1. Range of Motion (ROM) Exercises Upper and Lower Extremities

2. Range of Motion (ROM) – Definition: exercising joints through the available motion to maintain available range and flexibility of joint structures

3. People Who Need ROM Exercises – Patients on prolonged bed rest

4. Purpose of ROM Exercises – To promote and maintain joint mobility – Prevent contractures and shortening of muscles and tendons – Increase circulation to extremities – Decrease vascular complications of immobility – Enhance rehabilitation – Facilitate comfort for the patient

5. Types of Range of Motion (ROM) – Active Range of Motion – When the patient can perform the exercises alone – Passive Range of Motion – Patients cannot do for themselves and are performed by nurse or physical therapist – Active-Assisted Range of Motion – Performed by the patient with some assistance

6. Guidelines 1.Check the doctors orders. 2.Know the patient diagnosis and rationale (reasoning) for ROM. 3.Explain the procedure to the patient. 4.Frequency of providing ROM depends on the patient’s condition, but once a shift is usually the minimum (2-3 times daily).

7. Guidelines Continued… 5. Because warm water relaxes the muscles and joints, bathing is an ideal time to perform ROM. 6. Raise the bed to a height that keeps you from having to bend at the waist as you work. Lower the bed when finished. 7. While ROM is being performed, the patient is usually placed in the supine position and only expose limb being exercised. 8. During ROM, be sure to support the distal and proximal ends of the limbs. 9. Try to work on one joint at a time with about 5-10 repetitive actions per joint. Use slow rhythmic motions.

8. Key Factors – Start ROM exercises on the unaffected side – Start each movement in neutral position – Use a firm comfortable grip while maintaining support of the extremity. – Avoid forcing beyond range – Avoid overexerting patient – Avoid skin friction – Exercise just below point of pain, NOT beyond

9. Key Factors – If rigidity occurs slightly decrease ROM until is subsides – Stop if spastic contraction occurs – Talk to patient to help them relax – Expect heart rate and respirations to rise – Document the procedure and patient reaction

10. ASK YOURSELF! A nurse is putting Mr. Jones joints through ROM. What two conditions indicate that the nurse should stop?

11. ASK YOURSELF ANSWER! 1.Fatigue/weakness 2.Pain

12. ASK YOURSELF! – Do you always need an order to do ROM for a patient? – How many times should you perform ROM activity on a joint?

13. ASK YOURSELF ANSWER! – Yes!! – 2-3 times daily, 5-10 movements per joint!

14. Basic Terminology - ROM – Flexion – to bend a joint – Extension – to straighten a joint – Abduction – move away from midline of body – Adduction – move toward midline of body

15. Basic Terminology - ROM – Horizontal Abduction – moving away from body in a transverse plane – Horizontal Adduction – moving toward body in a transverse plane

16. Basic Terminology - ROM – Rotation – internal (medial) – pivoting inward along an axis – external (lateral) – pivoting outward along an axis

17. Basic Terminology - ROM – Supination – rotate forearm, palm up – Pronation – rotate forearm, palm down – Opposition – oppose thumb tip to base of little finger (may be done to each individual finger tip)

18. Basic Terminology - ROM – Eversion – sole of foot turned outward at the ankle – Inversion – sole of foot turned inward at the ankle – Dorsiflexion – an upward or backward motion of the ankle towards the hips – Plantar Flexion – a toe down motion of the foot at the ankle

19. Example of Flexion – Elbow flexion – bend

20. Example of Flexion – Knee flexion – bend

21. Example of Flexion – Toes flexion – bend

22. Example of Extension – Knee extension – straight

23. Example of Extension – Head & Neck extension – straight

24. Example of Abduction – Hip abduction – away from midline of body

25. Example of Adduction – Toes adduction – toward midline

26. Examples of Rotation – Head and Neck rotation – turning part on its axis Left Right

27. Example of Rotation – Hip internal rotation – pivoting inward

28. Example of Horizontal Adduction – Shoulder horizontal adduction – toward body in transverse plane

29. Example of Supination – Forearm supination – rotate forearm, palm up

30. Example of Pronation – Forearm pronation – rotate forearm, palm down

31. Example of Opposition – Thumb opposition – oppose thumb tip base of little finger or to finger tip of each individual finger

32. Example of Eversion – Ankle eversion – sole of foot turned outward at the ankle

33. Example of Inversion – Ankle inversion – sole of foot turned inward at the ankle

34. Example of Dorsiflexion – Ankle dorsiflexion – an upward or backward motion of the ankle toward the hips

35. Example of Plantar Flexion – Ankle plantar flexion – a toe down motion of the foot at the ankle