Active and passive exercises

DGN 213/3
Puan Low Kim Lian
Ext: 7747
 Introduction
• Exercise is important for healthy joints
• Moving joints daily helps keep them fully mobile
• Strengthening muscles help support the joints
• Joint movement transports nutrients and waste
products to and from the cartilage, protects and
cushions the ends of the bones.
 Why exercise?
1. increases energy levels
2. helps develop a better sleep pattern
3. helps with weight control
4. maintains a healthy heart
5. increases bone and muscle strength
6. decreases depression and fatigue
7. Serves to improve self-esteem and self-confidence
 Types of exercises

• Active exercise - patient exercises without any

assistance
• Active assistive exercise - patient requires some
help from therapist to do the exercises
• Passive exercise - therapist or equipment moves
patient through range of motion (no effort from
patient)
 Active exercises
• performed by patient, without assistance, to
increase muscle strength
• voluntary movement from a patient with no
assistance.
Bil Parts of body Joint movement

1. Temporomandibular Open mouth,

Joint closed mouth,
push out lower jaw
Tuck in lower jaw
Slide jaw from side to side
2. Cervical spine Flexion: rest chin on chest
Extension :return head to midline
Hypertension: tilt head back
Lateral flexion: move head to touch ear to shoulder
Rotation: turn head to look to side
3. Shoulder Flexion: raise straight arm forward to a position above
the head
Extension: return straight arm forward to side of body
Hyperextension: move straight arm behind body
Abduction: move straight arm laterally from side to a
position above the head, palm facing away from head
Adduction: move straight arm downward laterally and
across front of body as far as possible
Circumduction: move straight arm in full circle
4. Elbow Flexion: bend elbow, move lower arm toward shoulder, palm
facing shoulder
Extension: straighten lower arm forward and downward
Rotation for supination: elbow bent, turn hand and forearm
so palm is facing upward
Rotation for pronation: elbow bent, turn hand and forarm so
palm is facing downward
5. Wrist Flexion: bend wrist so fingers move toward inner aspect of
forarm
Extension: straighten hand to same plane as arm
Hyperextension: bend wrist so fingers move back as far
as possible
Radial flexion: abduction: bend wrist laterally toward
thumb
Ulnar flexion: adduction: bend wrist laterally away from
thumb
6. Hand and fingers Flexion: make a fist
Extension : straighten fingers
Hyperextension: bend fingers back as far as possible
Abduction: spread fingers back as far as possible
Adduction: bring fingers together
7. Thumb Flexion : move thumb across palmar surface of hand (90
degree)
Extension : move thumb away from hand (90 degree)
Abduction : move thumb laterally (30 degree)
Adduction : move thumb back
Opposition : touch thumb to tip of each finger of same
hand
9. Knee Flexion :bend knee to bring heel back toward thigh (120degree)
Extension: straighten each leg, place foot beside other foot
10. Ankle Plantar flexion: point toes downwards
Dorsiflexion: point toes upwards
11. Foot Eversion: turn sole of foot laterally
Inversion : turn sole of foot medially
 Active exercise of wrist

