ST.

FERDINAND COLLEGE
COLLEGE OF HEALTH SCIENCES
Calamagui 1st, Ilagan 3300, Isabela
Tel. No. (078) 622-3110
“ CHS – is a holistic department with dynamic staff that intend to produce a globally competitive health care provider”

Name:_____________________________ Year Level/Group:_____________

Instructor:__________________________ Date:_______________________

PASSIVE RANGE OF MOTION EXERCISE

NO. PERFORMANCE INDICATOR POOR FAIR GOOD

(3+ ERROR) (1-2 ERRORS) (NO ERRORS)
1 3 5
1. Identify the patient and obtain initial vital sign.

2 Perform hand hygiene

3. Introduce your self and Explain the procedure to

the patient.

4. Raise bed to your waist level. Adjust to flat

position or as low as patient can tolerate.

5. Begin ROM exercises at the patient’s head and

move down one side of the body at a time.

6. Perform each exercise two to five times, moving

each joint in a smooth and rhythmic manner

7. Protect joint during ROM exercises for each joint.

8 Progress through ROM exercises for each joint

Head:
 flexion-move chin down to rest in chest
 Extension-Return head to normal upright
position
 Lateral flexion-tilt head as far as possible
towards each shoulders
Neck:
 Rotation-move head from side to side,
bringing chin toward each shoulder
Shoulder
 Flexion-start with arm at side and lift arm
forward to above head
 Extension-return arm to starting position at
side of the body
 Abduction-Start with arm at side and move
laterally to upright position above head.
 Adduction- Lower arm to original position
and move across body as far as possible
 Internal and External rotation- raise arm at
side until upper arm is in line with the
shoulder. Bend elbow at a 90 degree angle
and move forearm upward and downward
Elbow
 Flexion- Bend elbow and move lower arm
and hand upward and toward shoulder
 Extension- return lower arm and hand to
original position while straightening elbow
Forearm
 Supination- Rotate lower arm and hand so
palm is up
 Pronation- Rotate lower arm and hand so
palm is downward
Wrist
  Flexion- Move hand downward toward inner
aspect of forearm
 Extension- Return hand to neutral position
even with forearm
 Hyperextension- Move dorsal (upper)
portion of hand backward as far as possible
Fingers
 Flexion- Bend fingers to make a fist
 Extension- Straighten fingers
 Abduction- Spread fingers apart
 Adduction- Return fingers until they are
together
 Opposition of thumb to fingers- touch thumb
to each finger on hand
Hip
 Flexion- with leg extended, lift upward
 Extension- return leg to original position
next to other leg
 Abduction- lift leg literally away from body
 Adduction- return leg toward other leg and
lift beyond it if possible
 Internal rotation- turn foot and leg toward
other leg
 External rotation- move feet and leg
outward away from other leg
Knee
 Flexion- bend leg, bringing heel toward back
of leg
 Extension- return leg to straight position
Ankle
 Dorsiflexion- move foot up and back until
toes are upright
 Plantar flexion- move foot with toes pointing
downward
 Inversion- turn sole of foot toward the
middle
 Eversion- turn sole of foot outward
Toes
 Flexion- curl toes downward
 Extension- straighten toes out
 Abduction- spread toes apart
 Adduction- bring toes together
9. Return the patient to a comfortable position.

10. Readjust bed height and position and raise side

rails if needed. Ensure that call light is within
patient’s reach.

11. Perform hand hygiene

12. Document patients response to the procedure.

Comments:

____________________________________________________________________________________________________

Evaluated by:

_____________________________________
(Print name and Signature)