Range of motion and strengthening exercises are presented. There are two types of range of motion exercises - active done by the patient, and passive done with assistance. Range of motion exercises involve moving each joint through its full range of motion. Muscle strengthening exercises include exercises for the upper and lower limbs like quadriceps setting, gluteal setting, and dangling to prepare patients for ambulation. Exercises are to be done under supervision, with precautions like proper clothing and stopping if the patient experiences discomfort.

1. RANGE OF MOTION EXERCISES &
ACTIVE AND PASSIVE EXERCISES
PRESENTED BY
NIKITA SHARMA

2. INTRODUCTION
▪ Introduction: Exercises that are performed by
patient himself or by a nurse in case of helpless
patients to mobilize all joint through their full range.
ROM exercises are those in which a joint is moved
through its full range of motion according to its
capacity.

3. CLASSIFICATION
▪ Classification: There are two types of ROM
exercises:
▪ Active
▪ Passive
▪ Active: Done by patient himself
▪ Passive: Done with help of assistant from another
person.

4. ACTIVE RANGE OF MOTION EXERCISE

5. PASSIVE RANGE OF MOTION EXERCISES

6. PURPOSES
▪ To increase muscle strength and endurance
▪ To maintain normal physiological function
▪ To prevent complications caused by immobility like
contractures
▪ To improve patient participation in activities of daily living
▪ To improve physical activities
▪ To increase joint flexibility.

7. BODY PLANE

8. TERMINOLOGIES
▪ Abduction
movement in the coronal plane that moves a limb laterally
away from the body e.g- spreading of the fingers
▪ Adduction
movement in the coronal plane that moves a limb medially toward
or across the midline of the body e.g- bringing fingers together
▪ Circumduction
circular motion of the arm, thigh, hand, thumb, or finger
that is produced by the sequential combination of flexion,
abduction,xtension, and adduction

9. CONTINUE….
▪ Depression
downward (inferior) motion of the scapula or mandible
▪ Dorsiflexion
movement at the ankle that brings the top of the foot
toward the anterior leg
▪ Elevation
upward (superior) motion of the scapula or mandible

10. CONTINUE….
▪ Eversion
foot movement involving the intertarsal joints of the foot
in which the bottom of the foot is turned laterally,
away from the midline
▪ Extension
movement in the sagittal plane that increases the angle of a joint (straightens the joint);
motion involving posterior bending of the vertebral column or returning
to the upright position from a flexed position
▪ Flexion
movement in the sagittal plane that decreases
the angle of a joint (bends the joint); motion involving anterior bending of the vertebral column

11. FLEXION & EXTENSION

12. CONTINUE…..
▪ Hyperextension
excessive extension of joint, beyond the normal range of movement
▪ Hyper flexion
excessive flexion of joint, beyond the normal range of movement
▪ Inferior rotation
movement of the scapula during upper limb adduction in
which the glenoid cavity of the scapula moves in a downward
direction as the medial end of the scapular spine moves in an
upward direction

13. CONTINUE….
▪ Inversion
foot movement involving the intertarsal joints of the foot in
which the bottom of the foot is turned toward the midline
▪ Lateral excursion
side-to-side movement of the mandible away from the midline,
toward either the right or left side
▪ Lateral flexion
bending of the neck or body toward the right or left side

14. CONTINUE…..
▪ Lateral (external) rotation
movement of the arm at the shoulder joint or the thigh at the
hip joint that moves the anterior surface of the limb away from
the midline of the body
▪ Medial excursion
side-to-side movement that returns the mandible to the midline
▪ Medial (internal) rotation
movement of the arm at the shoulder joint or the thigh at the hip joint
that brings the anterior surface of the limb toward the midline of the body

15. CONTINUE……
▪ Opposition
thumb movement that brings the tip of the thumb in contact
with the tip of a finger
▪ Plantar flexion
foot movement at the ankle in which the
heel is lifted off of the ground
▪ Pronated position
forearm position in which the
palm faces backward

