Range of motion

ROM for Early MICU Mobility

1. Range of Motion MICU Early Mobility Jess Trappe

2. Range of Motion 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).

3. Range of Motion 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

4. Range of Motion 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!

5. Range of Motion Ways to incorporate ROM to ADL’s Joint exercised ADL Movement Neck Nodding head yes Shaking head no Moving right ear to right shoulder Moving left ear to left shoulder Flexion Rotation Lateral flexion Lateral flexion Shoulder Reaching to turn on overhead light Reaching to bedside table Rotating shoulders toward chest Rotating shoulders toward back Flexion, extension Hyperextension Abduction Adduction Elbow & Wrist Eating, bathing Flexion, extension Fingers & Thumb All activities requiring fine motor coordination Flexion, extension, abduction, adduction, opposition Hip Walking Moving to side laying position Rolling feet inward Rolling feet outward Flexion, extension, hyperextension Flexion, extension, abduction Internal rotation External rotation Knee Walking Moving to and from side-laying position Flexion, extension Flexion, extension Ankle Walking Moving toe toward head of bed Moving toe toward foot of bed Dorsiflexion, plantar flexion Dorsiflexion Plantar flexion Toes Walking Wiggling toes Extension, hyperextension Abduction, Adduction

6. Range of Motion 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

7. Range of Motion Exercises Body Part Type of Joint Type of Movement Neck, Cervical spine Pivotal Flexion : Bring chin to rest on chest 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

8. Examples

9. Range of Motion Exercises Body Part Type of Joint Type of Movement Shoulder Ball & Socket Flexion : Raise arm from side position forward to position 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

10. Examples

11. Examples

12. Range of Motion Exercises Body Part Type of Joint Type of Movement Elbow 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 hand Forearm Pivotal Supination : turn lower arm and hand so that palm is up Pronation : Turn lower arm so that palm is down Wrist 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) Hyperextensio n: 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

13. Examples

14. Range of Motion Exercises Body Part Type of Joint Type of Movement Fingers Condyloid Hinge Flexion : make a fist Extension : Straighten fingers Hyperextension : Bend fingers back as far as possible Abduction : Spread fingers apart Adduction: Bring fingers together Thumb 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 hand Hip Ball & Socket Flexion : Move leg forward and up Extension : Move leg back beside other leg Hyperextension : Move leg behind body as far as possible.

15. Range of Motion Exercises Body Part Type of Joint Type of Movement Hip 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 circle Knee Hinge Flexion : Bring heel back toward back of thigh Extension : Return leg to floor Ankle Hinge Dorsal flexion : Move foot so that toes are pointed upward Plantar flexion : Move foot so that toes are pointed downward Foot Gliding Inversion : Turn sole of foot medially Eversion : Turn sole of foot laterally

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18. Examples

19. Range of Motion Exercises Body Part Type of Joint Type of Movement Toes 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

20. Range of Motion Exercises

21. 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.)