Passive Range of Motion (PROM) is a therapeutic technique where a joint is moved through its available range solely by an external force, such as another person or a mechanical device. The patient performs no active muscle contraction during the movement. PROM is performed to maintain existing joint flexibility, prevent contractures, and stimulate circulation. This is important for individuals who are temporarily or permanently unable to move a limb independently, such as those with paralysis or severe weakness.
Licensed Specialists Who Design and Direct Care
The overall strategy for a patient’s PROM exercises is established by licensed rehabilitation professionals, specifically Physical Therapists (PTs) and Occupational Therapists (OTs). These specialists conduct the initial assessment to determine which joints need PROM and the safe limits of movement for each joint. They function as the prescribers of the program, defining the frequency, intensity, and duration of the exercise regimen.
Physical Therapists often focus on the lower body and larger joints, aiming to preserve gross motor function and mobility necessary for tasks like walking and transfers. Their expertise centers on biomechanics and restoring physical function. Occupational Therapists concentrate on the joints and movements necessary for Activities of Daily Living (ADLs), such as the hands, wrists, and shoulders, which are involved in self-feeding, dressing, and hygiene.
Both therapists use manual techniques to feel for resistance and tissue tension, which informs the parameters of the PROM program. They are responsible for training all other individuals—including nurses, aides, and family—who will be implementing the program. This training ensures that the specific angles, supports, and precautions determined during the initial evaluation are followed. The licensed specialist modifies the program as the patient’s condition evolves.
Supportive Roles in Acute and Long-Term Settings
In clinical facilities, the day-to-day performance of PROM is integrated into the routine care provided by nursing staff and their assistants. Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) oversee the therapy plan and may perform PROM themselves, particularly in acute situations. Their primary responsibility is to monitor the patient’s response and report any adverse signs to the prescribing therapist.
Certified Nursing Assistants (CNAs) or Aides are the personnel most frequently performing PROM in these settings. They are trained to carry out the specific movements as delegated by the supervising nurse or therapist, often as a component of repositioning, bathing, or hygiene care. Their role is limited to maintenance and observation within the established plan.
CNAs must adhere to the specific range and repetitions prescribed. They are trained to immediately stop the exercise if the patient reports pain or if resistance is encountered. Consistent, gentle PROM prevents joint capsule and muscle shortening, which can occur rapidly in non-mobile patients. The daily integration of these exercises ensures continuity of care and the prevention of long-term immobility issues.
Training and Delegation for Home Care
Outside of a clinical facility, PROM is often performed by informal caregivers, home health aides, or family members. In this non-clinical environment, a licensed professional, usually a PT or OT, must thoroughly train the caregiver on the techniques for each joint. The training involves hands-on instruction and requires a return demonstration from the caregiver to verify competency and safety.
Delegating this therapeutic task requires the caregiver to understand proper body mechanics and joint support to prevent injury. They are taught to observe for non-verbal cues of pain and never force a joint past the point of initial resistance. A specialized form of movement delegation is “Self-PROM,” where the patient uses their unaffected limb to passively move the affected limb.
The licensed therapist teaches the patient this specific active-assisted technique only when it is safe to perform independently. Delegation to the patient or an informal caregiver requires periodic re-assessment by the therapist. This ensures the exercises are executed correctly and safely, maintaining the integrity of the therapeutic program.