16. CONTINUE…..
▪ Pronation
forearm motion that moves the palm of the hand
from the palm forward to the palm backward position
▪ Protraction
anterior motion of the scapula or mandible
▪ Reposition
movement of the thumb
from opposition back to the
anatomical position
(next to index finger)

17. CONTINUE……
▪ Retraction
posterior motion of the scapula or mandible
▪ Rotation
movement of a bone around a central axis (atlantoaxial joint) or around
its long axis (proximal radioulnar joint; shoulder or hip joint); twisting of the
vertebral column resulting from the summation of small motions between adjacent
vertebrae

18. CONTINUE…….
Superior rotation
movement of the scapula during
upper limb abduction
in which the glenoid cavity of the
scapula moves in
an upward direction as the medial
end of
the scapular spine moves in a
downward direction

19. CONTINUE…..
▪ Supinated position
forearm position in which the palm faces anteriorly (anatomical position)

20. POINTS TO REMEMBER
▪ Passive range of motion exercise
should be done only on patient
who are unable to do it on their
own.
▪ Passive ROM exercise should be
done to point of slight
resistance. Never do ROM
exercises beyond capacity of
individual that is to the point of
discomfort.
▪ Move the body parts smoothly,
slowly and rhythmically.
▪ Expect heart rate, respiratory
rate to increase during exercise
which return to resting level
within 3 minutes, if not
exercises are strenuous for
patient.
▪ If muscle spasticity occur during
movement, stop movement
temporarily, but continue to
apply slow gentle pressure on
part until the muscle relaxes,
then proceed with ROM
exercise.
▪

21. PREPROCEDURAL STEPS
▪ Remove all tight clothes and provides a hospital gown or loose clothes.
▪ Cover the patient with sheet and assist in assuming a supine position.
▪ Explain the patient purposes of doing exercises
▪ Provide privacy and wash hands
▪ Expose only the area that is being exercised.

22. INTRA-PROCEDURAL STEPS
Start providing ROM from head to downward
Neck:
 Move head through flexion, extension, lateral, rotation, hyperxtension
 Movement of head is contraindicated in supine surgery, spine trauma and patient
having central vein line.

23. CONTINUE….
Shoulder: Flexion, extension, hyperextension, abduction, adduction,
circumduction, external rotation, internal rotation.
• Shoulders should be supported proximally and distally.

25. Trunk:
 Flexion, extension, hyperextension,
 lateral flexion, rotation.
CONTINUE……

26. Elbow:
Flexion, extension,
pronation, supination.
CONTINUE….

27. Forearm:
Pronation, supination, position wrist in functional
position.
CONTINUE…..

28. Wrist:
Flexion, extension, hyperextension, lateral flexion
CONTINUE……

29. ▪ Hip:
Move hip through flexion, extension, abduction,
adduction, internal rotation, external rotation
and support above and below joint.
CONTINUE…..

30. ▪ Hand:
More through flexion, extension, hyperextension,
abduction, adduction, apposition of thumb.
CONTINUE…..

31. ▪ Knee:
Move through flexion, extension,
abduction and adduction.
CONTINUE……..

32. ▪ Postprocedural steps:
▪ Wash hands
▪ Make patient comfortable
▪ Record procedure.
▪ Special considerations:
▪ Move each joint through its full ROM exercises three times and follow regular
pattern of movements
▪ Provide passive ROM exercises two times a day
▪ Support measures should be used to prevent muscle strain or injury during
ROM exercises.

33. ▪ MUSCLE STRENGTHENING EXERCISES:
Introduction: weak patients after prolonged inactivity require physical
conditioning before they can ambulate again. These include exercises of lower
limbs, upper limbs and dangling at bed side.

34. Purposes:
▪To prepare the patient for
ambulation
▪To re-establish their previous ability
to walk
▪To promote muscle tone and
strength.

