RANGE OF MOTION EXERCISES

Range of motion exercises

refers to activity aimed at
improving movement of a
specific joint.
ROM exercises are carried out
to promote circulation,
maintain muscle tone &
promote flexibility. In doing
this, joint stiffness &
debilitating contractures are
prevented.
 Types of Range of Motion Exercises
ACTIVE – performed by the patient without help. Movement can
help your joints flexible, reduce pain, and improve balance and
strength.

PASSIVE – not performed by the patient and the health care worker
moves each joint through its ROM. Helps prevent weak muscles or
stiffness caused by non-use. (stroke, paralysis, bed ridden)

ACTIVE-ASSISTIVE – assistance is provided manually or mechanically

by an outside force because the prime mover muscles need
assistance to complete the motion.
 General Rules in Assisting the Patient with ROM
Exercises
1. Use good body mechanics
2. Expose only the body part being exercised.
3. Explain to the patient what you are going to do and
teach the patient how to do.
4. Support the extremity being exercised to prevent
strain/injury
5. Move each joint slowly, smoothly and gently
6. Reach the joint to a neutral position after the
movement
 7. Repeat each exercise 3-5 times and should be done
once per day.
8. Joints are exercised sequentially, starting with the neck
and moving down.
9. Don’t continue the exercise to the point that the
patient develops fatigue.
10. If muscle spasticity occurs during movement, stop the
movement temporarily, but continue to apply slow,
gentle pressure on the part until the muscle relaxes.
11. If a contracture is present, apply slow firm pressure,
without causing pain, to stretch the muscle fibers.
 Two Purposes of ROM
1. Maintain joint function

2. Restore joint function

• Do not exercise joints beyond the point of

resistance or to the point of fatigue or pain
 Contraindications to ROM
• ROM requires energy & increased circulation, any illness/disorder
where increased use of energy or increased circulation is hazardous
is contraindicated; puts strain/stress in soft tissues of the joint &
bony structures, therefore not done with swollen, inflamed joints.
 Performing Exercises from Head to Toe
• Start with the head and move down, always do bilaterally
• Do not grasp the joint directly
• Cup the joint gently (prevents pressure)
• Do not grasp fingernail or toenail
• Important joints – thumb, hip, knee, ankle
• Return to correct anatomic position
• Move joint through movement 5 times/session
• Plantar flexion – bending the foot down at the
ankle
• Pronation – turning the joint downward
• Supination – turning the joint upward
• Inversion – turning the sole of the foot towards
the midline
• Eversion – turning the sole of the foot away
from the midline
 JOINT MOVEMENTS
• Abduction – moving a body part away from the
midline of the body
• Adduction – moving a body part toward the midline
of the body
• Extension – straightening a body part
• Flexion – bending a body part
• Rotation – turning the joint
• Internal rotation – turning the joint inward
• External rotation – turning the joint outward
Neck Flexion – look @ the toes
Extension – look straight ahead
Hyperextension – look up @ ceiling
Lateral flexion – look straight ahead, tilt head to shoulder
SHOULDER
Flexion – raise arm forward & overhead
Extension – return arm to side of body
Abduction – raise arm to side to position
above head with palm away from
head.
Adduction – return arm & bring across
chest
Internal rotation – elbow flexed, rotate the
shoulder by moving arm until thumb is
turned inward & toward the back
(fingers to the floor)
External rotation – elbow flexed, move
arm until thumb is upward & lateral to
head. (fingers point up)
Circumduction – move arm in full circle
(arm straight out, move hand as if to
draw a circle.
Elbow Flexion – bend elbow
Extension – straighten elbow
Hyperextension – bend lower arm back as
far as possible

Forearm Supination – turn lower hand so palm is

up
Pronation - turn lower hand so palm is
down

Wrist Flexion – bend wrist forward

Extension – straighten wrist (fingers,
wrist & arm in same plane)
Hyperextension – bring dorsal surface of
hand as far back as possible
Abduction (radial flexion) – bring wrist
medially towards the thumb
Adduction (ulnar flexion) – bend wrist
laterally towards 5th finger
Elbow, Forearm, Wrist
Fingers & thumb Flexion – bend fingers & thumb into palm make a fist
Extension – straighten fingers & thumb
Hyperextension – bend fingers as far back as possible
Abduction – spread fingers apart / extend thumb laterally
Adduction – bring fingers together/ thumb back to hand
Circumduction – move finger/thumb in circular motion
Opposition – touch thumb to each finger of same hand
 Flexion – move leg forward (ROM
Hip 90-120 deg)
Extension – move leg back beside other
leg
Hyperextension – move leg backwards
(ROM 30-50 deg)
Abduction – move leg laterally away
from body (ROM 30-50 deg)
Adduction – move leg back to medial
position & beyond if possible (ROM
30-50 deg)

Flexion – bring heel toward back of

Knee thigh (120-130 deg)
Extension – return leg to floor
 Dorsiflexion – move foot so toes are
Ankle pointed upward
Plantarflexion – move foot so toes are
pointed downward

