1.

) Define the following terms

Abduction – Moving an extremity away from the body.

Adduction – bringing an extremity towards the body.
Circumduction – movement of the distal part of the bone in a circle while the proximal
end remains fixed.
Dorsal Flexion – movement of the foot toward the shin.
Eversion – turning of a body part away from the midline.
Extension – increasing the angle joint, straightening a flexed or bent joint.
External Rotation – a body part turning away from the midline of the body.
Hyperextension – the state of exaggerated extension, movement of the body part beyond
its normal resting extended position.
Immobility – incapable of being moved, unavoidable restriction of the arm in any area of
a person’s body.
Inversion – turning toward, inside out, upside down or other reversal of the normal
relation of a part.
Muscle atrophy – muscles wasted/withered away or failure to develop from lack of food
and use.
Plantar flexion – movement of the foot toward the plantar surface (sole of the foot).
Pronation – moving the bones of the forearm so that the palm of the hand faces
downward when held in front of the body.
Protraction – moving a part of the body forward in the same plane parallel to the
ground.
Retraction – moving a part of the body backward in the same plane parallel to the
ground.
ROM exercise – the totality of movement possible of a joint in one of the three planes:
frontal, transverse, and sagittal.
Rotation – is a movement in which the bone moves around a central point without being
displaced, such as turning the head from side to side.
Atony – absence of muscle tone or lack of normal muscle tone.
2.) State the effects of ROM on major body systems

A.) Musculoskeletal System

1 Muscle mass increase progressively.

2 Increase in speed, strength, resistance to fatigue, reaction time and coordination
due to the increase in muscle tone and nerve conduction.
3 Bones become stronger.
4 Improves mobility of the parts of the musculo-skeletal system.

B.) Cardio – Respiratory System

1 Respiratory efficiency is increased.

2 Increased arterial elasticity.
3 Heart rate easily responds to stress and immediately returns to normal.
4 Increased blood circulation.
5 ROM exercises helps function the cardio-respiratory system.

3.) State the factors that affect ROM exercises

1 Clinical status of the patient

2 Secondary diagnosis
3 Patient’s age
4 Timing
5 Resistance
6 Environment
7 Gender
8 Lifestyle
9 Nutrition
10 Individual Energy
4.) Identify the various ROM exercises

4.1) Isotonic exercise – Dynamic; All lifting exercises require Isotonic contractions. This
happens when the muscle shortens as it contracts; causes muscle contraction and change
in muscle length, constant muscle tension and shortening of muscles. An example of
isotonic contraction can be seen when we flex the bicep muscle. In fact, Isotonic
contractions are the most common, many exercises and activities involve this type of
contraction.

• lifting objects above the head - front shoulder (anterior deltoid) shortens
• lifting object up from lying position - chest muscle shortens
• lifting body up from squat position - quadriceps muscle shortens as legs extend
• doing a sit up
• throwing a ball
• swinging a bat
4.2) Isometric exercise – Static; produce a mild increase in blood flow to other parts of
the body. An Isometric contraction occurs when there is tension on a muscle but no
movement is made causing the length of the muscle to remain the same. This type of
contraction is also referred to as a static contraction. Some bodybuilders make up their
own exercises using Isometric contraction in order to develop strength, an example is
when someone attempts to curl one arm upwards but is held by using equal resistance
from the other arm.

• attempting to lift an immoveable object

• holding a weight at arm's length

• some wrestling movements

4.3) Isokinetic exercise – Resistive; involves tension against joint movement. Similar to
the Isotonic contraction, the Isokinetic contraction causes the muscle to shorten as it gains
tension. The difference is Isokinetic requires a constant speed over the entire range of
motion, therefore this type of contraction require special equipment to exercise properly.
An example is an arm stroke when swimming, the even resistance from the water offers a
constant speed at maximal contractions.

• One good beginning exercise is to use a stationary bicycle that can be set to only
allow a certain number of revolutions per minute. This helps to set the level of
resistance and thus prevent the individual from doing too much too fast. As the
leg muscles develop and can accommodate more resistance, the setting can be
altered to meet the needs of the individual.
4.4) ROM exercise
• Active - Active exercises are performed by the patient, without assistance, to
increase muscle strength.

• Passive - These exercises are carried out by the nurse without assistance from the
patient or by mechanical equipment. Passive exercises will not preserve muscle
mass or bone mineralization because there is no voluntary contraction,
lengthening of muscle, or tension on bones.

• Active-assistive - These exercises are performed by the patient with assistance

from the nurse. Active assistive exercises encourage normal muscle function
while the nurse supports the distal joint.
5.) Discuss the following principles involves in the performance of ROM

A.) Anatomy

- ROM secure bones together and they allow skeletons to be mobile. Muscles are
involved in rest and exercise.

