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 function2. to restore joint function that has been lost due to a disease, injury or lack of use3. To improve or maintain muscle tone and strength4. To help maintain cardiorespiratory function in an immobilized client5. To prepare the client for ambulation

II. Equipment:1. Hospital bed or bed2. Sturdy Non-slip shoes or slippers

III. Planning1. Plan when ROM exercises should be done2. Plan whether exercises will be active, active assistive, or passive as well as which joints are to be included

IV. ImplementationBasic guidelines:A. Start gradually and work slowlyB. Avoid overexertion and using exercises to the point that the client develops fatigueC. Move each joint until there is resistance but not painD. After each movement, return the part to its correct anatomic positionE. Keep friction to a minimum when moving to avoid injuring the skinF. Use range of motion exercises regularly as prescribed to build up muscle and joint capabilitiesG. Expect the clients respiratory rate and heart rate to increase during the activityH. 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 exercisesB. Clothe the client with a loose gownC. Use correct body mechanics when providing ROM exercises to avoid muscle strainD. Expose only the limb being exercisedE. 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 client7. 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 JointTMJ Opening: Open mouthTMJ Closure: Close mouthLateral motion: move jaw from side to side

NeckFlexion: Move the head from the upright midline position forward, so that the chin rest on the chestExtension: 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.

ShoulderFlexion: 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.

ElbowFlexion: 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.

WristFlexion: 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 fingersFlexion: 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.

ThumbFlexion: 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.

HipFlexion: 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.

KneeFlexion: 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.

AnkleExtension (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 ToesFlexion: 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.

TrunkFlexion: 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 Documentation1. Evaluate the client in terms of the following:a. fatigueb. joint discomfortc. joint mobility

2. Document and report the following:a. unexpected problems or notable changes in the clients movements such as rigidityb. type of exercise, body parts involved, duration, clients tolerancec. other assessment findings