Bend wrist up and down Move wrist in circle to the right or left
Active exercise of forearm and
elbow
Active ROM of shoulder
 Normal ROM for Each Joint
• Hip flexion (bending) 0-125
• Hip extension (straightening) 115-0
• Hip hyperextension (straightening beyond normal range)
0-15
• Hip abduction (move away from central axis of body) 0-
45
• Hip adduction (move towards central axis of body) 45-0
• Hip lateral rotation (rotation away from center of body) 0-
45
• Hip medial rotation (rotation towards center of body) 0-
45
• Knee flexion 0-130
• Knee extension 120-0
Ankle plantar flexion (movement downward) 0-50
Ankle dorsiflexion (movement upward) 0-20
Foot inversion (turned inward) 0-35
Foot eversion (turned outward) 0-25
Metatarsophalangeal joints flexion 0-30
Metatarsophalangeal joints extension 0-80
Interphalangeal joints of toe flexion 0-50
Interphalangeal joints of toe extension 50-0
Shoulder flexion 0-90
Shoulder extension 0-50
Shoulder abduction 0-90
Shoulder adduction 90-0
Shoulder lateral rotation 0-90
Shoulder medial rotation 0-90
• Elbow flexion 0-160
• Elbow extension 145-0
• Elbow pronation (rotation inward) 0-90
• Elbow supination (rotation outward) 0-90
• Wrist flexion 0-90
• Wrist extension 0-70
• Wrist abduction 0-25
• Wrist adduction 0-65
• Metacarpophalangeal (MCP) joints abduction
0-25
• MCP adduction 20-0
• MCP flexion 0-90
• MCP extension 0-30
• Interphalangeal proximal (PIP) joints of fingers
flexion 0-120
• PIP extension 120-0
• Interphalangeal distal (DIP) joint of fingers flexion 0-
80
• DIP extension 80-0
 Passive Range of Motion
(PROM)
• Perform by nurse, without assistance from the
patient.
• no voluntary contraction, lengthening of muscle,
or tension on bones.
• without the activation of the patient's muscles,
• movement is performed entirely by an external
source.
Passive exercise of knee flexion
Passive exercises
 Types of body movement.
• Flexion: The state of being bent. The cervical spine is flexed when
the chin is moved toward the chest.
• Extension : The state of being in a straight line. The cervical spine is
extended when the head is held straight.
• Hyperextension. The state of exaggerated extension. The cervical
spine is hyperextended when the person looks overhead, toward the
ceiling.
• Abduction. Lateral movement of a body part away from the midline
of the body. The arm is abducted when it is held away from the body.
• Adduction. Lateral movement of a body part toward the midline of
the body. The arm is adducted when it is moved from an
outstretched position toward the body.
• Rotation. Turning of a body part around an axis. The head is rotated
when moved from side to side to indicate "no."
• Circumduction. Rotating an extremity in a complete circle.
Circumduction is a combination of abduction, adduction, extension,
and flexion.
• Supination. The palm or sole is rotated in an upward position
Pronation. The palm or sole is rotated in a downward position.
 Range-of-motion exercises
• During the bath is appropriate time.
• The warm bath water relaxes the muscles and decreases
spasticity of the joints.
• areas are exposed so that the joints can be both moved and
observed.
• before bedtime.
• The joints of helpless or immobile patients should be
exercised once every eight hours to prevent contracture from
occurring.
• start with the neck and moving down.
• Avoid overexerting the patient;
• Do not continue the exercises to the point that the patient
develops fatigue.
• Some exercises may need to be delayed until the patient's
condition improves.
• move slowly using smooth and rhythmic movements
• Support the extremity when giving passive exercise to the
joints of the arm or leg.
• Stretch the muscles and keep the joint flexible.
• Move each joint until there is resistance, but never force a
joint to the point of pain.
• Keep friction at a minimum to avoid injuring the skin.
• Return the joint to its neutral position.
• Use passive exercises as required, however, encourage
active exercises when the patient is able to do so.
 Evaluation
• Evaluate the patient in terms of fatigue, joint
discomfort, and joint mobility.
• Record Keeping. Range of motion is often
placed on a flow sheet
• an entry should be made in the Nursing
Progress Notes
• address the extent to which joints can be
moved in degrees
 CONTRAINDICATIONS

• Heart and Respiratory Diseases.

• ROM exercises require energy and tend to
increase circulation.
• Increasing the level of energy
• increasing the demand for circulation is
hazardous to patients
 Connective Tissue Disorders.
• ROM exercises put stress on the soft tissues of
the joint and on the bony structures.
• should not be performed if the joints are:
swollen, inflamed or injury to the
musculoskeletal system
 Guidelines
• Encourage to participate as fully as possible so
that he feels involved in the process.
• explain to the patient what you are about to
do and get his cooperation.
• Maintain body mechanics when carry out the
exercises for the patient.
• Promote the maximum degree of mobility for
the patient and prevent
• Reduce the effects of immobility.
• Save the patient a long rehabilitation.
 How are passive ROM exercises done?
• Start exercises at the person's head and work
down toward his toes.
• Leave the person in a comfortable position after
you finish each exercise.
• Always wash your hands before and after doing
ROM exercises for a person.

