Passive Range Of Motion

Basim Kalantan
Part A ICU conference room
Passive Range Of Motion PROM
Practical Concept Demonstration

Part B ICU Simulation Lab

Practical Application Demonstration
Competencies PROM/Practical Evaluation
Passive range of motion

 Definition
 Benefits
 Physiological Stability
 Contraindications/ Precautions/ Physical Therapy Consultation
 Pain/ Inflammation
 End feel Normal/Abnormal
 Pain and End feel
 How to apply it?
Practical session

Mobility Protocol screening / Contraindication

 Positioning of Patient/Nurse
 How frequent? How long?
 Grasp and Manual Handling?
 End feel Normal/ Abnormal

 Maneuvers Techniques Shoulder, Elbow, wrist and finger,

Hip/knee, Hip and ankle.
Competencies (In Simulation Lab)
 Able to define Passive range of motion?
 Able to mention benefit of passive range of motion
 Able to screen patient for passive range of motion
 Knows contraindication of passive range of motion
 Knows when to consult Physical Therapist

 Positioning of Patient/ Nurse

 Grasping and Manual Handling
 Maneuvers
 Shoulder Flexion
 Shoulder Abduction / External and internal rotation
 Elbow Flexion/ Extension
 Wrist and fingers Flexion/ Extension
 Hip/knee Flexion
 Hip Abduction
 Ankle Dorsiflexion / Plantarflexion
 Passive range of motion

Definition
 Benefit
 Physiological Stability
Pain/ Inflammation
End feel Normal/Abnormal
Pain and End feel
Contraindications/ Precautions/ Consult
How to apply it?
 Definition

Movement of the joints ( Segments i.e. bones)

for full possible amount of motion

which is delivered by External force

Persons or Machine
But NOT patient ( No voluntary active movement by patient )

It assess the integrity of structures of joints

 Benefits/ Indications

 Maintain joint range and soft tissue integrity

 Shortening of muscle prevention
 Stiffness and contracture prevention
 Assist Healing process
 Flexibility Mechanical elasticity
 Assist Circulation
 Oedema reduction Enhance synovial move
 Pain reduction
 Comatose Paralyzed Complete bed rest
  Other Benefits/ Indications

 Commands in ICU Teaching patient active motion

 Used for assessment for integrity of structures
Capsules, ligaments, Bursa, Cartilages, Nerves
 Prepare for stretching
 Breathing expansion / Demand exercises
 Physiological Stability

Blood pressure SBP, DBP and MAP

HR
Saturation

For 20 minutes as Early as 36 hours in studies

At 4-5 points
Prior to PROM
5, 10, 20 and 60 minutes Post exercises
No significant changes from baseline
Pain and inflammation

Effect of PROM in pain in ICU Not studied

Pain
Inflammation
IL6 reduction
IL6:IL10 Reduction Normal 3:1

Pain control Prevents Muscle damage

End feel Normal vs Abnormal

Normal End feel Abnormal

 Hard Bone to bone Fractures
 Soft Muscle to muscle Oedema

 Firm Capsular / Tissue stretch Capsular tightness

2 hard rubber Empty (Pain)

End feel : Feeling imparted to examiner hand as end point of PROM.

Pain and End feel

• No Pain + Tone at end = Normal

• No Pain + No tone = Flaccid / Ruptured muscle

• Pain + Increased tone = Tendinitis

• Pain + Low tone = Fractures

 Contraindication/ Precaution / Consult

 Acute sharp Pain / End Feel Pain free/Tone not free=Normal

 Fractures Not operated /Ligaments injuries

Osteoporosis/ Contractures
 Inflammation/Infection Osteomyelitis
 Spasticity and flaccidity
 Open Abdomen
 Skin Graft / Burn wound/Large wound
 DVT
Resistance from patient***
How to apply passive range of motion?

 Manual Persons Not patient

 Machines CPM Letto2
 Practical session
Mobility Protocol screening / Contraindication
 Positioning of Patient/Nurse
 Grasp and Manual Handling
 How frequent? How long? Repetitions
 End feel Normal/ Abnormal
Maneuvers Techniques Shoulder, Elbow, wrist and finger,
Hip/knee, Hip and ankle.
 Mobility screening and contraindication
Listed in the Mobility Protocol

• Osteoporosis
• Fractures
• Flaccidity
• Spasticity/Contractures
• Resisting patient

• Pain
• DVT
• Infection
 Positioning of patient and Nurse
 Comfortable position for patient and Nurse (Body Mechanic)
 Nurse trunk control while performing
 Nurse Intrinsic muscles care
 Grasp and Manual Handling

 Fix and Support Fixable part

 Move Movable part

(Smoothly Not beyond limits)
Free range

 Great attention to shoulder

(Poor structural integrity)
How frequent? How Long?

 3, 5, 7 and 10 Reps
 Roughly 10 Repetitions
 Time less than 20 minutes
 Intensive Twice/ Day
End feel Normal Vs Abnormal

 Hard
 Soft
 Firm
 Empty
 Techniques Maneuvers
Anatomical plane Frontal Sagittal Transverse
 Maneuvers Techniques
Position/ Grasp / Move / Implications

1-Shoulder Flexion
Firm Capsular

Flexion 0-160/180 Degrees

NOT to full range

if Scapula not stabilized
 Maneuvers Techniques

Position/ Grasp / Move / Implications

2-Shoulder Abduction
Firm Capsular

Abduction 0-150 Degrees

NOT to full range

if scapula not stabilized
 Maneuvers Techniques

Position/ Grasp / Move / Implications

3-Shoulder External/Internal rotation

Firm Capsular

Arm abducted 90
Elbow flexed 90
(Volleyball)
 Maneuvers Techniques
Position/ Grasp / Move / Implications

4-Elbow Flexion/ Extension

Soft / Hard End feel

Flexion 0-150 Degrees

Extension -150-0 Degrees
 Maneuvers Techniques

Position/ Grasp / Move / Implications

5-Wrist/ Finger Flexion/ Extension

 Maneuvers Techniques
Position/ Grasp / Move / Implications

6-Hip / Knee Flexion Simultaneous

Firm Capsular / Soft

Full range of Hip Flexion 0-130 degrees

Knee flexion 0-130 degrees

Can be done with knee flexion

Why?
Hamstring release
 Maneuvers Techniques
Position/ Grasp / Move / Implications

7-Hip Abduction
Firm Capsular

Range 0-45 degrees

 Maneuvers Techniques
Position/ Grasp / Move / Implications

8- Ankle Dorsiflexion
(Plantarflexion may not be needed as drop feet)
Dorsi 0-20/45 Degrees
Planter 0-50 Degrees

Full range of Ankle dorsiflexion

can be done only with knee flexion

Why? Gastrocnemius release

Competencies
 Able to define and describe Passive range of motion
 Able to mention benefits and indications of passive range of motion
 Able to screen patient for passive range of motion
 Knows and identify contraindications of passive range of motion
 Knows when to consult Physical Therapist

 Positioning of Patient/ Nurse

 Grasping and Manual Handling
 Maneuvers Procedures of applying
 Shoulder Flexion
 Shoulder Abduction
 Elbow Flexion/ Extension
 Wrist and fingers Flexion/ Extension
 Hip/knee Flexion
 Hip Abduction
 Ankle Dorsiflexion / Plantarflexion
Thank you