Passive Range of Motion Exercises
Used to move the patient's joints through as full a range of motion (ROM) as possible, passive ROM exercises improve or maintain joint mobility and help prevent contractures. Performed by a nurse, a physical therapist, or a caregiver of the patient's choosing, these exercises are indicated for the patient with temporary or permanent loss of mobility, sensation, or consciousness. Performed properly, passive ROM exercises require recognition of the patient's limits of motion and support of all joints during movement.
Passive ROM exercises are contraindicated in patients with septic joints, acute thrombophlebitis, severe arthritic
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joint inflammation, or recent trauma with possible hidden fractures or internal injuries.
Implementation
Determine the joints that need ROM exercises, and consult the physician or physical therapist about limitations or precautions for specific exercises. The exercises below treat all joints, but they don't have to be performed in the order given or all at once. You can schedule them over the course of a day, whenever the patient is in the most convenient position. Remember to perform all exercises slowly, gently, and to the end of the normal ROM or to the point of pain, but no further. (See Glossary of joint movements, page 46.)
Before you begin, raise the bed to a comfortable working height and provide privacy for the patient.
Exercising the neck
Support the patient's head with your hands and extend the neck, flex the chin to the chest, and tilt the head laterally toward each shoulder.
Rotate the head from right to left.
Exercising the shoulders
Support the patient's arm in an extended, neutral position; then extend the forearm and flex it back. Abduct the arm outward from the side of the body, and adduct it back to the side.
Rotate the shoulder so that the arm crosses the midline, and bend the elbow so that the hand touches the opposite shoulder, then touches the mattress of the bed for complete internal rotation.
Return the shoulder to a neutral position and, with elbow bent, push the arm backward so that the back of the hand touches the mattress for complete external rotation.
Exercising the elbow
Place the patient's arm at his side with his palm facing up.
Flex and extend the arm at the elbow.
Exercising the forearm
Stabilize the patient's elbow, and then twist the hand to bring the palm up (supination).
Twist it back again to bring the palm down (pronation).
Exercising the wrist
Stabilize the forearm, and flex and extend the wrist. Then rock the hand sideways for lateral flexion, and rotate the hand in a circular motion.
Exercising the fingers and thumb
Extend the patient's fingers, and then flex the hand into a fist; repeat extension and flexion of each joint of each finger and thumb separately.
Spread two adjoining fingers apart (abduction), and then bring them together (adduction).
Oppose each fingertip to the thumb, and rotate the thumb and each finger in a circle.
Exercising the hip and knee
Fully extend the patient's leg, bend the hip and knee toward the chest, allowing full joint flexion, and then return to the extended position.
Next, move the straight leg sideways, out and away from the other leg (abduction), and then back, over, and across it (adduction).
Rotate the straight leg internally toward the midline, and then externally away from the midline.
Exercising the ankle
Bend the patient's foot so that the toes push upward (dorsiflexion), and then bend the foot so that the toes push downward (plantar flexion).
Rotate the ankle in a circular motion.
Invert the ankle so that the sole of the foot faces the midline, and then evert the ankle so that the sole faces away from the midline.
Exercising the toes
Flex the patient's toes toward the sole, and then extend them back toward the top of the foot.
Spread two adjoining toes apart (abduction), and then bring them together (adduction).
Special considerations
Because joints begin to stiffen within 24 hours of disuse, start passive ROM exercises as soon as possible and perform them at least every 4 hours. Passive ROM exercises can be performed while bathing or turning the patient. Use proper body mechanics, and repeat each exercise at least three times.
Patients who experience prolonged bed rest or limited activity without profound weakness can be taught to perform ROM exercises on their own (called active ROM), or they may benefit from isometric exercises. (See Learning about isometric exercises, page 47.)
If a disabled patient requires long-term rehabilitation after discharge, consult with a physical therapist and teach a family member or caregiver to perform passive ROM exercises.
Documentation
Record which joints were exercised, the presence of edema or pressure areas, any pain resulting from the exercises, any limitation of ROM, and the patient's tolerance of the exercises.
Passive ROM exercises are contraindicated in patients with septic joints, acute thrombophlebitis, severe arthritic
P.45
joint inflammation, or recent trauma with possible hidden fractures or internal injuries.
Implementation
Determine the joints that need ROM exercises, and consult the physician or physical therapist about limitations or precautions for specific exercises. The exercises below treat all joints, but they don't have to be performed in the order given or all at once. You can schedule them over the course of a day, whenever the patient is in the most convenient position. Remember to perform all exercises slowly, gently, and to the end of the normal ROM or to the point of pain, but no further. (See Glossary of joint movements, page 46.)
Before you begin, raise the bed to a comfortable working height and provide privacy for the patient.
Exercising the neck
Support the patient's head with your hands and extend the neck, flex the chin to the chest, and tilt the head laterally toward each shoulder.
Rotate the head from right to left.
Exercising the shoulders
Support the patient's arm in an extended, neutral position; then extend the forearm and flex it back. Abduct the arm outward from the side of the body, and adduct it back to the side.
Rotate the shoulder so that the arm crosses the midline, and bend the elbow so that the hand touches the opposite shoulder, then touches the mattress of the bed for complete internal rotation.
Return the shoulder to a neutral position and, with elbow bent, push the arm backward so that the back of the hand touches the mattress for complete external rotation.
Exercising the elbow
Place the patient's arm at his side with his palm facing up.
Flex and extend the arm at the elbow.
Exercising the forearm
Stabilize the patient's elbow, and then twist the hand to bring the palm up (supination).
Twist it back again to bring the palm down (pronation).
Exercising the wrist
Stabilize the forearm, and flex and extend the wrist. Then rock the hand sideways for lateral flexion, and rotate the hand in a circular motion.
Exercising the fingers and thumb
Extend the patient's fingers, and then flex the hand into a fist; repeat extension and flexion of each joint of each finger and thumb separately.
Spread two adjoining fingers apart (abduction), and then bring them together (adduction).
Oppose each fingertip to the thumb, and rotate the thumb and each finger in a circle.
Exercising the hip and knee
Fully extend the patient's leg, bend the hip and knee toward the chest, allowing full joint flexion, and then return to the extended position.
Next, move the straight leg sideways, out and away from the other leg (abduction), and then back, over, and across it (adduction).
Rotate the straight leg internally toward the midline, and then externally away from the midline.
Exercising the ankle
Bend the patient's foot so that the toes push upward (dorsiflexion), and then bend the foot so that the toes push downward (plantar flexion).
Rotate the ankle in a circular motion.
Invert the ankle so that the sole of the foot faces the midline, and then evert the ankle so that the sole faces away from the midline.
Exercising the toes
Flex the patient's toes toward the sole, and then extend them back toward the top of the foot.
Spread two adjoining toes apart (abduction), and then bring them together (adduction).
Special considerations
Because joints begin to stiffen within 24 hours of disuse, start passive ROM exercises as soon as possible and perform them at least every 4 hours. Passive ROM exercises can be performed while bathing or turning the patient. Use proper body mechanics, and repeat each exercise at least three times.
Patients who experience prolonged bed rest or limited activity without profound weakness can be taught to perform ROM exercises on their own (called active ROM), or they may benefit from isometric exercises. (See Learning about isometric exercises, page 47.)
If a disabled patient requires long-term rehabilitation after discharge, consult with a physical therapist and teach a family member or caregiver to perform passive ROM exercises.
Documentation
Record which joints were exercised, the presence of edema or pressure areas, any pain resulting from the exercises, any limitation of ROM, and the patient's tolerance of the exercises.
