Learning Supplement
Range of Motion Exercises
Range
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of motion exercises are done 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.
Principles related to Range of Motion Exercises
1.
Normal range of motion of a joint prevents limitation of movement and loss of
joint function.
2.
Bones are moved with contraction of the skeletal muscles.
3.
Muscles are always in a mild state of contraction (tonus).
4.
Muscle contraction is under control of the central nervous system.
5.
Muscle contraction is influenced by the transport of nutrients and oxygen and
removal of waste by-products.
6.
Muscle fatigue is caused by the build up of waste products.
7.
Muscles need alternate periods of rest and work.
8.
Almost every muscle has an antagonist that works in the opposite direction.
9.
Muscles act in groups to perform work.
10. The strongest of any muscle group will dominate when there is sufficient stress
placed on the group.
11. If muscles are not used, they degenerate in size (atrophy), shape and strength.
12. If muscles are overused, they increase in size (hypertrophy), shape and
strength.
13. Muscle weakness and atrophy / hypertrophy result in limited range of motion
for the related joint.
14. Passive exercises provide only for joint mobility, not muscle tone.
15. Active exercises provide for joint mobility and muscle tone.
16. Moving a muscle beyond it elastic limits will result in tearing or damage.
17. Decreased activity affects all body systems.
Types of Range of Motion Exercises
Range of motion exercises are isotonic exercises in which the patient or
caregiver moves each synovial joint through it complete range of motion. These
exercises begin as soon as the patient is medically stable. There are three main
types of range of motion exercises and the patient’s condition determines which type
of exercises is needed.
1.
Active Range of Motion - when the patient can perform the exercises
alone.
2.
Passive range of motion exercises are those that patients cannot do
themselves and are performed by the nurse or physical therapist.
3.
Active-assistive exercises are performed by the patient with some
assistance.
The patient’s medical condition also determines which part of the body needs
exercising.
Assessment Prior to Performing Range of Motion Exercises
1.
Be aware of the patient’s medical condition.
2.
Familiarize yourself with the patient’s current range of motion. Note any
joint pain, stiffness, of inflammation that might limit the patient’s
motion.
3.
Assess the patient’s ability to participate in the ROM exercises.
Guidelines in Performing ROM Exercises
1.
Frequency of providing ROM depends on the patient’s condition, but
once a shift is usually the minimum.
2.
Because warm water relaxes the muscles and joints, during bathing is
an ideal time to perform ROM.
3.
Raise the bed to a height that keeps you from having to bend at the
waist as you work. ALWAYS be sure to lower the bed when finished.
Keep the side rail up on the side opposite to where you are standing.
4.
While ROM is being performed, the patient is usually placed in the
supine position.
5.
During ROM, be sure to support the distal and proximal end of the limbs.
6.
Try to work on one joint at a time with about 5 repetitive actions per
joint.
IV.
Learning Activities
1.
Practice ROM on your partner who pretends to be comatose and is
unable to help you.
a.
Identify the type of exercise regimen you would do in this
situation.
b.
Identify each joint that will require exercise for this patient, and
the specific motions that joint is capable of making.
c.
Demonstrate the ROM for each joint with appropriate support for
the joint and extremity.
2.
Identify
a.
b.
c.
d.
modifications to ROM for the following situations:
left side paralysis
post-operative status after a hip replacement
fractured clavicle
severe pain and swelling in the left calf region
Guide Sheet for ROM of Major Joints
NOTE: Performing ROM in a SYSTEMATIC manner (neck to toes) is important.
Order of the ROM activity done with each joint varies.