35. Points to remember:
▪ Be with the patient
▪ Never leave the patient alone
▪ Clothes should be appropriate
▪ Assess for the patient strength
▪ Check for physician order
▪ Communicate with patient and see the
condition of patient
▪ Document the procedure with date and time
▪ Collaborate with other team and family
members.

36. Procedure:
Lower limb exercises:
Quadriceps setting:
Quadriceps muscles covers front and side of the
thigh. Together they aid in extending the leg.
Exercising these muscles enable the patient to
stand and support their body weight.
Steps/ Patient Teaching:
▪ Tighten the quadriceps muscles by flattening
the back of the knees into the mattress.

37. ▪ If difficult then put a pillow under the
knee or heel.
▪ Hold the contracted position for the
count of five.
▪ Relax and repeat 2-3 times each times
every hour.
CONTINUE……

38. Gluteal setting:
▪ Isometric exercises that strengths and
tones the gluteal muscles. It includes
contracting and relaxing the gluteal
muscles. These are easily performed in
bed or chair.
Steps/ Patient Teaching:
▪ Tighten the gluteal muscles by pinching
the cheeks of buttocks together.
▪ Hold and contract the position for the
count of five.
▪ Relax and repeat for two and three times.
CONTINUE….

39. Straight leg exercises:
▪ For strengthening lower legs after knee
or hip replacement surgeries.
Steps/ Teaching:
▪ Tighten the thigh muscle with knee
straightened in the bed or in sitting.
▪ Lift leg several inches
▪ Hold for 5-10 seconds
▪ Repeat for several times
▪ Helps in early ambulation
CONTINUE…..

40. Upper Arm Strengthening:
Indications:
▪ Patient using walker, cane, or crutches. It includes:
▪ Flexion, extension of arms and wrists.
▪ Raising and lowering the wrist with hand.
▪ Squeezing a ball or spring grip or make a fist.
▪ Modified hand pushups in bed.
▪ Performed in several ways depending on patient age
and condition. While in patient bed patient may lift
hips off the bed by pushing down on mattress with
hands.
CONTINUE…..

41. If patient lies on abdomen:
▪ Flex the elbows
▪ Place the hands palms down appropriately at shoulder level
▪ Straighten the elbows to lift the head and chest off the bed.
▪ Pushups are performed 3-4 times a day.
Dangling:
▪ Helps to normalize blood pressure due to orthostatic hypotension.
Steps/ Teaching:
▪ Place the patient in Fowler’s position or in a chair for few minutes
CONTINUE…..

42. ▪ Lower the height of bed if possible because the patient can use floor for support or
provide foot stool.
▪ Provide slippers
▪ Ask the patient raise and lower the feet several times.
Special Considerations:
▪ Alternate the activities of rest and sleep
▪ Give prescribed pain killer half an hour before
▪ Empty the bladder before exercise
▪ Begin exercises for few minutes and gradually increase the time
▪ Use hard surface to perform exercises
▪ Use loose garments while exercising
CONTINUE……

43. ▪ See the condition of patient. Exercises
can be discontinued according to
condition of patient
CONTINUE…..

44. Summarization:
▪ Introduction
▪ Classification
▪ Points to remember
▪ Procedure of range of motion exercises
▪ Special consideration
▪ Introduction of the muscle strengthening exercises
▪ Purposes of muscle strengthening exercises
▪ Procedure of muscle strengthening exercise
▪ Special considering during muscle strengthening
exercises

45. Recaptualization:
True/false:
▪ Passive exercises are done by the patient
themselves.
▪ Gluteal strengthening is done for strengthening
the lower leg muscles
▪ `Loose the clothes while exercising
▪ We should provide ROM exercises beyond
resistance
▪ Exercises should performed in the bed.

46. Bibliography:
▪ Ghai Sandhya, “NINE Clinical Nursing
Procedures”, CBS publishers & Distributors
Pvt. Ltd., 1st Edition, Page no.- 277-282.
▪ www.sweethaven02.com>pdf_Health
▪ https://www.ncbi.nlm.nih.ov>articles
▪ https://www.flintrehab.com>active-vs-Passive