This document discusses range of motion (ROM) exercises, including passive, active, and active-assistive ROM. It defines each type and their goals, indications, limitations, and how to perform them properly. A case study example is provided of a 67-year old female stroke patient with right-sided weakness requiring ROM exercises to maintain joint flexibility. Evidence suggests simple ROM exercises can improve physical function in older stroke patients. An appropriate exercise prescription for this patient would be active-assistive ROM of both upper and lower extremities.

1. Range-of-motion
Exercises
JOTHAM MUNALA

2. Learning Objectives
At the end of the lecture, the students
should be able to:
 Differentiate the types of range-of-motion
(ROM) exercises in terms of
◦ Goals of treatment
◦ Indications
◦ Treatment variables
◦ Limitations
◦ Contraindications
 Identify the appropriate type of ROM
exercise to employ given a condition
 Perform ROM exercises properly (lab)

3. Why use ROM exercises?
 Basic technique for movement
examination
 Technique used for initiating or
incorporating movement into a
therapeutic intervention program
◦ Full ROM vs Functional ROM

4. TYPES OF ROM EXERCISES
 Passive range-of-motion exercises
◦ PROM
 Active range-of-motion exercises
◦ AROM
 Active-Assistive range-of-motion
exercises
◦ AAROM

5. PASSIVE ROM EXERCISES
 Movement produced by an
external force within the
unrestricted range of
motion of a segment
◦ Gravity
◦ Machine
◦ Therapist or another person
◦ Another part of the
individual’s own body
 Little to or no muscle
contraction elicited

6. G
O
A
L
S
 Maintain joint and connective tissue
mobility
 Minimize the effects of the formation of
contractures
 Maintain mechanical elasticity of
muscles
 Assist circulation
 Enhance synovial movement along joints
 Decrease pain
 Assist with healing process after injury or
surgery
! Minimize ill-effects of
immobilization

7. I
N
D
I
C
A
T
I
O
N
S
 Acute or inflamed tissue where active
motion may disrupt the normal healing
process
 Patients who are unable to move or
are not allowed to move such as when
comatose, paralyzed, or on complete
bed rest
 For assessment purposes
 When teaching a patient movement
 To prepare a patient for stretching

8. L
I
M
I
T
A
T
I
O
N
S
Passive ROM exercise WILL NOT:
 prevent atrophy
 increase strength or endurance
 assist in circulation to the extent that
active, voluntary muscle contraction
does

9. Evidence in Practice
Clinical Question:
Is there evidence to suggest the
effectiveness of continuous passive
motion following total knee
arthroplasty?

10. Evidence in Practice
Key articles:
 Grella, RJ (2008) Continuous passive
motion following total knee arthroplasty:
a useful adjunct to early mobilisation? A
systematic review
 Brosseau L, et al (2004) Efficacy of
continuous passive motion following total
knee arthroplasty: A meta analysis
 Lenssen AF, et al (2003) Continuous
passive motion following primary total
knee arthroplasty: Short- and long-term
effects on range of motion

11. Evidence in Practice
Results/conclusion:
 Conflicting evidence on the
effectiveness of continuous passive
motion following total knee
arthroplasty
 Potential benefits may need to be
weighed against additional cost and
inconvenience
 There is need for further trials to
ascertain the effects of using
continuous passive motion post-total
knee arthroplasty

12.  Movement produced on a
segment upon active
contraction of the muscles
crossing the joint within
the unrestricted range of
motion.
 Assistance is provided by
an outside force (manual
or mechanical), as the
prime mover muscles is
unable to complete the
ACTIVE ROM EXERCISES
ACTIVE-ASSISTIVE ROM
EXERCISES

13.  Maintain elasticity and contractility of
muscles
 Provide sensory feedback from the
contracting muscles
 Provide a stimulus for bone and joint
tissue integrity
 Increase circulation and prevent
thrombus formation
 Develop coordination and motor skills
for functional activities
G
O
A
L
S

14.  When a patient is able to actively
contract the muscles and move the
segment with or without assistance
 Muscle weakness and inability to
move segment completely against
gravity
 Aerobic conditioning programs
 During periods of immobilization,
AROM is used in joints above and
below the immobilized segment
I
N
D
I
C
A
T
I
O
N
S

15. Free Active ROM exercise WILL NOT:
 maintain or increase strength of
already strong muscles
 develop skill or coordination except in
the movement patterns used
L
I
M
I
T
A
T
I
O
N
S

16. PRECAUTIONS AND
CONTRAINDICATIONS OF ROM
EXERCISES
 Should not disrupt the healing process
◦ Excessive movement/wrong performance
of movement leads to increased pain and
inflammation
 Should not be done if response will be
life-threatening to the patient