Inversion – turn sole of foot medially

Foot (ROM 10 deg)
Eversion – turn sole of foot laterally
(ROM 10 deg)
Flexion – curl toes downward (ROM
30-60 deg)
Extension – straighten toes (ROM 30-60
deg)
Abduction – spread toes apart
Adduction – bring toes together
Spine Flexion – when standing – bend forward from the waist
Extension – straighten up
Hyperextension – bend backward
Lateral flexion – bend to the side
Rotation – twist from the waist
 Effects of Immobility
1. Venous stasis by prolonged inactivity
2. Thrombus and embolus- a formation caused by slow flowing blood
which begin clotting within hours.
Homan’s sign – pain in the calf upon dorsiflexion
3. Orthostatic hypotension
4. Hypostatic pneumonia
5. Atelectasis – collapse of lung tissue
6. Muscle atrophy – decreased muscle size
7. Contracture – decreased joint movement leads to permanent
shortening of muscle tissue
8. Altered sensation caused by prolonged pressure
9. Renal calculi caused by stagnation of urine in the renal pelvis
10. Decreases metabolic rate
 Exercises
In addition to ROM exercises, some immobilized clients may be able to
perform muscle-strengthening exercises:

• Isotonic exercise (Dynamic) – it increases muscle tone, strength and

joint felxibilty. E.g. running, swimming, cycling, ROM exercise.
• Isometric exercise (static) – there is muscle contraction without
moving the joint. E.g. squeezing a towel or pillow at knees.
• Isokinetic (resistive exercise) – Special machines or devices provide
resistance to the movements
 Video ROM Exercises
• https://www.youtube.com/watch?v=t6hE_ntz4Ho
(Passive ROM)

• https://www.youtube.com/watch?v=qXdCVeD4jEU

• https://www.youtube.com/watch?v=2U4dIq7It9A
( Active ROM)
• Clients who have been immobile even for a short time
may require assistance

• A client may require the use of an assistive device to aid in

ambulation.

• Assistive devices
• Increase stability
• Support a weak extremity
• Reduce the load on weight bearing structures; hip,
knees
Assisting the Patient Using Walking
Assistive Devises
SIMPLE ASSIST
1. Place arm near patient under the
arm and at the elbow and grasp
patient’s hand, synchronize
walking with the pt (move inside
foot forward at same time as
patient’s inside foot)
2. Grasp patient’s left hand in
nurses’ left hand and encircle
patient’s waist with the right
hand & synchronize walking
3. Using a transfer belt (hold at
the waist from the rear by
the belt – helps maintain
balance)
 Special Considerations
⬥ The nurse is to stand on the patient’s weak side.
The nurse provides support with his/her leg to the
patient’s weakened one if necessary. Do not allow
the patient to place their arm around your
shoulder.
⬥ The nurse should walk slowly with even gait and
synchronized steps.
 Canes
Walking Canes are devices used primarily to
aid walking, provide postural stability or support, or
assist in maintaining a good posture.
These are light weight, easily movable devices that are
made of wood or metal.

Types of Canes:
1. Single ended canes with half circle handle
2. Single ended canes with straight handles
3. Canes with 3 or 4 prongs (quad canes)
 Walking with a Cane
• Instruct patient to stand with
weight, evenly distributed
between the feet and the
cane.
• The cane is held on the
patient’s stronger side,
instruct patient to position
cane 6 inches (15 cm)
anterior of the foot.
 Walking with a Cane
• Instruct to move the affected leg
forward to the cane while the
weight is borne by the cane and
stronger leg.
• Next move the unaffected leg
forward ahead of the cane and
weak leg while the weight is borne
by the cane and weak leg.
• Repeat the steps.
Remember: “Up with the Good; Down with the Bad.”
 Walkers
• A walker is a light weight metal frame with four legs.
• It has a wide base of support and provides great stability and
security.
• This is used for clients who are weak or who has problems with
balance.
Patient’s requirements to be able to use the walker:
1. Partial strength in both hands and wrist
2. Strong elbow extensors such as triceps brachia
3. Strong shoulder depressors such as the pectoralis minor
4. Ability to bear at least partial weight on both legs

Height – upper bar of walker should be slightly below the client’s

waist with arms flexed 15-30 degrees
Walker Height
Upper bar of walker
should be slightly
below the client’s waist
with arms flexed 15-30
degrees
Standard Walker Two-wheeled Walker
 Assisting the Patient in Using the Walker
• Explain the method of using walker
• Instruct patient to wear no-skid shoe or slipper
• Instruct patient not to use walker on stairs
• Have patient stand in center of walker and grasp handgrips on upper bars
• Lift walker and move it 6-8 inches forward, making sure all 4 feet of the
walker stays on the floor, take a step forward with one foot follow through
with other leg.
IF ONE LEG IS WEAKER THAN THE OTHER:
• Move the walker and the weak leg ahead together about 6 inches while
your weight is borne by the stronger leg.
• Then move the stronger leg ahead while weight is borne by the affected
leg and both arms.
 Special Considerations
• The patient should be taught to examine the frame daily.
• Use caution when attempting to ambulate a patient who has
already been given an antihypertensive or analgesic medication,
this may cause dizziness or instability.
• Caution should be used if the patient uses a walker or inclines
• Care must be taken if the patient has IV line, urinary catheter etc.
 Assisting with Crutch Walking
Crutches - Wooden or metal staff that reaches from the ground to 11/2 –
2 inches below the axilla. When standing tip of crutch rests 4-6 inches in
front & 4-6 inches to side of foot.

