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Lesson 5: Active and Passive Range of Motion Exercises

5-5. TYPES OF BODY MOVEMENT

NOTE: For types of body movement, see figure 5-1.

  1. Flexion. The state of being bent. The cervical spine is flexed when the chin is moved toward the chest.

  2. Extension. The state of being in a straight line. The cervical spine is extended when the head is held straight.

  3. Hyperextension. The state of exaggerated extension. The cervical spine is hyperextended when the person looks overhead, toward the ceiling.

  4. Abduction. Lateral movement of a body part away from the midline of the body. The arm is abducted when it is held away from the body.

  5. Adduction. Lateral movement of a body part toward the midline of the body. The arm is adducted when it is moved from an outstretched position toward the body.

  6. Rotation. Turning of a body part around an axis. The head is rotated when moved from side to side to indicate "no."

  7. Circumduction. Rotating an extremity in a complete circle. Circumduction is a combination of abduction, adduction, extension, and flexion.

  8. Supination. The palm or sole is rotated in an upward position

  9. Pronation. The palm or sole is rotated in a downward position.

Click on the pictures to start the videos.

5-6. GUIDELINES FOR RANGE OF MOTION EXERCISES

  1. Plan when range of motion exercises should be done (see figures 5-2 and 5-3). Plan whether exercises will be passive, active-assistive, or active. Involve the patient in planning the program of exercises and other activities because he/she will be more apt to do the exercises voluntarily.

  2. Expect the patient's heart rate and respiratory rate to increase during exercise.


Figure 5-1. Types of body movement.

  1. Range-of-motion exercises should be done at least twice a day. During the bath is one appropriate time. The warm bath water relaxes the muscles and decreases spasticity of the joints. Also, during the bath, areas are exposed so that the joints can be both moved and observed. Another appropriate time might be before bedtime. The joints of helpless or immobile patients should be exercised once every eight hours to prevent contracture from occurring.

  2. Joints are exercised sequentially, starting with the neck and moving down. Put each joint needing exercise through the range of motion procedure a minimum of three times, and preferably five times. Avoid overexerting the patient; do not continue the exercises to the point that the patient develops fatigue. Some exercises may need to be delayed until the patient's condition improves.

    3.


Figure 5-2. Example of Assessment/Planning Form.

  1. Start gradually and move slowly using smooth and rhythmic movements appropriate for the patient's condition.

  2. Support the extremity when giving passive exercise to the joints of the arm or leg.

  3. Stretch the muscles and keep the joint flexible.

  4. Move each joint until there is resistance, but never force a joint to the point of pain.

  5. Keep friction at a minimum to avoid injuring the skin.

  6. Return the joint to its neutral position.

  7. Use passive exercises as required, however, encourage active exercises when the patient is able to do so.

    8.


Figure 5-3. Range of Motion Flow Sheet

5-7. DOCUMENTATION

  1. Evaluation. Evaluate the patient in terms of fatigue, joint discomfort, and joint mobility.

  2. Record Keeping. Range of motion is often placed on a flow sheet (see figure 5-3). If a flow sheet is not used, an entry should be made in the Nursing Progress Notes using a narrative format. If there is any adverse response to the exercises, a narrative note must be made. Nursing notes should address the extent to which joints can be moved in degrees (see figure 5-4).


Figure 5-4. Example of Narrative Note.

5-8. CONTRAINDICATIONS TO RANGE OF MOTION EXERCISES

  1. Heart and Respiratory Diseases. 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.

  2. Connective Tissue Disorders. 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.

5-9. CLOSING

Encourage the immobile patient to participate as fully as possible so that he feels involved in the process. Always explain to the patient what you are about to do and enlist his cooperation. To avoid strain, remember to maintain your own proper body mechanics as you carry out the exercises for the patient. The overall nursing goal is to promote the maximum degree of mobility for the patient who cannot engage in the normal activities of daily living and prevent or reduce the effects of immobility. Performing range of motion exercises can often save the patient a lengthy rehabilitation.

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LESSON OBJECTIVES

Identify the effects of immobility.

Identify the purposes of exercise for the immobile patient.

Define the five types of exercises.

Define the nine types of body movement.

Identify guidelines for range-of-motion exercises.