Xavier University – Ateneo De

Cagayan
College of Nursing

PERFORMANCE RATING
SCALE ACTIVE RANGE OF
MOTION EXERCISE

NAME: Ira Velle J. Vios DATE: February 16, 2022

BLOCK: NJ SCORE:

PERFORMANCE EVALUATION CRITERIA

Scor Description Indicato

e rs
4 Very Good
3 Good
2 Fair
1 Needs
Improvement
Student performs behaviors/tasks reflecting the highest level of
performance: consistent, independent, effective.
Student performs behaviors/tasks reflecting mastery of
performance with minimal supervision.
Student performs behaviors/tasks reflecting development and
movement
toward mastery of performance: with help or direct supervision in
some aspects.
Student performs behaviors/tasks reflecting beginning level of
performance;
tasks not done properly majority of the time but demonstrate
understanding of concepts involved with tasks.

PROCEDURE: ACTIVE ROM Exercise Detailed Procedure 4 3 2 1 REMARKS

1. Neck, Cervical and Spine Starting

position: You may sit
1.1 Flexion or stand. Face
1.2 Extension forward. Your
1.3 Hyperextension shoulders should be
1.4 Lateral Flexion
straight and relaxed.
1.1-3
Head tilts, forward
and back : Gently
bow your head and try
to touch your chin to
your chest. Raise your
chin back to the
starting position. Tilt
your head back as far
as possible so you are
looking up at the
ceiling. Return your
head to the starting
position.
1.4
Head tilts, side to
side: Tilt your head to
 the side, bringing your
ear toward your
shoulder. Do not raise
your shoulder to your
ear. Keep your
shoulder still. Return
your head to the
starting position.

2. Shoulder Starting
position: Stand or sit.
2.1 Flexion Hold your arm straight
2.2 Extension down at your side.
2.3 Hyperextension Face palms in toward
2.4 Abduction your body. It is best to
2.5 Adduction use a chair without
2.6 Internal Rotation
arms if you are in a
2.7 External Rotation
sitting position.
2.8 Circumduction
2.1-3
Shoulder movement,
up and down: Raise
your arm forward and
then up over your
head. Try to raise it so
that your inner arm
touches your ear.
Bring your arm back
down to your side.
Bring it back as far as
possible behind your
body. Return your arm
to the starting
position.
2.4 -5
Shoulder movement,
side to side: Raise
your arm to the side
and then up over your
head as far as
possible. Return your
arm to your side.
Bring your arm across
the front of your body
and reach for the
opposite shoulder.
 Return your arm to
the starting position.
2.6
With arm out to side
at shoulder level and
elbow bent to right
angle, bring arm
forward so that palm
faces backwards
2.7
Using same position,
take the arm back
toward head so that
palm faces forward
2.8
Hands on the side.
Raise the arm with the
thumb pointed up.
Bringing the arm
down behind, turn
thumb in towards the
head. Keep arm as far
as possible. Bring the
thumb down towards
side. Do it in reverse.

3. Elbow With your palm facing

forward (supine),
3.1 Flexion bend your elbow. Try
3.2 Extension to touch your shoulder
with your fingertips.
Return your arm to
the starting position.

4. Forearm 4.1

4.1 Supination Rotate the radius in a

4.2 Pronation lateral direction,
leaving thumbs
pointing away and
palms up or forward
4.2
 Rotate the radius in a
medial direction,
leaving thumbs
pointing medially and
palms down or back.

5. Wrist 5.1-3 Bend your hand

back toward your wrist
5.1. Flexion so that your fingers
5.2. Extension point toward the
5.3 Hyperextension ceiling. Then bend
5.4 Abduction your hand down so
5.5 Adduction that your fingers point
toward the floor.
5.4
Wrist moves away
from the body’s
midline
5.5
Wrist moves toward
the body’s midline
6. Fingers 6.1-3
6.1. Flexion Make a tight fist. Then
6.2. Extension open and relax your
6.3. Hyperextension hand.
6.4. Abduction 6.4-5
6.5. Adduction Open your hand and
stretch the fingers as
far apart as possible.
Bring your fingers
together again.
7. Thumb 7.1-2
7.1. Flexion Move your thumb and
7.2. Extension rest it across your
7.3. Abduction palm. Move it out to
7.4. Adduction the side again.
7.5 Opposition 7.3-4Abduction
Move the thumb away
from the plane of
hand and then return
it back to the hand
7.5 One at a time,
touch each fingertip to
 the pad of your
thumb.

8. Hip 8.1-2
8.1. Flexion Raise your leg so that
8.2. Extension your foot is 6 to 12
8.3. Abduction inches (15 to 31
8.4. Adduction centimeters) off the
8.5 Internal Rotation bed. Hold it in the air
8.6. External Rotation for a few seconds.
Return your leg to the
8.7. Circumduction
bed.
8.3-4
Flex your foot so your
toes point up toward
the ceiling. Move your
leg out to the side as
far as possible. Bring
your leg back to the
middle.
8.5-6
Put your leg flat on
the bed. Roll your leg
toward the middle so
your big toe touches
the bed. Then roll
your leg out and try to
make your smallest
toe touch the bed.
8.7
Do a circular motion
with hip and thigh
while the knee is bend
at right angle
9. Knee Lie flat on the bed
9.1 Flexion with your legs flat and
9.2 Extension straight. Point your
toes. Slowly bend
your knee up as close
to your chest as
possible. Straighten
your leg and return it
to a flat position on
the bed.
10. Ankle Bend the foot
10.1 Dorsal Flexion backward. Then
10.2 Plantar Flexion return to position and
bend the foot forward.
11. Foot Move the sole of the
11.1 Inversion foot inward. Back to
 11.2 Eversion position. Move the
sole of the foot
outward.
12. Toes Flexion
12.1 Flexion Move the toes toward
12.2 Extension plantar surface of the
12.3 Abduction foot
12.4 Adduction Extension
Move the toes away
from plantar surface
of the foot
Abduction and
adduction
Spread toes apart and
bring them back
together

Overall Score:

CI Name: Mrs. Joie Oliveros