, joint swelling, redness, or pain. client. 5. Assist the client to a supine position near the nurse, and expose the body parts requiring exercise. Place the clients feet together, place the arms at the side, and leave space around the head and the feet. 6. Return to the starting position after each motion. Repeat each motion three times. Without some form of ROM exercises, joints begin to stiffen several days of disuse and may be permanently impaired Positioning the client close to the nurse prevents excessive reaching Note amount A client at ease and relaxed about exercising can more actively take part in it. Each clients to needs will vary, with based on and

abilities, willingness exercises.

activity

level,

prognosis,

cooperate

suggested

of spontaneous movement shown by the

PROCEDURE 7. Throughout the exercise assess a. ability to tolerate the exercise b. range of motion of an affected joint 8. Neck Movement a. Remove the clients pillow

RATIONALE

b. Place the palm of one hand under To flex and extend the neck
the clients head and the palm of the other hand on the clients chin. Move the head forward until the chin rests on the chest, then back to resting supine position without the head pillow. c. Place the heels of hands on each side of the clients cheeks. the left. 9. Shoulder and Elbow Movement a. Begin each exercises with the To flex, externally rotate, and extend the shoulder clients arms at his/her side. Grasp the arm beneath the wrist with the other hand, unless otherwise indicated. b. Move the arm up to the ceiling and toward the head of the bed. head-board is in the way. c. Move the arm away from the body and toward the clients head until the hand is under the head. d. Move the arm over the body until the hand touches the clients other hand. To rotate the shoulder internally and To adduct the shoulder The elbow may need to be flexed if the To abduct and externally rotate the shoulder Move the top of the head to right and to To laterally flex the neck

externally

PROCEDURE e. Place the arm out of the side at shoulder level (90 abduction), and bend the elbow so that the forearm is at right angle to the mattress. Move the forearm down until the palm touches the mattress and then up until the back of the hand touches the bed. f. Bend the elbow until the fingers touch the chin, then straighten the arm. g. Grasp the clients and hand the for a

RATIONALE To flex and extend the elbow

To pronate and supinate the forearm

handshake

turn

palm

downward and upward, ensuring that only the forearm moves (not the shoulder). 10. Wrist and Hand Movement a. Flex the clients arm at the elbow until the forearm is at a right angle to the mattress. Support the wrist joint with one hand while your other hand manipulates the joint and the fingers. b. Bend the wrist backward, and at the same time flex the fingers, moving the tips of the fingers to the palm of the hand. Align the wrist in a straight line with the arm, and your fingers over the clients fingers to make a fist. c. Bend the wrist forward and at the same time extend the fingers. d. Move the thumb away from the fingers and then across the hand toward the base of the little finger. To abduct and oppose the thumb Flex the wrist and extend the fingers To hyperextend the wrist and flex the fingers

PROCEDURE e. Place the wrist in prone position while being held by the nurses hand on the palm then move the wrist laterally in both directions. 11. Leg and Hip Movement a. Place one hand under the clients knee ankle. b. Lift the leg and bend the knee, moving the knee up toward the chest as far as possible. Bring the leg down, straighten the knee, and lower the leg to the bed. and the other under the

RATIONALE To laterally flex the wrist

To flex and extend the hip and the knee

c. Move the leg to the side, away To abduct and adduct the leg
from the client and back across in front of the other leg. d. Roll the leg inward, then outward 12. Ankle and Foot Movement a. Place your hands in the positions described, b. b. depending on the To dorsiflex the foot and stretch the Achilles tendon motion to be achieved. Place one hand under the clients heels, resting your inner forearm against the bottom of the clients foot. Place the other hand under the knee to support it. Press your forearm against the foot to move it upward and toward the leg. c. Place on hand under the clients ankle and the other hand over the arch of the foot. foot inward, and outward. Turn the whole then turn it To invert and evert the foot To rotate the hip internally and externally

PROCEDURE foot to push the foot away from the leg. Place fingers of the other hand under the toes, to bend the toes, to bend the toes upward, and then over the toes downward. 13. Hyperextension Movements a. Assist the clients to a prone or lateral position on the side of the bed nearest the nurse. b. Remove the pillow. With the the toes

RATIONALE

d. Place one hand over the arch of the To plantarflex the foot and extend and flex

To hyperextend the neck

clients face down, place one hand on the forehead and the other on the back of the skull. head backward. c. Place one hand on the shoulder to keep it from lifting off the bed and the others under the clients elbow. Pull the upper arm up and backward. d. Place one hand on the hip to stabilize and keep it from lifting off the bed. With the other arm and hand, cradle the lower leg in the forearm, and cup the knee joint with the hand. Move the leg backward from the hip joint. In sitting position, the nurse can To circumduct the shoulder To hyperextend the hip To hyperextend the shoulder Move the

straighten the clients elbow while supporting it with one hand, and hold the clients hand on the other hand then rotate the arm in full circle. In standing position, the hip is placed through a circular motion. To circumduct the hip

PROCEDURE 14. Encourage the client to do active exercises as soon as possible. 15. Following the exercise, assess the clients pulse and endurance to the exercise. 16. Report to the nurse in charge any

Passive

RATIONALE exercises only help

prevent

contractures and retard atrophy Expect the clients pulse rate and respiratory rate to increase

unexpected problem or notable changes in the clients movements, e.g. rigidity or contractures. 17. Do handwashing 18. Document the exercises and all pertinent findings Accurate assessment and documentation are important exercsises baseline guide for later ROM