Assisting patient to walk using crutches while providing support and

balance and as a convenient method of getting from one place to
another.
Types of Crutches:
Axillary Crutch
Loftstand crutch – it has a handgrip and metal band that fits around the
patient’s forearm.
Platform crutch – it is used by the patients who are unable to bear
weight on their wrists.
Platform Crutch
Purposes of Using Crutches
1. To improve balance
2. To either relieve weight bearing fully or partially on a lower
extremity.
3. To increase the base of support
4. To improve lateral stability
5. To permit functional ambulation while maintaining a restricted
weight bearing status.
 Axillary Crutch Measurement:
1. The client lies in supine
position and the nurse
measures from the anterior
fold of the axilla to the heel
of the foot and add 2.5 cm
(1in.)
2. The client stands erect and
the shoulder rest of the
crutch is at least three finger
widths, approximately 2.5 to
5 cm (1 to 2 in.) below the
axilla.
 Crutch Measurement:
To determine the correct
placement:
1. The client stands upright and
supports the body weight by
the hand grips of the crutches.
2. The nurse measures the angle
of elbow flexion about 30
degrees using goniometer.
Assisting the Patient with Crutch Walking
Review patient’s chart. Medical history, previous and current activity.
Assess patient’s physical readiness: Vital signs, orientation to time, place
and person.
Assess patient for any visual, perceptual, or sensory deficits.
Place bed in low position and slowly assist patient to upright position, let
patient sit or stand for a few minutes until balance is gained.
Assist patient in crutch walking by choosing appropriate gait.
Crutch Gaits – is the gait a
person assumes on
crutches by alternating
body weight on one legs
and the crutches.
Four point gait: This is the most stable of crutch gaits because it provides at least 3
points of support at all times.
Indication: Weakness in both legs or poor coordination.
• Begin in tripod position: crutches are placed 6 inches in front and 6 inches to
side of each foot.
• The right crutch is advanced 10-15 cm. (4-6 in.)
• The left front foot forward, preferably to the level of left crutch.
• Move the left crutch forward. Move the right foot forward.
• Pattern Sequence: Left crutch, right foot, right crutch, left foot. Then repeat.
 Three point gait
• Indication: Inability to bear
weight on one leg.
(fractures, pain,
amputations).
• The client must be able to
bear the entire body
weight on affected leg the
nurse asks the client to:
1. Move both crutches and
the weaker leg forward.
2. Move the stronger leg
forward.
Two-point Gait
• Indication: Weakness
in both legs or poor
coordination.
• Pattern Sequence: Left
crutch and right foot
together, then the right
crutch and left foot
together. Repeat.
 Swing To gait
• Used by patients whose lower extremities are paralyzed or wear
supporting braces on the legs, unable to fully bear weight on both legs.
(fractures, pain, amputations).
1. Move both crutches forward.
2. Lift and swing leg crutches, letting crutches support body weight.
3. Repeat previous steps.
• Swing through gait; requires that patient have the ability to sustain
partial weight bearing on both feet.
- Move both crutches forward
- Lift and swig legs through and beyond crutches.
 Assisting patient in climbing stairs
1. Begin a tripod position
2. Patient transfers body weight to crutches
3. Patient advances unaffected leg to stair
4. Then advance affected leg and crutches
5. Repeat sequence until patient reaches top of stairs.
 Assist patient in descending stairs
• Begin in tripod position
• Patient transfer body weight to unaffected
leg
• Move crutches to stairs and instruct patient
to begin to transfer weight to crutches and
move affected forward.
• Patient moves unaffected leg to stair and
align with crutches.
• Repeat sequence until stairs are descended.
• Record in nurse’s progress notes type of gait
patient used, amount of assistance
required, distance walked, patient’s
tolerance of activity
 Special Considerations
• Inspect rubber tips on bottom of ambulation device
frequently.
• If wooden crutch is used, examine it for cracks.
• Remove obstacles from pathways. Avoid large crowds.
• Instruct patient to continue muscle strengthening exercise
at home.
• Teach patient with axillary crutches about the dangers of
pressure on the axillae.
• Instruct patient to routinely inspect crutch tips.
• Explain that crutch tips should remain dry.
 Video in using assistive devices
• https://www.youtube.com/watch?v=r-9OxwOQX9
c
 RLE MS- SKILLS 116
Lecture Series

Ruby A. Paderes. R.N., M.N.

Cygnette s. Lumbo, R.N., Ph.D.