NCM103A FUNDAMENTALS 0F NURSING (RLE)

Topic: Range of Motion Exercises

Activate prior knowledge

Review and identify the following bone structures?

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2
7

1 8
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4

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Learning Outcomes

At the end of the Session the students will be able to;

1. Differentiate different types of joints

2. Know and identify types of range of motion exercises
3. Properly demonstrate range of motion exercises

Acquire New Knowledge:

Range of motion (ROM) is the maximum amount of movement possible at a joint in the sagittal, frontal,
or transverse place of the body:

 Sagittal plane is a line that passes through the body from front to back dividing the body
into a left and a right side. The specific joint movement for this plane is flexion
and extension (fingers and elbows) and hyperextension (hip).
 The frontal plane passes through the body from side to side and divides the body into
front and back. The specific joint movement for this plane is abduction and
adduction (arms and legs) and eversion and inversion (feet).
 The transverse plane is a horizontal line that divides the body into upper and lower
portions. The specific joint movement for this plane is pronation and supination
(hands), internal and external rotation (knees), and dorsiflexion and plantar
flexion (feet).

Range-of-Motion exercises are exercises in which a nurse or patient moves each joint through as full
range as is possible without causing pain. Most people move and exercise their joints through the
normal activities of daily living. When any joint cannot be moved in this way, the patient or nurse must
move it at regular intervals to maintain muscle tone and joint mobility.

Purposes:
1. For the maintenance of present level of functioning and mobility of extremities involved;
2. For the restoration of joint function that has been lost through disease, injury or lack of use;
3. For the prevention of contractures and shortening of musculoskeletal structures or vascular
complications of immobility;
4. To facilitate comfort.

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Contraindications:
1. Any illness or disorder on which increasing the level of energy expended or increasing the demand for
circulation is potentially hazardous, particularly in those with heart and respiratory disease.
2. Swollen joints or inflamed or if there has been injury to the musculoskeletal system in the vicinity of
the joint.

Types of Joints

All the 6 types of the body joints are synovial. A synovial joint moves freely due to its construction. The
ends of the bones involved in the joint are encased in a capsule, lubricated with synovial fluid.
Supporting cartilage provides a smooth gliding surface as the joint is moved. Joints can move only in
certain ways>

1. Pivotal joints. The neck or upper cervical spine is a pivotal joint. The axis or bony
protuberance of the second cervical vertebrae rests in the atlas or cavity of the first cervical
vertebra. Supported by ligaments, this joint, as the name implies, can only perform a rotating
movement.

2. Ball-and-socket joints. The ball-shaped end of the bone rests in a socket-like cavity which
provides a wide range of movement. The shoulder and hip are examples of ball-and-socket
joints.

3. Hinge joints. The convex end of one bone rests on the concave surface of another. These
joints only move in flexion and extension. The elbows, knees, and ankles are hinge joints.

4. Condyloid joints. A knuckle-shaped end of a bone rests in an oval depression. These joints
move in all directions except rotation. Examples are the wrists, fingers (except the thumb), and
toes.

5. Saddle joints. The two bones forming the joint rest together in convex and concave position.
They have the ability to assume right angles allowing for flexion, extension, adduction, and
abduction. The thumbs are saddle joints.

6. Gliding joints. The bones involved in a gliding joint rest and glide on one another. These joints
are not so obvious as actual joints when performing range of motion exercises. The foot has

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 gliding joints as do the vertebra of the spine. The wrist and ankle also have gliding component
but are essentially condyloid (wrist) and hinge (ankle) joints.

Types of ROM:

1. Active - the patient is instructed to perform the movements on a nonfunctioning joint actively and
carrying out their plan of ROM on their own care.
2. Active-Assistive – carried out with both patient and nurse. The patient is encouraged to carry out as
much of each movement as possible, within the limitations of strength and mobility. The nurse supports
or complete the desired movement.
3. Passive – ROM is performed by a nurse on a patient’s immobilized joints, with an assessment skill to
determine which parts or joints must be ranged and with what frequency.

