1. Unit 5: Range of Motion Exercises
Lesson 1: Range of
Motion Exercises

2. Lesson 1 – Range of Motion Exercises
Full range of motion (ROM)
Normal direction and distance through which a joint moves
Limited ROM
Reduction in normal movement of joint
Range of Motion Exercises
Full range of motion (ROM) is the normal direction and distance through which a joint moves. For example, the elbow joint moves in such a way that the elbow fully bends. As a result, the hand can be brought all the way up to the shoulder. Limited ROM is a reduction in the normal movement of a joint. For example, some people's elbow joint moves in such a way that the elbow only partially bends. As a result, the hand can be brought toward the shoulder but not all the way up to the shoulder. Patients needing rehabilitation and restorative care often have limited ROM.
To achieve full range of motion, the muscles and tissue surrounding a joint have to be flexible enough to allow the joint to move through the range of motion. ROM exercises increase flexibility.
ROM exercises are an important part of rehabilitation and restorative care, especially in terms patients' activity of daily living (ADL) abilities. Furthermore, OBRA requires that patients receive the necessary care to attain, maintain, and improve their range of motion as well as to prevent further decrease in their range of motion. ROM exercises are a routine rehabilitation and restorative care procedure. Therefore, a physician or therapist's order is not necessary for most patients.

3. Lesson 1 – Range of Motion Exercises
Increases flexibility
ROM Exercises
To achieve full range of motion, the muscles and tissue surrounding a joint have to be flexible enough to allow the joint to move through the range of motion. ROM exercises increase flexibility.
ROM exercises are an important part of rehabilitation and restorative care, especially in terms patients’ activity of daily living abilities. Furthermore, OBRA requires that patients receive the necessary care to attain, maintain, and improve their range of motion as well as to prevent further decrease in their range of motion. ROM exercises are a routine rehabilitation and restorative care procedure. Therefore, a physician or therapist’s order is not necessary for most patients.

4. Lesson 1 – Range of Motion Exercises
Role of an assistant
Health Assistants and ROM Exercises
When assisting with range of motion (ROM) exercises, health assistants must follow the patient's care plan. Specifically, health assistants need the following information:   
The joint(s) to exercise   
Any areas of injury or weakness, such as the right leg, the left hip, or the back   
How much assistance the patient needs   
How many times to repeat the ROM exercises   
How many times to do the ROM exercises each day
In some states and agencies, only physicians, therapists, and nurses may perform range of motion exercises to the neck. Health assistants should only exercise the neck if their state and agency permit them to do so.
While assisting a patient, health assistants must immediately report any problems to their supervisor.
After assisting a patient, health assistants must report all of the actions taken. They must also report any observations. For example, they should report how well the patient did the ROM exercises and if the patient complained of discomfort.

5. Lesson 1 – Range of Motion Exercises
Levels of ROM assistance
Active ROM exercises
Active assistive ROM exercises
Passive ROM exercises
Resistive ROM exercises
Levels of ROM Assistance
Patients should do range of motion (ROM) exercises as independently as possible. As a result, health care workers should encourage patients and provide the least amount of assistance necessary. Depending on a patient's ability, there are various levels of ROM assistance:   
Active ROM exercises   
Active assistive ROM exercises   
Passive ROM exercises   
Resistive ROM exercises

6. Lesson 1 – Range of Motion Exercises
Active ROM exercises
Least assistive
Patient can do full ROM exercises without being watched or helped
Active ROM Exercises
The least assistive level of ROM assistance is active. With this level of assistance, patients can do full range of motion exercises independently. Health care workers do not need to watch or help patients.

7. Lesson 1 – Range of Motion Exercises
Active assistive ROM exercises
Patient can move joint
Health care worker needs to move joint through full range of motion
Active Assistive ROM Exercises
The next level of ROM assistance is active assistive. With this level of assistance, patients can move their joints, but health care workers need to move the patients' joints through the full range of motion.

8. Lesson 1 – Range of Motion Exercises
Passive ROM exercises
Most assistive
Patient cannot move joint
Health care worker assists to move joint through limited ROM
Passive ROM Exercises
The most assistive level of ROM assistance is passive. With this level of assistance, patients cannot move their joints. As a result, health care workers need to move the patients' joints through the patients' limited range of motion.

9. Lesson 1 – Range of Motion Exercises
Resistive ROM exercises
Health care worker provides resistance
Patient does full ROM
Strengthens muscles
Resistive ROM Exercises
Another level of ROM assistance is resistive. With this level of assistance, health care workers provide resistance while patients do full range of motion exercises independently. This strengthens patients' muscles

10. Lesson 1 – Range of Motion Exercises
Guidelines for ROM exercises
Explain
Expose
Support
Move slowly, gently, and smoothly
Do not force
Guidelines for ROM Exercises
When assisting patients with range of motion (ROM) exercises, health care workers must follow these guidelines:   
Tell patients what you are doing.   
Expose only the body part being exercised.   
Support the body part being exercised.   
Move body parts slowly and gently.   
Do not force joints beyond their range of motion.

11. Lesson 1 – Range of Motion Exercises
Range of motion terms and movements
NOTE: Consider demonstrating these movements to the class
Flexion: bending a body part   
Plantar flexion: bending a body part forward   
Dorsal flexion: bending a body part backward   
Extension: straightening a body part   
Hyperextension: excessive straightening of a body part   
Abduction: moving a body part away from the midline of the body   
Adduction: moving a part toward the midline of the body   
Rotation: moving a body part around on it own axis or moving a joint in a circular motion   
Supination: turning a body part upward   
Pronation: turning a body part downward   
Radial deviation: moving toward the thumb side of the hand   
Ulnar deviation: moving toward the little finger side of the hand   
Circumduction: moving one end of a body part in a circle while the other end remains stationary
Opposition: touching each of the fingers with the tip of the thumb   
Inversion: turning a body part inward   
Eversion: turning a body part outward

12. Unit 5: Range of Motion Exercises
Lesson 2: Passive
ROM Exercises

13. Lesson 2 – Passive ROM Exercises
Most assistive level
Patient cannot move joint
Health care worker moves joint through limited ROM
Passive ROM Exercises
Recall that the least assistive level of range of motion (ROM) assistance is active. With this level of assistance, patients can do full range of motion exercises independently. Health care workers do not need to watch or help patients.
On the other hand, the most assistive level of ROM assistance is passive. With this level of assistance, patients cannot move their joints. As a result, health care workers need to move the patients' joints through the patients' limited range of motion. Health assistants often perform passive ROM exercises.