Range of motion (ROM) exercises are foundational to maintaining physical function. When a person cannot move a joint effectively through its natural arc, an external force must provide the movement. This intervention is known as Passive Range of Motion (PROM), where the joint is mobilized entirely without the patient’s muscular effort. The correct application of PROM requires specific training and adherence to a defined care protocol to ensure patient safety and treatment effectiveness. Performing these exercises involves a hierarchy of skilled healthcare professionals and trained caregivers.
Understanding Passive Range of Motion
Passive Range of Motion requires the complete relaxation of the muscles surrounding the joint being moved. The movement is performed by a therapist, a caregiver, or sometimes a mechanical device like a Continuous Passive Motion (CPM) machine. This contrasts with Active Range of Motion (AROM), where the patient uses their own muscle power, and Active-Assisted Range of Motion (AAROM), where the patient uses some effort with external help. The primary goal of PROM is to counteract the negative effects of immobility, such as preventing the shortening of soft tissues that leads to joint contractures. Performing PROM helps maintain the existing mobility of the joint structures and supports local circulation.
Licensed Professionals Who Prescribe and Initiate PROM
The responsibility for prescribing and initiating a Passive Range of Motion program rests with licensed rehabilitation specialists, specifically Physical Therapists (PTs) and Occupational Therapists (OTs). These professionals conduct a thorough evaluation of the patient’s musculoskeletal and neurological status. This assessment determines the precise joint angles, frequency, and safe limits of the passive movements required.
Physical Therapists establish a diagnosis, prognosis, and a comprehensive plan of care that includes the PROM protocol. Their role is to design the complete therapeutic regimen, not just perform the initial movements. They are responsible for identifying contraindications, such as an unhealed fracture or recent surgical repair, that would make passive movement harmful.
These licensed practitioners also serve an educational function by providing initial, detailed instruction and training to the individuals who will be maintaining the program. They teach the proper body mechanics, hand placement, and the acceptable end-range of motion to ensure patient safety and comfort. This establishes the PT or OT as the primary decision-maker regarding the PROM treatment protocol, which is documented in the patient’s medical record.
Support Staff and Caregivers Who Maintain PROM
Once a licensed therapist has established the PROM protocol, the daily execution is often delegated to other trained personnel operating under supervision. This group includes Physical Therapist Assistants (PTAs) and Certified Occupational Therapy Assistants (COTAs), who work directly under the guidance of the prescribing therapist. Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) frequently perform these exercises as part of routine patient care in hospital or long-term care settings.
Certified Nursing Assistants (CNAs) and other support staff are also commonly trained to execute PROM exercises to prevent immobility-related complications. A fundamental requirement for all these individuals is the strict adherence to the established plan, including the correct speed and repetition count. They must continuously monitor the patient for signs of pain or resistance, which must be immediately reported back to the prescribing therapist or physician.
In the home environment, trained family members and private caregivers maintain the PROM schedule. They receive instruction from the licensed therapist to ensure they understand the difference between a gentle stretch and a harmful over-mobilization. Consistent, proper performance by these individuals is necessary to achieve the long-term goals of preserving joint integrity and tissue length.
Conditions Requiring Passive Movement
Passive Range of Motion is medically necessary when a patient cannot generate sufficient muscle contraction to move a joint due to injury or illness. Neurological impairments are a common reason, such as paralysis following a stroke, spinal cord injury, or multiple sclerosis, where external movement maintains the mechanical integrity of the joint capsule and ligaments. Patients who are unconscious, in a coma, or under heavy sedation also require PROM to substitute for their lack of voluntary movement. Following major orthopedic surgery, such as a total knee or hip replacement, PROM is often initiated immediately post-operatively to maintain mobility while protecting the surgical repair. Individuals experiencing profound muscular weakness, severe pain, or prolonged immobilization also benefit from PROM to prevent the rapid onset of contractures and joint stiffness.