• How to start:
• Lay the person on his back with his head as flat
(no pillow) as possible.
• Support the back of the person's head with one
of your hands. Support the chin with other hand.
• Head and Neck exercises:
• Chin-to-chest. Raise the back of the person's
head up from the bed. Gently tip his chin
toward his chest. Try to rest the person's chin
on his chest if possible.
 Head turns.
• Put one hand on each side of the person's face.
Turn the person's head toward the right as if he
were looking over his right shoulder. Then slowly
turn the person's head so he is looking over his
left shoulder. Turn the head only far enough so
that the person's nose is lined up above their
shoulder.
 Head tilts.
• Put one of your hands on each side of the person's
face. Tilt the head to the side, bringing the right ear
toward the right shoulder. Then slowly tilt the
person's head to bring the left ear toward the left
shoulder.
 Shoulder exercises
• Shoulder movement, up and down. Turn the
person's palm in toward the body. Bring the
right arm forward and upward over the
person's head until the inner arm touches his
ear. Bring the arm back down to his side.
 Elbow exercises:
• Put one hand under the person's elbow and
hold his wrist with your other hand. Keep the
person's elbow straight, or bend the elbow
slightly if necessary.
•
• Shoulder rotation
• Bring the right arm out to the person's side.
Bend the elbow so the thumb and fingers are
pointing up. Rotate (turn) the arm so the
thumb and fingers point down toward the
person's toes.
 Forearm and Wrist exercises:
• How to start: Start with the person's arms at his sides.
Hold just below the person's wrist with one of your
hands. Hold the person's hand with your other hand.
• Wrist rotation. Hold the wrist and hand of the right
arm with the palm face down. Keeping his elbow on
the bed, lift the forearm up. Hold the hand and bend it
back toward the wrist. Then bend the hand down only
until you feel resistance. Rock the hand back and forth
sideways. Gently rotate the hand in smooth circles.
• Palm up, palm down. Keep the person's
elbow and forearm on the bed and raise his
hand. Gently twist it so his palm is up. Then
twist it so his palm is down.
• Repeat the above exercises with the left arm.
 Finger spreads.
• Gently straighten out his fingers. Spread the
fingers wide apart, one at a time. Then bring
the fingers back together.
 Hip exercises:

• Leg movement, side to side. Move the right

leg out to the right side as far as possible.
Then return the leg to the middle and cross it
over the left leg.
 Ankle exercises:
• How to start: Hold the right ankle with one
hand. Put your other hand on the bottom of the
foot.
• Ankle bends. Push the person's foot so his toes
point up toward the ceiling. Then put your hand
on top of the foot and push the foot down again.
 Ankle rotation.
• Hold the ankle with one hand. Hold the
person's upper foot with your other hand.
Gently turn the foot and ankle in circles.
 Toe bends
• With your palm on top of the person's foot,
curl the toes down toward the sole
(bottom) of the foot. Then straighten and
stretch the toes.
 Passive range of motion

Chin to chest Head turns Head tilts

Shoulder flexion Shoulder rotation

Elbow flexion
 Passive range of motion

Wrist rotation
Palm up, palm down Hand and finger

Hip and knee bends Hip extension Leg in and out

 Passive range of motion

Hamstring stretch Heel cord stretch Leg side to side

Ankle bends Ankle rotation Toe bends

 Strengthening Exercises
• Strengthening exercises help increase muscle
strength. Strong muscles help support the
joints -- making the joints more stable and
helping you move more easily and with less
pain. The two types of strengthening exercises
are isometric and isotonic.
 Isometric exercises
• involve tightening the muscles, without
moving the joints.
• These exercises are especially useful
when joint motion is impaired.
• works muscles and strengthens bone.
 Isometric exercise
• Increased muscle mass elevates metabolism, which
in turn burns fat. Strength training is called anaerobic
exercise
• exercise consisting of muscular contractions without
movement of the involved parts of the body.

•
 Isotonic exercise
• involve strengthening the muscles by moving
the joints.
• raise workload of cardiovascular system
• Examples :jogging, skipping, cycling,
swimming ,running
 Isotonic/dynamic exercises
• a dumbbell is lifted from the ground and used
to perform an exercise.
• The tension generated by the dumbbell is
now constant,
• if you pick up a 2 kilo dumbbell it weighs 2
kilos whatever you do with it.
• Thank you