Definition
Range of Motion (ROM) exercises are therapeutic movements designed to maintain or improve the flexibility and mobility of joints. They’re essential in rehabilitation, injury prevention, and maintaining functional independence, especially in patients with limited mobility, neurological conditions, or post-surgical recovery.
Purposes
- To increase muscle strength and endurance.
- To maintain normal physiological function.
- To prevent complications caused by immobility-like contracture.
- To improve patient’s participation in activities of daily living.
- To improve physical activity.
- To increase joint flexibility.
General Guidelines
- Passive ROM exercise should be done only on patients who are unable to do it on their own.
- Passive ROM exercise should be done to the point of slight resistance.
- Never do ROM exercise beyond the capacity of the individual that is to the point of discomfort.
- Move body parts smoothly, slowly, and rhythmically.
- Expect heart rate and respiratory rate to increase during exercise, which should return to resting levels within 3 minutes, if not, exercises are strenuous for patient.
- 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 ROM exercises.
Procedure
| Nursing action | Rationale | |
| 1 | Before procedure: Explain to the patient the purpose of doing exercise. | Ensure cooperation of patient. |
| 2 | Remove rings or other constructive jewellery, if present. | In case of hand swelling, this may impaired circulation. |
| 3 | Remove all the tight-fitting cloth and provide hospital gown. | Ensure comfort of the patient. |
| 4 | Cover patient with a bath blanket or sheet and assist assuming a supine position. | Ensure comfort of the patient. |
| 5 | During procedure: Provide privacy and wash hands. | Reduce patient anxiety and reduce risk of transfer of micro-organism. |
| 6 | Expose only the area that is being exercised. | Avoid discomfort of the patient. |
| 7 | Position bed to an appropriate height. | Ensure proper body mechanism. |
| 8 | Start providing passive ROM exercise from the head downward. Neck: Move head through flexion,extension,lateral flexion,rotation,and hyper extension of the neck. Movement of head is contra indicated in spinal surgery, spinal trauma and other central nervous system trauma and for patient having central nervous line. Shoulder: Flexion,extension,hyper extension, abduction, adduction, and circumduction, external rotation and internal rotation. Shoulder should be supported proximally and distally. Trunk: Flexion, extension, hyper extension, lateral flexion, and rotation of the trunk. Elbow: Flexion, extension, pronation and supination. Support elbow joint both proximally and distally Forearm: Pronation and supination. Position wrist in functional position. Wrist: Flexion, extension, hyper extension and lateral flexion (radial and ulnar). Position wrist in functional position. Hand: Move hand through flexion, extension, hyper extension, abduction, adduction, position of the thumb, and circumduction of thumb. Hip: Move hip through flexion, extension abduction, internal and external rotations, and circumduction with support of the above and below joints. Knee: Move knee through flexion and extension Ankle and foot: Extension, plantar flexion, Dorsi flexion, eversion, and inversion of foot. Toes: Move through flexion, extension, abduction, and adduction. | |
| 9 | After procedure: Wash hands. | |
| 10 | Record procedure. | |
| 11 | Position the patient in a comfortable position. |
Special Consideration
- Move each joint through its full ROM exercise three times and follow regular pattern of movement.
- Provide passive ROM exercise two times a day.
- Support measures should be used to prevent muscle strain or injury during ROM exercise.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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