Assessment:
Assessment should focus on the following:
1. Medical diagnosis
2. Doctor’s orders for indications of specific restrictions
3. Present range-of-motion of each extremity
4. Physical and mental ability of client to perform the activity, including normal age-related
changes
5. History of factors that contraindicate or limit the type of amount of exercise
6. Client and family knowledge of techniques

Special Considerations:

 Decreased muscle mass, degenerative changes of joints, and degenerative connective tissue
changes result in limited range of motion.

 A client able to perform all or part of ROM exercise program should be allowed to do so and
should be properly instructed. Observe the client performing activities of daily living to
determine the limitations of movement and the need, if any, for passive ROM exercise to
various joints.

 When performing a ROM exercise, a joint should be moved only to the point of resistance, pain,
or spasm, whichever comes first.

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  Consult doctor’s orders before performing a ROM exercise on a client with acute cardiac,
vascular, or pulmonary problems or a client with musculoskeletal trauma and acute flare-ups of
arthritis.

 Instruct family members in performance of ROM techniques to be used during periods between
nurse visits.

Geriatric: The presence of various chronic conditions in elderly clients required the use of extra
caution when performing ROM exercise. Clients with chronic cardiopulmonary conditions should be
observed closely during ROM activity for respiratory difficulty, chest pain, and general comfort.

General Procedure for Range-of-Motion Exercise

Procedure
1. Assess the patient’s joint mobility and
activity status.
2. Assess the patient’s general health status.
3. Assess the patient’s ability to
participate.
4. Plan when range-of-motion exercises
should be done.
5. Plan whether exercises will be active,
active-assistive or passive.
6. Wash hands/hand hygiene. Wear
gloves if contact with body fluids is possible.
7. Identify the patient.
8. Provide privacy by closing the door or
pulling curtains around the bed
9. Explain the procedure.
10. Adjust bed to comfortable height for
performing ROM
11. Lower bed rail only on the side you are
working.
12. Describe the passive ROM exercises you are
performing, or verbally cue client, perform
ROM exercises with your assistance.
Include all applicable exercises.
13. Start at the client’s head and perform ROM
exercises down each side of the body.
14. Repeat each ROM exercise as the client
tolerates, to a maximum of 5 times.
Perform each motion in a slow, firm
manner. Encourage full joint movement,
but do not go beyond the point of pain,
resistance or fatigue.
a. Neck – perform this movement with the
client in a sitting position, if possible.
1) Flexion – bring chin to rest on chest.
2) Extension – return head to erect
Rationale
To determine the need for range-of-
motion exercise.
To determine whether any
contraindications to range-of-motion
exercises are present.
Allows the nurse to observe client’s
functional abilities.
Schedule of ROM will be based on client’s
tolerance and fatigue level.
To determine degree of assistance
required to perform exercises.
Reduces the transmission of
microorganisms.
To be sure that the procedure is carried
out for the correct patient.
Decreases embarrassment.
Decreases anxiety, and encourages
compliance and participation.
Prevents muscle strain and discomfort for
nurse.
Prevents falls.
To exercise all joint areas.
Provides a systematic method to ensure
that all body parts are exercised.
Provides exercise to the client’s tolerance
or to a level that will maintain the joint
function.
If there is a flexion contracture of the neck,
the client’s neck is permanently flexed
with chin actually touching the chest, body
alignment is altered and visual field is

