Passive Range of Motion Exercises

Written by Hollie Finders, RN
Hollie Finders is a registered nurse with years of experience working in the health care field. She has degrees in both biochemistry and nursing. After working with patients of all ages, Hollie now specializes in pediatric intensive care nursing. Hollie’s LinkedIn

Procedure

Perform hand hygiene.
Explain the procedure to the patient and ask for his or her assistance in following directions.
Raise the bed to a comfortable working height.
Assist the patient into a supine position.
In the following exercises, move the patient’s joints in a natural motion and stop at the point of resistance. Do not continue the motion if the patient reports pain.
Repeat each exercise a minimum of three times.
To exercise the shoulder, keep the arm straight and support the patient’s arm by holding the elbow and wrist.
- Raise the arm above the patient’s head (flexion) and return arm in the same path to the patient’s side (extension).
- Move the arm laterally away from the patient’s body (abduction) and return arm to patient’s side (adduction).
To exercise the elbow and forearm, hold the patient’s wrist and elbow.
- Bend at the elbow to allow the patient’s hand to touch the shoulder (flexion). Straighten the arm (extension).
- Turn the palm downward (pronate) and rotate it upward (supinate).
To exercise the wrist, fingers, and thumb, hold the patient’s wrist with one hand and use the other hand to guide the fingers.
- Bend the hand up (extension) and down (flexion).
- Turn hands inward toward the thumbs (radial flexion) and outward toward the pinky (ulnar flexion).
- Keep the thumb parallel to the index finger (adduction) and move the thumb laterally away from the index finger (abduction).
- Turn the thumb inward toward the palm (flexion) and back out (extension).
- Touch each finger to the thumb (opposition).
- Make a fist (flexion) and straighten fingers (extension).
- Separate the fingers (abduction) and bring them back together (adduction).
To exercise the hip, straighten the leg and support at the knee and ankle.
- Slightly raise the leg off the bed and move the leg away laterally away from the other leg (abduction). Bring the legs back together (adduction).
- Carefully rotate the leg inward (internal rotation) and outward (external rotation).
To exercise the knee, support under the knee and ankle. Slide the patient’s ankle toward the thigh (flexion) and straighten the leg (extension).
To exercise the ankle and toes, support the ankle and use the other hand to guide the toes.
- Pull the patient’s toes up toward the legs (dorsiflexion) and push down toward the ground (plantar flexion).
- Bend the sole of the foot inward (supination) and outward (pronation).
- Curl the toes down (flexion) and straighten them (extension).
- Separate the toes (abduction) and return them (adduction).
Assist the patient into a comfortable position and lower the bed.
Perform hand hygiene.
Document the procedure in the patient’s chart and report any changes in the patient’s condition to the nurse.

Important Information

Range of motion exercises are used to help prevent or decrease contractures, improve flexibility of joints, and improve strength [1]. Bedridden patients as well as those with reduced mobility may greatly benefit from passive range of motion exercises. However, do not perform these exercises without an order to do so, as it may be contraindicated in certain situations. To avoid injuring the patient, always follow the correct procedure, make natural motions, and stop when resistance is encountered.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482407/

More Resources

Nail Care (Fingers and Toes) for CNAs

Nail care of both the feet and the hands should be performed as part of the patient’s daily hygiene routine. The status of the patient’s nails can reflect their overall health. Nail issues can also lead to infection that can spread systemically (ex, ingrown nails or fungus). You should never clip a patient’s nails with nail clippers, and always review your institution’s policy about what nail care is allowed.

Measuring Blood Pressure

Many factors can interfere with obtaining an accurate blood pressure. The most common mistakes that lead to inaccurate blood pressures are a result of improper technique, including: not supporting the patient’s arm, using the wrong sized cuff, positioning the cuff too low on the patient’s arm, improper positioning of the cuff’s artery marker, and attempting to measure blood pressure through clothing.

Perineal Care of the Female Resident

Perineal care should be performed during a bath, after using the bedpan, and/or after incontinence. Proper technique is important for maintaining hygiene, preventing infection, and avoiding skin breakdown. Because of the close proximity between a woman’s urethra, vagina, and anus, it is essential to only wipe in a front to back motion. Wiping in the opposite direction is associated with a greater risk for developing a urinary tract infection.

Measuring the Apical Pulse

The apical pulse rate is the most accurate non-invasive measurement of heart rate because it is measured directly over the apex of the heart. Apical pulse is preferred in cases when the radial pulse is difficult to palpate, when the pulse is irregular, greater than 100 beats per minute, or less than 60 beats per minute when measured by other means (electronic, radial, etc.).

Removing Personal Protective Equipment

It is important to follow the correct procedure while removing personal protective equipment to avoid contaminating your skin or clothing. The most common source of contamination in this process stems from improper removal of gloves. Gloves are often the most soiled piece of equipment. To avoid contaminating your skin or the other equipment worn, gloves should always be removed first. Then remove the goggles, gown, and mask, in that order.

Offering the Bedpan

When a resident is bed-bound, they must use a bedpan to urinate and defecate. This can be embarrassing for the resident, so it should be done with sensitivity to the resident’s privacy and dignity. There are two types of bedpans. A regular bedpan is the deeper and more rounded of the two. A fracture pan has a relatively flat upper end with a trough at the lower end. Fracture pans are used for residents who have difficulty, or restrictions against, moving their hips and/or backs.