Providing Range of Motion Exercises

Goal: The patient maintains joint mobility.

1. Review the physician’s orders and nursing plan of care for patient activity. Identify any movement limitations.

2. Perform hand hygiene and put on PPE, if indicated.

3. Identify the patient. Explain the procedure to the patient.

4. Close curtains around bed and close the door to the room, if possible. Place the bed at an appropriate and comfortable working height, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009). Adjust the head of the bed to a flat position or as low as the patient can tolerate.

5. Stand on the side of the bed where the joints are to be exercised. Lower side rail on that side, if in place. Uncover only the limb to be used during the exercise.

6. Perform the exercises slowly and gently, providing support by holding the areas proximal and distal to the joint. Repeat each exercise two to five times, moving each joint in a smooth and rhythmic manner. Stop movement if the patient complains of pain or if you meet resistance.

7. While performing the exercises, begin at the head and move down one side of the body at a time. Encourage the patient to do as many of these exercises by him- or herself as possible.

8. Move the chin down to rest on the chest. Return the head to a normal upright position. Tilt the head as far as possible toward each shoulder.

9. Move the head from side to side, bringing the chin toward each shoulder.

10. Start with the arm at the patient’s side and lift the arm forward to above the head. Return the arm to the starting position at the side of the body.

11. With the arm back at the patient’s side, move the arm laterally to an upright position above the head, and then return it to the original position. Move the arm across the body as far as possible.

12. Raise the arm at the side until the upper arm is in line with the shoulder. Bend the elbow at a 90-degree angle and move the forearm upward and downward, then return the arm to the side.

13. Bend the elbow and move the lower arm and hand upward toward the shoulder. Return the lower arm and hand to the original position while straightening the elbow.

14. Rotate the lower arm and hand so the palm is up. Rotate the lower arm and hand so the palm of the hand is down.

15. Move the hand downward toward the inner aspect of the forearm. Return the hand to a neutral position even with the forearm. Then move the dorsal portion of the hand backward as far as possible.

16. Bend the fingers to make a fist, and then straighten them out. Spread the fingers apart and return them back together. Touch the thumb to each finger on the hand.

17. Extend the leg and lift it upward. Return the leg to the original position beside the other leg.

18. Lift the leg laterally away from the patient’s body. Return the leg back toward the other leg and try to extend it beyond the midline.

19. Turn the foot and leg toward the other leg to rotate it internally. Turn the foot and leg outward away from the other leg to rotate it externally.

20. Bend the leg and bring the heel toward the back of the leg. Return the leg to a straight position.

21. At the ankle, move the foot up and back until the toes are upright. Move the foot with the toes pointing downward.

22. Turn the sole of the foot toward the midline. Turn the sole of the foot outward.

23. Curl the toes downward, and then straighten them out. Spread the toes apart and bring them together.

24. Repeat these exercises on the other side of the body. Encourage the patient to do as many of these exercises by him- or herself as possible.

25. When finished, make sure the patient is comfortable, with the side rails up and the bed in the lowest position.

26. Remove gloves and any other PPE, if used. Perform hand hygiene.