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 position changed.
3) Hyperextension – bend head as far
back as possible
4) Lateral flexion – tilt head as far as
possible toward each shoulder
5) Rotation – rotate head in circular
motion
b.Shoulder Exercising shoulder effectively increases
1) Flexion – raise arm from side position power of deltoid muscle. This strength will
forward to above head help if client needs to use crutches later.
2) Extension – return arm to position at
side of body
3) Hyperextension – move arm behind
body, keeping elbow straight
4) Abduction – raise arm to side to
position above head with palm away
from head
5) Adduction – lower arm sideways and
across body as far as possible
6) Internal rotation – with elbow flexed,
rotate shoulder by moving arm until
thumb is turned inward and toward
back
7) External rotation – with elbow flexed,
move arm until thumb is upward
and lateral to head
8) Circumduction – move arm in full
circle. Circumduction is a
combination of all movements of
ball-and-socket joint
c. Elbow For optimal functioning, elbow must be
1) Flexion – bend elbow so that lower able to fully extend and flex
arm moves toward its shoulder joint
and hand is level with shoulder
2) Extension – straighten elbow by
lowering hand
3) Hyperextension – bend lower arm
back as far as possible
d. Forearm For optimal functioning, forearm must be
1) Supination – turn lower arm and able to rotate from supination to
hand so that palm is up pronation
2) Pronation – turn lower arm so that
palm is down
e.Wrist Wrist strength is necessary to be able to
1) Flexion – move palm toward inner use crutches
aspect of forearm
2) Extension – move fingers so fingers,
hands, and forearm are in same
plane
3) Hyperextension – bring dorsal
surface of hand back as far as
possible
4) Abduction (radial flexion) – bend
wrist medially toward thumb

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 5) Adduction (ulnar flexion) – bend
wrist laterally toward fifth finger
f. Fingers Flexibility of fingers and thumb is
1) Flexion – make fist necessary to grasp items
2) Extension – straighten fingers
3) Hyperextension – bend fingers back
as far as possible
4) Abduction – spread fingers apart
5) Adduction – bring fingers together
g. Thumb Flexibility of thumb maintains
1) Flexion – move thumb across palmar coordination for fine motor activities.
surface of hand
2) Extension – move thumb straight
away from hand
3) Abduction – extend thumb laterally
(usually done when placing fingers in
abduction and adduction)
4) Adduction – move thumb back
toward hand
5) Opposition – touch thumb to each
finger of same hand
h.Hip Contracture of hip can cause unsteady gait
1) Flexion – move leg forward and up or difficulty ambulating
2) Extension – move leg back beside
other leg
3) Hyperextension – move leg back
4) Abduction – move leg laterally away
from body
5) Adduction – move leg back toward
medial position and beyond if
possible
6) Internal rotation – turn foot and leg
toward other leg
7) External rotation – turn foot and leg
away from other leg
8) Circumduction – move leg in circle
i. Knee Flexibility of knee is necessary to lift
1) Flexion – bring heel toward back objects and to ambulate.
of thigh
2) Extension – return leg to floor
j. Ankle Deformity of ankle can impair client’s
1) Dorsiflexion – move foot so toes ability to walk. A common, debilitating,
are pointed upward and at times preventable contracture is
2) Plantar flexion – move foot footdrop. When footdrop occurs, the foot
so toes are pointed is permanently fixed in plantar flexion.
downward

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 k. Foot Adequate ROM in feet allows client to
1. Inversion – turn sole of foot walk.
medially
2. Eversion – turn sole of foot
Laterally
3. Flexion – curl toes downward
4. Extension – straighten toes
5. Abduction – spread toes
Apart
6. Adduction – bring toes
together

15. Observe client’s joints and face for signs of Alerts nurse to discontinue exercise.
exertion, pain, or fatigue during movement.

16. Replace covers and position client in proper Promotes comfort.

body alignment.

17. Place side rails in original position. Prevents falls.

18. Place call light within reach. Facilitates communication.

19. Wash hands/hand hygiene Reduces the transmission of

microorganisms.

20. Document required data. For continuity of care.

Neck ROM Shoulder ROM

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Elbow ROM Wrist ROM

Fingers and thumb ROM Hip and knee ROM

Ankle and Toes ROM

Assessment:
Range of motion exercise return demonstration

Graded Recitation

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References:

 Kozier & Erb’s (2007).Fundamentals of nursing (8 th ed.)Pearson Education South Asia Pte.Ltd.
 https://www.cdc.gov/Body mechanics/index.html
 https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/hand-washing/art-
20046253
 NurseReview.Org - Safety Basic Body Mechanics

Prepared By:
NCM 103a LECTURERS

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