Range of Motion

1. Range of Motion

2. What does the term range-of-motion mean? • Why are range-of-motion exercises important?

3. Activity and exercise are important for all individuals • When patients have limited ability to move, range-of-motion (ROM) exercises help keep muscles and joints functioning • ROM exercises are done to maintain the health of the musculoskeletal system • Each joint and muscle in the body is moved through its full ROM

4. ROMs are frequently ordered by the doctor for patients with limited ability to move • ROMs are administered by Physical Therapists, Nurses, health care assistants, or other authorized person. • Can be done during the daily bath or at other times during the day.

5. Problems caused by lack of movement and inactivity: • Contractures • Tightening and shortening of a muscle that results in a permanent flexing of a joint • Foot drop is a common contracture • Contractures can also affect knees, hips, elbows and hands

8. Contractures of feet

9. Contractures of Knees

11. Contracture of Hands and Wrists

12. Lack of activity and decrease muscle and joint function leading to muscle ATROPHY causing the muscles to become weak

14. When there is a lack of movement, blood circulation is affected causing pressure ulcers and blood clots.

20. When there is a lack of activity, the body loses minerals, especially calcium from the bones. • Bones become more brittle, increasing the risk for fractures.

21. Other problems with inactivity: • Poor appetite • Constipation • Urinary tract infections • Respiratory problems Pneumonia

22. 4 Main Types of ROM exercises: • Active • Active-Assistive • Passive • Resistive

23. Active ROM • Performed by the patient who moves each joint without assistance • Helps strengthen muscles • Maintains joint function and movement • Helps prevent deformities

24. Active-assistive ROM • Patient actively moves the joints but receives assistance to complete the entire ROM • At times, equipment such as a pulley is used to complete the ROM • Helps strengthens muscles • Maintains joint function and movement • Helps prevent deformities

25. Passive ROM • Performed when another person moves each joint for a patient who is not able to exercise • Maintains joint function and movement • Helps to prevent deformities • Does not strengthen muscles

26. Resistive ROM • Performed by a therapist, and the exercises are performed against resistance provided by the therapist • Helps patient develop increased strength and endurance • Applies more pressure to muscles.

27. Notes: • Health care assistants should find out what type of ROMs are to be performed and determine if limitations to ROMs exist before performing or assisting patient with the exercises • In some states and healthcare facilities, only PT’s and RN’s may perform ROM to the head and neck, especially if stretching is involved.

28. !!!Warning!!! • After hip or knee replacement surgeries, some ROM exercises may be restricted or limited • Patients with osteoporosis, a condition in which the bones become porous and are prone to fracture, may have limitations on ROM • Check legal requirements regarding ROM exercises.

29. Midline

30. Proper terms for movements of each joint: • Abduction: moving a part away from the midline of the body • Adduction: moving a part toward the midline of the body • Flexion: bending a body part • Extension: straightening a body part • Hyperextention: excessive straightening of a body part • Rotation: Moving a body part around on its own axis • Circumduction: Moving in a circle at a joint or moving one end of a body part in a circle while the other end remains stationary (ex. Swinging arm in circle)

31. Pronation: turning a body part downward, turning palm down • Supination: turning a body part upward, turning palm up • Opposition: touching each of the fingers with the tip of the thumb • Inversion: turning a body part inward • Eversion: turning a body part outward

32. Things to observe while performing ROMs • Movements should be slow, smooth, and gentle to avoid injury • Support should be provided to the part above and below the joint being exercised • A joint should never be forced beyond its range of motion or exercised to the point of pain, resistance, or extreme fatigue • If a patient complains of pain, stop the exercise and report this to the immediate supervisor.

33. Observe the patient closely…if you notice the patient is in pain, has SOB, or is perspiring and pale, stop the exercise. • Each movement should be performed three to five times or as ordered • Patient should be encouraged to assist as much as possible • Avoid unnecessary exposure of the patient • Close door and screen unit to provide privacy • Use good body mechanics at all times to prevent injury

34. Steps of Range of Motion: • Obtain prior authorization and determine the type of ROM and any limitations to movement • Knock on door, pause before entering, introduce yourself, identify patient, explain procedure, and provide privacy • Observe all safety points regarding body mechanics, side rails, height of bed, and patient safety • Position pt in a supine position and drape with a bath blanket

35. Perform range of motion exercises in an organized manner • Start at the head and move to the feet • Complete one side of the body and then move to the opposite side • Perform each movement three to five times or as ordered • Provide support for the body part above and below the joint being exercised • Never force a joint beyond its ROM or cause pain • Use good body mechanics if the patient complains of pain or discomfort notify supervisor

36. Page 933