NECK:
flexion (chin to chest)
extension (return head to midline)
rotation (face rt & lt)
lateral flexion (ear to shoulder)
SHOULDER:
flexion (entire arm up)
extension (arm back down)
abduction (arm away from the body)
adduction (arm back to body)
external rotation (elbow bent/shoulder high - hand up)
internal rotation (elbow bent/shoulder high - hand down)
circumduction (arm out/move in circle)
ELBOW:
pronation (palm down)
supination (palm up)
flexion (bend elbow)
extension (straighten elbow)
WRIST:
flexion (fingers pointing down)
extension (fingers pointing forward)
hyperextension (fingers pointing up)
radial flexion (hand toward radial bone)
ulnar flexion (hand toward ulnar bone)
FINGERS:
flexion (fingers into a ball)
extension (straighten fingers out)
abduction (fingers & thumb apart)
adduction (fingers & thumb together)
opposition (thumb to each finger)
HIP:
abduction (leg pulled away from midline)
adduction (return leg to body)
flexion (knee included) (knee bent & moved toward chest)
extension (leg straightened)
internal rotation (roll leg in)
external rotation (roll leg out)
circumduction (move leg in a circle)
ANKLE:
plantar flexion (toes pointing down toward bed)
dorsi flexion (toes pulled back toward body)
inversion (soles of feet together)
eversion (soles of feet out)
rotation (move foot in circle)
TOES:
same as for fingers (except no opposition)
NOTE: Place patient prone or on their side, do hyperextension of neck, shoulder,
and hip.
Independent Review
PART I - Definitions for ROM
Match the correct definition to the listed term.
GROUP A
______ 1. Bending or folding movements which
decrease the size of the angle between the
anterior surfaces of articulated bones with
the exception of the knee and toe joints.
A. Hyperextension
B. Abduction
C. Flexion
______ 2. Straightening movements which return a
part to its anatomic position.
______ 3. Extending movements which position a body
part beyond the anatomic position.
D. Adduction
E. Extension
F.
______ 4. Movement of a body part away from the
median place of the body.
______ 5. Movement of a body part toward the median
plane of the body.
G. Pronation
H. Rotation
I.
______ 6. Pivoting or moving a bone upon its own axis.
______ 7. Movement which causes a bone to describe
the surface of a cone as it moves.
______ 8. Movement of the forearm which turns the
palm forward as in the anatomic position.
______ 9. Movement of the forearm which turns the
back of the hand forward.
Circumduction
Supination
PART I - Definitions (continued)
GROUP B
_____ 10. Front or ventral
A. Proximal
_____ 11. Located behind or following after (dorsal).
B. Posterior
_____ 12. Parts of the body nearest to the midsagittal
plane.
C. Superior
D. Internal
_____ 13. Parts of the body farthest from the
midsagittal plane which divide body into
right and left halves.
E. Plantar
F.
_____ 14. Describes a position near the origin of any
part.
_____ 15. Describes a position away from the source of
any part.
Anterior
G. Lateral
H. Inferior
I.
External
J.
Medial
_____ 16. Within or on the inside.
_____ 17. Exterior or on the lateral side.
K. Distal
_____ 18. Lower
L.
_____ 19. Higher
_____ 20. Pertaining to the sole of the foot.
_____ 21. Pertaining to the palm of the hand.
Palmar
PART II - The Joints
Match the type of joint with the correct description and/or examples.
_____ 22. Joints permitting widest range of movement.
A. Ball and socket
_____ 23. Elbow, knee, and ankle joints.
B. Hinge
_____ 24. Arch-shaped surface rotates about a rounded
or peglike pivot.
C. Pivot
D. Gliding
_____ 25. Ball-shaped head fits into concave socket.
E. Condyloid
_____ 26. Wrist joint.
F.
_____ 27. Joints permitting movement in one plane C
like a hinged door.
_____ 28. Spool-shaped surface fits into a concave
surface.
_____ 29. Joints permit gliding movement.
_____ 30. Shoulder and hip joints.
_____ 31. Joint between radius and ulna.
_____ 32. Articulating surfaces are usually flat.
_____ 33. Joints permit rotation movement.
_____ 34. Joints between the carpal bones.
_____ 35. Joint permits movement in two planes at right
angles to each other.
_____ 36. Oval-shaped condyle fits into elliptical cavity.
_____ 37. A modified condyloid joint which permits freer
movement. Example: joint between
metacarpals of the thumb and the carpal of
the wrist (multangular bone).
Saddle
Key for Independent Review
PART I
PART II
1. C
22. A
2. E
23. B
3. A
24. C
4. B
25. A
5. D
26. E
6. H
27. B
7. F
28. B
8. I
29. D
9. G
30. A
10. F
31. C
11. B
32. D
12. J
33. C
13. G
34. D
14. A
35. E
15. K
36. E
16. D
37. F
17. I
18. H
19. C
20. E
21. L