How to assist patient in passive range of motion exercises?

Exercising is essential for the physical fitness of the patients. Therefore, CNAs make patients work out a little to keep them active and prevent them from problems like joint stiffening which might affect one’s ability to walk. It is recommended that the patient must practice exercises while doing some tasks like bathing, dressing up, etc. Passive range of motion test must be performed on the patients periodically so that they remain energetic and recover quickly.

Procedure to be Followed to Check the Patient’s Passive Range of Motion

Wash your hands before start practicing the skill.
Bring the bed in a comfortable position. Either raise one part of the bed or lower it down, whichever is convenient.
You must start checking the range of motion from the patient’s head. Ensure that the patient is not suffering from any injuries related to spinal cord or neck. Make him move his head in left and right direction slowly.
After head, you must check the patient’s hand. Ask him to extend his arm towards you and then contract it. Make him bring his arm towards his body and then move it away in a crossing motion. Make him flex his wrist and move his fingers. These exercises must be done for 10 minutes on one arm, then next 10 minutes on the other arm. Care must be taken that the patient does not get tired while performing these activities.
After this, you must work with the patient’s knees. Ask him to extend his knees in the forward direction and then contract them to bring close to the center of the body. This activity must be performed for 10 minutes on one leg.
Afterwards, ask the patient to stretch at the ankles and twist and turn the toes in clockwise and anti-clockwise directions.

Points to Remember

These exercises must be practiced two – three times a day by the patients who are not able to move from the bed.
If the patient complains about stiffness in the joints, let the supervisor nurse know immediately.
Always keep a close watch over the patients while they perform such exercises, for any inflammations or swollen joints.
The patient must not have respiratory problems or severe pain while doing these exercises, in case they have, nurse must be informed immediately.
These tests can be done in five types of positions:High Fowler Position – In this position, one of the sides of the bed is elevated and the patient lies on his back. He is supported by the raised portion of bed.
Supine / Lying Position – The patient normally lies on the bed with stretched arms.
Semi-Fowler Position – In this, one portion of the bed is raised at 45-degree angle and the patient lies on it.
Sims Position – In this position, the patient rolls to one side of the bed with legs stretched straight.
Lateral Position – Patient lies on one side of bed with flexed arms and legs. The arms and legs are raised with the help of a pillow.

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What does examiner notice when you perform this skill?

If you rinse your hands properly with the help of antiseptic soap and lukewarm water before commencing the activity.
Whether you make use of passive range of motion exercises (Supination & Pronation, Extension & Flexion, Abduction and Adduction, Internal and External Rotation, Plantar Flexion & Dorsal, and Radial Deviation or Ulnar Deviation, Opposition).
Whether you provide support to the joints and distal and proximal ends of the extremities.
If you keep a note on how patient reacts during the whole process.
What you do when the patient try to resist the procedural exercises or face the pain?
If you end the procedure by washing your hands.

Expert’s Tips

It is very important to keep the patient active during the entire procedure as this will help him recover quickly.
You must make the patients do the exercises regularly so that they may not suffer from stiffness in the joints.
One of the ways to follow an exercise routine is to make patients exercise while doing other activities like make them workout while you are giving them bed baths, etc.
You must apply your strictness in following a particular exercise regime, but at the same time, you must be gentle enough and should not exert too much pressure on the patients to give the output at once.