Range of motion - Is the degree of movement possible for each joint

Passive Range of motion the nurse or another person moves each of the
clients joints through their complete range of motion, maximally stretching
all muscle groups within each plane over each joint
Active Range of motion the client moves each joint in the body through its
complete range of movement, maximally stretching all muscle groups within
each plane over each joint
Active Assistive Range of motion is carried out with the client and the nurse
participating. The client is encouraged to carry out as much of each
movement as possible, within the limitation of strength and mobility
I. Rationale:
1. To improve or maintain joint function
2. to restore joint function that has been lost due to a disease, injury or lack
of use
3. To improve or maintain muscle tone and strength
4. To help maintain cardiorespiratory function in an immobilized client
5. To prepare the client for ambulation
II. Equipment:
1. Hospital bed or bed
2. Sturdy Non-slip shoes or slippers
III. Planning
1. Plan when ROM exercises should be done
2. Plan whether exercises will be active, active assistive, or passive as well
as which joints are to be included
IV. Implementation
Basic guidelines:
A. Start gradually and work slowly
B. Avoid overexertion and using exercises to the point that the client
develops fatigue
C. Move each joint until there is resistance but not pain
D. After each movement, return the part to its correct anatomic position
E. Keep friction to a minimum when moving to avoid injuring the skin
F. Use range of motion exercises regularly as prescribed to build up muscle
and joint capabilities
G. Expect the clients respiratory rate and heart rate to increase during the
activity
H. Use passive exercises as necessary but encourage active exercises of the
same kind if the clients health condition permits

General guidelines:
A. Ensure that the client understands the reason for doing the ROM exercises
B. Clothe the client with a loose gown
C. Use correct body mechanics when providing ROM exercises to avoid
muscle strain
D. Expose only the limb being exercised
E. If muscle spasticity occurs during movement, stop the movement
temporarily but continue to apply slow gentle pressure on the part until the
muscle relaxes then proceed with the motion.
F. For elderly clients, it is not essential to achieve full range of motion in all
joints but instead, emphasize achieving a sufficient range of motion to carry
out activities of daily living.
Action:
1. Wash your hands.
2. Identify the client.
3. Close the door or pull curtains around the bed.
4. Explain to the client what you are about to do.
5. Position bed. Lower the head of the bed. Raise the entire bed to a
comfortable working level for you.
6. Maintain your own proper body mechanics as you carry the exercises for
the client
7. Follow the procedure below to administer ROM. Complete the ROM on
joints you have determined should be exercised.
8. After the procedure, wash your hands.
Temporomandibular Joint
TMJ Opening: Open mouth
TMJ Closure: Close mouth
Lateral motion: move jaw from side to side
Neck
Flexion: Move the head from the upright midline position forward, so that the
chin rest on the chest
Extension: Move the head from the flexed position to the upright position.
Hyperextension: Move the head from the upright position back as far as
possible.
Lateral flexion: Move the head laterally to the right and left shoulders while
facing front.
Rotation: Turn the face as far as possible to the right and left.
Shoulder
Flexion: Raise each arm from a position by the side forward and upward to a
position beside the head.
Extension: Move each arm from a vertical position beside the head forward
and down to a resting position at the side of the body.

Hyperextension: Move each arm from a resting side position to behind the
body.
Abduction: Move each arm laterally from a resting position at the side to a
side position above the head, palm of the hand away from the head.
Adduction (anterior): Move each arm from a position beside the head toward
laterally and across the front of the body as far as possible.
Adduction (posterior): Move each arm from a position beside the head
downward laterally and across behind the body as far as possible.
Horizontal flexion: Extend each arm laterally at shoulder height and move it
through a horizontal plane across the front of the body as far as possible.
Horizontal extension: Extend each arm laterally at shoulder height and move
it through a horizontal plane as far behind the body as possible.
Circumduction: Move each arm forward, up, back, and down in a full circle.
External rotation: With each arm held out to the side at the shoulder level
and the elbow bend to a right angle, fingers pointing down, move the arm
upward so that the fingers point up.
Internal rotation: With each arm held out to the side at shoulder level and the
elbow end to the right angle, fingers pointing up, bring the arm forward and
down so that the fingers point down.
Elbow
Flexion: Bring each lower arm forward and upward so that the hand is at the
shoulder.
Extension: Bring each arm forward and downward, straightening the arm.
Rotation for supination: Turn each hand and forearm so that the palm is
facing upward.
Rotation for pronation: Turn each hand and forearm so the palm is facing
downward.
Wrist
Flexion: Bring the fingers of each hand toward the inner aspect of the
forearm.
Extension: Straighten each hand to the same plane as the arm.
Hyperextension: Bend the fingers of each hand back as far as possible.
Circumduction: Move the wrist in a circular motion.
Radial flexion (abduction): Bend each wrist laterally toward the thumb side
with the hand supinated.
Ulnar flexion (adduction): Bend each wrist laterally toward the fifth finger
with the hand supinated.
Hand and fingers
Flexion: Make a fist with each hand.
Extension: Straighten the fingers of each hand.
Hyperextension: Bend the fingers of each hand back as far as possible.
Abduction: Spread the fingers of each hand apart.
Adduction: Bring the fingers of each hand together.

Thumb
Flexion: Move each thumb across the palmar surface of the hand toward the
fifth finger.
Extension: Move each thumb away from the hand.
Abduction: Extend each thumb laterally.
Adduction: Move each hand back to the hand.
Opposition: Touch each thumb to the tip of each finger of the same hand. The
thumb joint movements involved are abduction, rotation and flexion.
Circumduction: Move the thumb in a circular motion.
Hip
Flexion: Move each leg forward and upward. The knee maybe extended or
flexed.
Extension: Move each leg back beside the other leg.
Hyperextension: Move each leg back behind the body.
Abduction: Move each leg out to the side.
Adduction: Move each leg back to the other leg and beyond in front of it.
Circumduction: Move each leg backward, up, to the side, and down in a
circle.
Internal rotation: Turn each foot and leg inward so that the toes point as far
as possible away from the other leg.
Knee
Flexion: Bring each leg bringing the heel toward back of the thigh.
Extension: Straighten each leg, returning the foot to each position beside the
other foot.
Ankle
Extension (plantar flexion): Point the toes of each foot downward.
Flexion (dorsiflexion): Point the toes of each foot upward.
Eversion: Turn the sole of each foot laterally.
Inversion: Turn the sole of each foot medially.
Foot and Toes
Flexion: Curve the toe joints of each foot downward.
Extension: Straighten the toes of each foot.
Abduction: Spread the toes of each foot apart.
Adduction: Bring the toes each foot together.
Trunk
Flexion: Behind the trunk toward the toes.
Extension: Straighten the trunk from a flexed position.
Hyperextension: Bend the trunk backward.
Lateral flexion: Bend the trunk to the right and to the left.
Rotation: Turn the upper part of the body from side to side.

V: Evaluation and Documentation

1. Evaluate the client in terms of the following:
a. fatigue
b. joint discomfort
c. joint mobility
2. Document and report the following:
a. unexpected problems or notable changes in the clients movements such
as rigidity
b. type of exercise, body parts involved, duration, clients tolerance
c. other assessment findings