Range of motion (ROM) exercises are a fundamental component of restorative care, designed to maintain joint flexibility and prevent complications associated with immobility. These exercises involve moving a joint through its full available arc of movement to preserve the health of muscles, tendons, ligaments, and joint surfaces. The primary purpose of performing ROM exercises is to prevent joint contractures, which are permanent shortenings of muscle and connective tissue that limit movement, and to slow down muscle atrophy, or wasting, that occurs from disuse. A Nursing Assistant (NA) plays the direct role of implementing the care plan created by licensed nurses and physical therapists to ensure the resident’s mobility is preserved.
Essential Preparations and Safety Checks
Before initiating any range of motion exercises, the Nursing Assistant must prioritize resident safety and comfort through careful preparation. The first step involves reviewing the resident’s care plan to confirm which joints require exercise and the specific type of motion prescribed. Next, the NA must ensure resident privacy by closing the door or pulling the privacy curtain before exposing any body parts for the exercises.
The NA should then explain the procedure to the resident, even if the resident is unresponsive, to maintain dignity and encourage cooperation. Hand hygiene is performed, and any necessary supplies, such as pillows for limb support, are gathered and placed within easy reach. Proper positioning of the resident is also important, typically lying supine, with the bed rails down on the working side and up on the opposite side to prevent falls.
The NA must also ensure that the bed is raised to a comfortable working height to allow for good body mechanics, preventing strain on their own back. Obtaining verbal consent before touching the resident’s limb is a legal and ethical requirement. Throughout the preparation, the NA is actively observing the resident’s skin condition and joint appearance for any swelling, redness, or warmth, which could indicate a need to delay the exercise and consult the nurse.
Understanding Exercise Modalities
Range of motion exercises fall into three main categories, differentiated by who is providing the effort for the movement.
Active Range of Motion (AROM)
Active Range of Motion (AROM) is where the resident moves the joint entirely on their own, using their own muscles. In this scenario, the NA’s role is to supervise, encourage, and provide verbal cues to ensure the movement is performed correctly and safely.
Active Assistive Range of Motion (AAROM)
Active Assistive Range of Motion (AAROM) involves a partnership, where the resident is able to move the joint partially, but the NA assists to complete the full movement. This modality is frequently used when a resident has some muscle strength but needs help to achieve the full range or is working to build endurance.
Passive Range of Motion (PROM)
Passive Range of Motion (PROM) is performed when the resident is unable to move the joint independently due to paralysis, unconsciousness, or significant weakness. With PROM, the NA moves the resident’s joint completely through the prescribed arc. The resident’s muscles remain relaxed and uninvolved. The NA will most frequently be assisting with PROM for residents who are severely limited in their mobility.
Step-by-Step Execution Guidelines
When performing Passive Range of Motion, the NA’s technique must be slow, smooth, and deliberate to protect the joint and surrounding tissues. A fundamental principle is joint stabilization, which requires the NA to support the extremity gently but firmly above and below the joint being moved. This two-point stabilization prevents strain and injury to the joint capsule and ligaments.
The movement itself should never be rushed or bouncy. Instead, the joint is moved gently through the range of motion until the NA feels slight resistance. A movement must stop immediately if the resident reports pain or shows non-verbal signs of discomfort, such as grimacing or guarding the limb. The exercise is performed only up to the point of resistance or the onset of pain, never forcing the joint beyond that limit.
The care plan will dictate the exact number of repetitions; generally, each joint movement is repeated about three to five times per session. Exercises are typically performed in a sequence, starting with the neck and working downward, moving from the shoulder, elbow, wrist, and fingers, then proceeding to the hip, knee, ankle, and toes. After completing the prescribed repetitions for a specific joint motion, the limb must be returned to a comfortable, neutral starting position before moving to the next joint.
Monitoring Resident Response and Documentation
Throughout the entire exercise session, the Nursing Assistant must be aware of the resident’s physical and verbal responses. The NA should frequently ask the resident if they are experiencing any pain and observe for objective signs of distress, which include rapid breathing, changes in facial expression, or muscle tightening, known as guarding. The appearance of the skin around the joint, including any new or increased redness, swelling, or heat, must also be monitored closely.
If pain or any adverse reaction occurs, the NA must immediately stop the movement, stabilize the limb in a comfortable position, and report the findings to the supervising nurse without delay. The NA’s responsibility is to observe and report, not to clinically assess the cause of the pain or swelling.
Documentation is the final, essential step and must be completed accurately according to facility protocol. The NA records the date and time the exercises were performed, the specific joints that were exercised, and the type of range of motion performed (e.g., Passive, Active Assistive). Any adverse reactions, such as the resident complaining of pain, or observed changes in the joint’s condition are documented and reported to the nurse to ensure the care plan is adjusted as needed.