Shoulder flexion, abduction, external and internal rotationElbow flexion and extensionWrist flexion and extensionGross finger flexion and extensionHip and knee flexion and extension to neutral onlyHip abduction and to neutralHip internal and external rotationAnkle dorsiflexion, rotationToe gross flexion/extension.
Range of motion
MICU Early MobilityJess Trappe
Why? Attempt to maintain and/or restore optimal mobility. Decrease hazards r/t immobility ▪ i.e. frequent repositioning, deep breathing & coughing, muscle & joint exercises (ROM).
Types of ROM Active ▪ Pt able to perform the exercise independently Passive ▪ ROM performed by the caregiver Active assisted ▪ ROM performed by pt with assistance
Active and Active-assisted ROM help to prevent muscular atrophy and joint contracture. Passive ROM help to maintain joint function ROM can be incorporated into ADL’s!
Joint exercised ADL MovementNeck Nodding head yes Flexion Shaking head no Rotation Moving right ear to right shoulder Lateral flexion Moving left ear to left shoulder Lateral flexionShoulder Reaching to turn on overhead light Flexion, extension Reaching to bedside table Hyperextension Rotating shoulders toward chest Abduction Rotating shoulders toward back AdductionElbow & Wrist Eating, bathing Flexion, extensionFingers & Thumb All activities requiring fine motor coordination Flexion, extension, abduction, adduction, oppositionHip Walking Flexion, extension, hyperextension Moving to side laying position Flexion, extension, abduction Rolling feet inward Internal rotation Rolling feet outward External rotationKnee Walking Flexion, extension Moving to and from side-laying position Flexion, extensionAnkle Walking Dorsiflexion, plantar flexion Moving toe toward head of bed Dorsiflexion Moving toe toward foot of bed Plantar flexionToes Walking Extension, hyperextension Wiggling toes Abduction, Adduction
When performing active-assisted or passive ROM exercises support joint by holding distal portion of extremity or using cupped hand to support joint. Complete exercises in head-to-toe sequence, each movement should be repeated 5 times during an exercise period
Body Part Type of Type of Movement JointNeck, Cervical Pivotal Flexion: Bring chin to rest on chestspine Extension: Return head to erect position Hyperextension: Bend head back as far as possible Lateral flexion: tilt head as far as possible toward each shoulder Rotation: Turn head as far as possible in circular movement
Body Part Type of Type of Movement JointShoulder Ball & Flexion: Raise arm from side position forward to position Socket above head Extension: Return arm to position at side of body Hyperextension: move arm behind body, keeping elbow straight Abduction: Raise arm to side to position about head with palm away from head Adduction: Lower arm sideways and across body as far as possible Internal rotation: With elbow flexed, rotate shoulder by moving arm until thumb is inward and palm is facing the back External rotation: With elbow flexed, move arm until thumb is upward and lateral to head Circumduction: Move arm in full circle
Body Type of Type of MovementPart JointElbow Hinge Flexion: Bend elbow so that lower arm moves toward its shoulder joint and hand is level with shoulder (bicep curl) Extension: straighten elbow by lowering handForearm Pivotal Supination: turn lower arm and hand so that palm is up Pronation: Turn lower arm so that palm is downWrist Condyloid Flexion: Move palm toward inner aspect of forearm (fingers point to the ground) Extension: Move fingers and hand posterior to midline (fingers point to the ceiling) Hyperextension: Bring dorsal surface of hand back as far as possible Radial Deviation: Bend wrist laterally toward fifth finger Ulnar Deviation: Bend wrist medially toward thumb
Body Part Type of Joint Type of MovementFingers Condyloid Flexion: make a fist Hinge Extension: Straighten fingers Hyperextension: Bend fingers back as far as possible Abduction: Spread fingers apart Adduction: Bring fingers togetherThumb Saddle Flexion: Move thumb across palm surface of hand Extension: Move thumb straight away from hand Abduction: Extend thumb laterally Opposition: Touch thumb to each finger of same handHip Ball & Socket Flexion: Move leg forward and up Extension: Move leg back beside other leg Hyperextension: Move leg behind body as far as possible.
Body Type of Joint Type of MovementPartHip cont’d Ball & Socket Abduction: Move leg laterally away from body Adduction: Move left back toward medial position and beyond if possible Internal rotation: Turn foot and leg toward other leg External rotation: Turn foot and leg away from other leg Circumduction: Move leg in circleKnee Hinge Flexion: Bring heel back toward back of thigh Extension: Return leg to floorAnkle Hinge Dorsal flexion: Move foot so that toes are pointed upward Plantar flexion: Move foot so that toes are pointed downwardFoot Gliding Inversion: Turn sole of foot medially Eversion: Turn sole of foot laterally
Body Part Type of Joint Type of MovementToes Condyloid Flexion: Curl toes downward Extension: Straighten toes Abduction: Spread toes apart Adduction: Bring toes together The main points are to move the extremities to promote circulation and decrease entrapment syndromes and neuropathies It is imperative that the RN assesses the pt to perform the correct ROM exercises. Not all of these exercises will be appropriate for all pts
Performing Range of Motion Exercises, Skill 11-1 (Perry AG, Potter PA: Clinical nursing skills & Techniques, ed 7, St. Louis, 2010, Mosby.) Tables Incorporating Active Range of Motion Exercises Into Activities of Daily Living, Range of Motion Exercises (from Perry AG, Potter PA: Clinical nursing skills &t, ed 7, St. Louis, 2010, Mosby.)