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). The client moves each joint
through its complete range of motion. In addition to preventing loss of joint movement, active
ROM exercises increase muscle strength and endurance. The nurse instructs the client to
perform each exercise three times and to do the entire series twice a day. Joints should be
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
client’s 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 RATIONALE
1. Obtain the physician’s or physiotherapist’s The nurse should consider any medical
order before beginning the exercises. contraindications for each client. The type
and amount of exercises are approved by the
physician or the physical therapist.

2. Do handwashing. To remove transient microorganisms that

might be transmitted to the client.

3. Explain the rational for the procedure to A client at ease and relaxed about exercising
the client. can more actively take part in it.

4. Determine the client’s physical ability to Each client’s needs will vary, based on
perform exercise, degree of ROM of joints abilities, activity level, prognosis, and
needed to ambulate, or perform essential willingness to cooperate with suggested
ADL’s, presence of contracture, joint exercises.
swelling, redness, or pain. Note amount
of spontaneous movement shown by the
client.

5. Assist the client to a supine position near Positioning the client close to the nurse
the nurse, and expose the body parts prevents excessive reaching
requiring exercise. Place the client’s 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 Without some form of ROM exercises, joints
motion. Repeat each motion three times. begin to stiffen several days of disuse and
may be permanently impaired
 PROCEDURE RATIONALE
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 client’s pillow

b. Place the palm of one hand under To flex and extend the neck
the client’s head and the palm of
the other hand on the client’s 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 To laterally flex the neck

side of the client’s cheeks. Move
the top of the head to right and to
the left.

9. Shoulder and Elbow Movement

a. Begin each exercises with the To flex, externally rotate, and extend the
client’s arms at his/her side. Grasp shoulder
the arm beneath the wrist with the
other hand, unless otherwise
indicated.

b. Move the arm up to the ceiling and To abduct and externally rotate the shoulder
toward the head of the bed. The
elbow may need to be flexed if the
head-board is in the way.

c. Move the arm away from the body To adduct the shoulder
and toward the client’s head until
the hand is under the head.

d. Move the arm over the body until To rotate the shoulder internally and
the hand touches the client’s other externally
hand.
 PROCEDURE RATIONALE
e. Place the arm out of the side at To flex and extend the elbow
shoulder level (90 abduction), and
bend the elbow so that the forearm
is at right angle to the mattress. To pronate and supinate the forearm
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 client’s hand for a

handshake and turn the palm
downward and upward, ensuring
that only the forearm moves (not
the shoulder).

10. Wrist and Hand Movement

a. Flex the client’s 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 To hyperextend the wrist and flex the fingers
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
client’s fingers to make a fist.

c. Bend the wrist forward and at the Flex the wrist and extend the fingers
same time extend the fingers.

d. Move the thumb away from the To abduct and oppose the thumb
fingers and then across the hand
toward the base of the little finger.
 PROCEDURE RATIONALE
e. Place the wrist in prone position To laterally flex the wrist
while being held by the nurse’s
hand on the palm then move the
wrist laterally in both directions.

11. Leg and Hip Movement

a. Place one hand under the client’s
knee and the other under the
ankle.

b. Lift the leg and bend the knee, To flex and extend the hip and 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.

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 To rotate the hip internally and externally

12. Ankle and Foot Movement

a. Place your hands in the positions
described, depending on the
motion to be achieved.
b. b. Place one hand under the To dorsiflex the foot and stretch the Achilles
client’s heels, resting your inner tendon
forearm against the bottom of the
client’s 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 client’s To invert and evert the foot
ankle and the other hand over the
arch of the foot. Turn the whole
foot inward, and then turn it
outward.
 PROCEDURE RATIONALE
d. Place one hand over the arch of the To plantarflex the foot and extend and flex
foot to push the foot away from the the toes
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 To hyperextend the neck

client’s face down, place one hand
on the forehead and the other on
the back of the skull. Move the
head backward.

c. Place one hand on the shoulder to To hyperextend the shoulder

keep it from lifting off the bed and
the other’s under the client’s
elbow. Pull the upper arm up and
backward.

d. Place one hand on the hip to To hyperextend the hip

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

straighten the client’s elbow while
supporting it with one hand, and
hold the client’s hand on the other
hand then rotate the arm in full
circle.

In standing position, the hip is To circumduct the hip

placed through a circular motion.
 PROCEDURE RATIONALE
14. Encourage the client to do active exercises Passive exercises only help prevent
as soon as possible. contractures and retard atrophy

15. Following the exercise, assess the client’s Expect the client’s pulse rate and respiratory
pulse and endurance to the exercise. rate to increase

16. Report to the nurse in charge any

unexpected problem or notable changes in
the client’s movements, e.g. rigidity or
contractures.

17. Do handwashing

18. Document the exercises and all pertinent Accurate assessment and documentation are
findings important baseline guide for later ROM
exercsises