17. PRINCIPLES OF ROM TECHNIQUES
 Examination, Evaluation, and
Treatment Planning
 Patient preparation
 Application of techniques
◦ Application of PROM
◦ Application of AROM

18. Examination, Evaluation, and
Treatment Planning
 Examine and evaluate the impairments
and level of function.
◦ Determine any precautions and prognosis,
and plan of intervention
 Determine the ability to participate in the
ROM activity
◦ Note what type of ROM exercise to meet
goals
 Decide on the patterns of movement
o Anatomic plane vs muscle range of
elongation vs combined patterns vs functional
patterns

19.  Monitor the general condition and
response during and after the
examination and intervention
◦ Take vital signs, presence of pain, quality
of movement, change in ROM
 Document and communicate findings
and intervention
 Re-evaluate and modify the
intervention as needed
Examination, Evaluation, and
Treatment Planning

20. Patient Preparation
 Communicate with the patient that
plan of intervention and the method to
be used
 Remove all restrictive clothing, linen,
splint, and dressings; drape
appropriately
 Position the patient comfortably
maintaining proper alignment and
stabilization while allowing movement
along the available ROM
 Maintain proper biomechanics

21. Application of Techniques
 Grasp the extremity around the joints
providing support needed for control
 Support areas of poor structural
integrity
 Move the segment throughout its pain-
free range to point of tissue resistance
 Perform the movements smoothly and
rhythmically 5 to 15 reps
◦ Depends on the objectives of the program
and patient’s general condition and
response to the exercise

22. Application of Passive ROM
 Movement is being provided by an
external force
 No active resistance or assistance is
provided by the muscles that cross the
joint.
 Motion is performed within the
available or free ROM

23.  Demonstrate the desired motion through
PROM
 Ask the patient to perform the movement
independently
◦ Be ready to provide assistance or guidance
when necessary
 To complete movement smoothly
 In the presence of weakness (may provide at the
beginning or end of ROM, or when torque is
greatest)
 Perform the motion within the available
range
Application of Active ROM

24.  Identify the appropriate ROM exercise
for the case with due consideration to
the:
◦ baseline function of the patient
◦ available resources
 Note the joint segments that are
involved, therefore, require
mobilization
 Identify joint motions required
 State the number of repetitions, sets,
and the frequency (how often in a day)
EXERCISE PRESCRIPTION

25. You are a physical therapist working in an
aged care facility. A 67-year old female
diagnosed with cerebrovascular accident
was referred to you for management.
She presents with weakness of both the
right upper and lower extremity muscles.
Result of which, she has difficulty moving
her involved extremities to full range.
One of your goals is to maintain joint
flexibility. You deem that a regular ROM
exercise may be beneficial.
SAMPLE CASE 1

26. What does the case tell you?
 Patient has inability to move both
upper and lower extremities to full
range due to weakness of muscles
 There’s a need for an ROM exercise
that will maintain joint flexibility

27. What does evidence say?
Tseng et al, in 2007, reported that a simple
range-of-motion exercise can generate
positive effects in physical function of
older people with stroke.
* randomized controlled trial
* statistically significant improvements in
joint angles, activity function, and
perception of pain and depressive
symptoms

28. What ROM ex is appropriate?
 AROM?
 AAROM?
 PROM?
WHY?

29. Exercise prescription
AAROM exercise of the right upper and
lower extremities, all planes x 10
repetitions x 1 set, 3 times daily

30. References
Brosseau, L., Milne, S., Wells, G., Tugwell, P., Robinson, V., Casimiro,
L., Pelland, L., Noel, M.J., Davis, J., and Drouin, H. (2004) Efficacy
of continuous passive motion following total knee arthroplasty: a
metaanalysis. The Journal of Rheumatology. 31(11): 2251-2264.
Encabo, M. (2004). Lecture notes on PT 153: Therapeutic exercises II,
range of motion exercise and stretching. UP-College of Allied
Medical Professions
Grella, R. J. (2008) Continuous passive motion following total knee
arthroplasty: a useful adjunct to early mobilisation? Physical Therapy
Reviews. 3(4): 269-279.
Kisner, C., Colby, L. (2007). Therapeutic exercise: Foundations and
techniques (4th ed). Philadelphia: F. A. Davis Company.
Lenssen, A. F., Koke, A., de Bie, R. A., and Geesink, R. (2003).
Continuous passive motion following primary total knee arthroplasty:
short- and long-term effects on range of motion. Physical Therapy
Reviews. 8(3):113-121.
Rothstein, J., Roy, S., and Wolf, S. (2005). The rehabilitation
specialist’s handbook (3rd ed). Philadelphia: F. A. Davis Company.
Tseng, C. N., Chen, C. C., Wu, S. C. & Lin, L. C. (2007). Effects of a
range of motion exercise programme. Journal of Advanced Nursing.
57(2): 181-191.