1. Terms and Definitions
• Abduction – away from the center (midline) of the body
• Active-assistive ROM – The nurse assistant assists the resident in performing the exercise.
• Active range of motion (AROM) exercises – movements carried out by the resident
• Adduction – toward the center (midline) of the body
• Eversion – a turning outward
• Extension – to straighten; to extend
• External rotation – to move the extremity in a circular motion away from the center of the body
• Flexion – to bend
• Hyperextension – extensive extension, beyond the normal range of the joint
• Internal rotation – to move the extremity in a circular motion toward the center of the body

2. Terms and Definitions • Inversion – a turning inward
• Lateral – to the side
• Passive range of motion (PROM) exercises – movements the staff routinely conduct for the resident to prevent complications
• Pronation – to turn downward
• Rotation – to move a joint in a circular motion
• Supination – to turn upward
• Supine – lying on one’s back

3. Purposes • Musculoskeletal system must be exercised to remain healthy.
• Exercises prevent joints from becoming stiff and contractures (deformities) from developing.
• Exercises prevent muscles from losing strength and shrinking (atrophy).
• ROM exercises prevent loss of minerals from bones (osteoporosis).
• ROM exercises improve circulation.
• ROM exercises allow residents’ joints to move more freely and as a result, the residents remain more independent.

4. Three Types of Range of Motion
• Active – Resident performs exercises alone or uses a device such as a pulley or bicycle.
• Active-assistive – The nurse assistant assists the resident when performing the exercises.
• Passive – The exercise is done for the resident who is unable to move independently; involves moving the resident’s body parts through a series of exercises.

5. Nurse Assistant’s Responsibilities
• Always check with charge nurse and/or the plan of care for instructions or limitations.
• In addition to regularly scheduled range of motion exercises, exercises can be incorporated into activities of daily living.
• Never exercise or stretch a joint to the point of pain. Exercise joints only within the range of easy movement.
• Exercise as many times as ordered, usually three to five times.
• Always stop the exercise if discomfort or pain develops and report to the charge nurse.
• Support each joint above and below the joint being exercised. This prevents joint pain and possible injury.
• Always handle the resident gently with open palms. Be aware of the normal ROM for each joint.

6. Nurse Assistant’s Responsibilities
• Remember, hyperextension of the neck is not possible with the resident in a supine position.
• Allow resident to assist in procedure as much as possible.

7. Conclusion
Range of motion exercises are an important aspect of residents’ well-being because they promote circulation; prevent osteoporosis, contractures, and atrophy; and help residents feel a greater sense of independence.

8. Steps of Procedure for Giving Range of Motion Exercises
NOTE: Check care plan for instructions before performing range of motion exercises.
1. Wash your hands.
2. Identify and greet resident. Identify self.
3. Explain what you are going to do.
4. Provide privacy. Make sure the resident is wearing adequate clothing.
5. Raise bed to a comfortable working height.
6. Assist resident into supine position.

9. Steps of Procedure for Giving Range of Motion Exercises
7. Shoulders (See Figure 5.1.)
Figure 5.1 – Shoulder Exercises
a. Flexion/extension
(1) Support the arm at the wrist and elbow and lift the arm toward the ceiling. Continue lifting the arm over the resident’s head until you feel resistance.

10. Steps of Procedure for Giving Range of Motion Exercises
(2) Slowly lower the arm to the resident’s side.
b. Abduction/adduction
(1) Support the arm at the elbow and shoulder and move the arm out to the side. Continue moving toward resident’s head.
(2) Slowly move the arm back toward the center of body.
c. Internal/external rotation
(1) Move the arm away from the body to shoulder level.
(2) Bring the hand forward to touch the bed and then backward to touch the bed.

11. Steps of Procedure for Giving Range of Motion Exercises
8. Elbow (See Figure 5.2.)
Figure 5.2 – Elbow Exercises
a. Flexion/extension
(1) Bend the arm at the elbow, touch the shoulder, then straighten the arm.
(2) Bend the arm at the elbow and touch the chin, then straighten the arm.

12. Steps of Procedure for Giving Range of Motion Exercises
b. Supination/pronation
(1) Hold the resident’s hand in a handshake position; support the arm at the elbow point.
(2) Turn palm of the hand toward the floor and then toward the ceiling.

13. Steps of Procedure for Giving Range of Motion Exercises
9. Wrist (See Figure 5.3.)
Figure 5.3 – Wrist Exercises
a. Flexion/extension/hyperextension – Support arm and hand; bend the wrist forward, straighten it, and then bend it backward.
b. Abduction/adduction – Move the hand from side to side at the wrist.

14. Steps of Procedure for Giving Range of Motion Exercises
10. Fingers (See Figure 5.4.)
Figure 5.4 – Finger Exercises
a. Flexion/extension – Support the hand at the wrist. Instruct resident to make a clenched fist and then relax it. Make sure that the thumb is on top of the fingers and open hand fully.

15. Steps of Procedure for Giving Range of Motion Exercises
b. Abduction/adduction – Move each finger away from the nearest finger and then return it.
c. Thumb opposition – Bend the little finger toward inner hand and stretch the thumb toward the little finger and move it to the base of the little finger and back. Repeat with each finger.
d. Thumb rotation – Move the thumb in a circle one direction and then the other direction.

16. Steps of Procedure for Giving Range of Motion Exercises
11. Hip and knee (See Figure 5.5.)
Figure 5.5 – Hip and Knee Exercises
a. Flexion/extension
(1) Support the leg at the knee and ankle joints and keep the knee straight. Raise and lower the leg.
(2) Bend the knee and move toward the chest; slowly straighten the knee.

17. Steps of Procedure for Giving Range of Motion Exercises
b. Abduction/adduction
(1) Move the leg straight out to the side of the body until you feel some resistance.
(2) Slowly move the leg back toward the center of the body.
c. Internal/external rotation – Support knee and ankle joints; move the ankle in toward the opposite leg and then outward.

18. Steps of Procedure for Giving Range of Motion Exercises
12. Ankle (See Figure 5.6.)
Figure 5.6 – Ankle Exercises
a. Inversion/eversion – Support the foot at the ankle joint and turn the foot toward the opposite foot and then away from the opposite foot.
b. Dorsiflexion/plantarflexion – Bend the foot up toward the knee then down toward the floor.

19. Steps of Procedure for Giving Range of Motion Exercises
13. Toes (See Figure 5.7.)
Figure 5.7 – Toe Exercises
a. Flexion/extension – Bend and then straighten the toes.
b. Abduction/adduction – Move each toe toward the next toe and then away from the next toe.

20. Steps of Procedure for Giving Range of Motion Exercises
14. Lower bed to a position of safety; raise side rails as directed by care plan.
15. Make the resident comfortable; place call signal within reach.
16. Wash your hands.
17. Record and report.