B.) Physiology

- When moving a segment through its ROM, all structure in the region are
affected: muscles, joint surface capsules, ligaments, fascia, vessels and nerves.

C.) Physics

- Segments of a particular body part can be moved and stopped with an aid of
external force.

D.) Psychology

- Promotes the well – being of the patient

E.) Chemistry

- ROM increase blood circulation which facilitates the distribution of nutrients.

F.) Body Mechanics

- Use of proper body mechanics when placing patients in ROM exercises.

6.) Explain the guidelines involved in the performance of ROM exercises.

a.) Plan when range of motion exercises should be done. Involve the patient in planning
the program of exercises and other activities because he/she will be more apt to do the
exercises voluntarily.
b.) Position yourself so that proper body mechanics can be used.
c.) It is optimal to warm up before stretching vigorously
d.) Start gradually and move slowly using smooth and rhythmic movements appropriate
for the patient's condition.
e.) Support areas of poor structured integrity.
f.) To increase flexibility, the muscle must be overloaded or stretched beyond its elastic
ROM, but not to the point of pain
g.) Stretch the muscles and keep the joint flexible.
h.) Move each joint until there is resistance, but never force a joint to the point of pain.
i.) Exercise caution when stretching muscles around painful joints
j.) Avoid over-stretching ligaments and capsules that surround joints
k.) Use caution if there is history of steroid use
l.) Use caution stretching patients with known or suspected osteoporosis, or who have
been on prolonged bed rest
m.) Ballistic stretching should be done only by patients who are already flexible
n.) Use caution stretching patients with frail integument
o.) Use caution stretching older patients because their collagen loses its elasticity and
they have reduced capillary blood supply
p.) Keep friction at a minimum to avoid injuring the skin.
q.) Return the joint to its neutral position
r.) Stretching should be performed at least 3 times per week, but between 5 and 6 will
yield maximal results

.
7.) Enumerate the indications and contradictions of ROM exercise.

Indications:

• Essential for establishing normal ROM of joints and soft tissue

• Important decreasing risk of injury to the musculotendinous unit
• Prevent contractures and adaptive shortening
• Combats the effects of prolonged immobilization
• Optimal flexibility will reduce stresses to surrounding joints and tissues

Contraindications: Do not stretch…

• Around acutely inflamed or infected joints

• Patients who are already hypermobile
• Patients when shortened muscles are providing stability if normal joint stability is
decreased or assists with functional abilities such as in persons with paraparesis
• Across a joint when a bony block prevents motion

Patients who are: (still under Contraindications)

a.) Immobilized patients

b.) Paralyzed patients
c.) Patients with weak musculature
d.) Heart and Respiratory Diseases
e.) Connective Tissue Disorders

Range of motion exercises require energy and tend to increase circulation.

Increasing the level of energy expended or increasing the demand for circulation is
potentially hazardous to patients with heart and respiratory diseases. Range of motion
exercises put stress on the soft tissues of the joint and on the bony structures. These
exercises should not be performed if the joints are swollen or inflamed or if there has
been injury to the musculoskeletal system in the vicinity of the joint.
8.) Demonstrate the beginning skills in performing ROM exercise.

a.) Neck Hyperextension and Neck flexion

• Support the client's neck and bring the chin toward the chest and then as far back
in the opposite position as possible.
- Flexes and hyperextends the neck.

b.) Flexion and Extension of the elbow

• Place the arm at the client's side and bend the forearm toward the shoulder, and
then strengthen it again.
- Flexes and extends the elbow
c.) Flexion and Extension of the wrist

• Bend the wrist forward and then backward - moves the wrist from flexion to
extension and then hyperextension
• Twist the wrist to the right and then left - rotates the wrist joint

d.) Abduction and Adduction of the wrist

• Bend the thumb side of the hand way from the wrist and then in the opposite
direction.
- Provides Adduction and then Abduction of the wrist.
e.) Pronation and Supination of the wrist

• Turn the palm downward and then upward

- Pronates and Supinates the wrist.

f.) Abduction and Adduction of the hips

• Move the straightened leg away from the body and back beyond the midline.
- Abducts and then Adducts the hip.

g.) Internal and External Rotation of the hip

• Turn the leg away from the other leg and then toward it.
- Rotates the hip externally and then internally
h.) Circumduction of the hip

• Turn the leg in a circle

- Circumducts the hip

i.) Flexion and Extension of the toes

• bend and then straighten the toes

- flexes and extends the toes