CNA · Self-Care and Independence · 6 min read
Safe Range of Motion and Contracture Prevention
- Distinguish between active, active-assistive, and passive range of motion exercises and identify key joint movement terms.
- Describe safe nurse aide techniques for supporting joints, following the care plan, and responding immediately to signs of pain or resistance.
- Explain the causes and risks of contractures, supportive positioning devices, and the nurse aide's role in observation, documentation, and reporting.
Understanding Range of Motion and Joint Mobility
Range of motion (ROM) exercises move joints through their normal span of movement. Regular movement helps maintain joint flexibility and keeps tissues healthy. Every resident has different capabilities, so the care plan outlines the exact type of range of motion assistance each person requires to remain safe and comfortable.
There are three primary forms of range of motion exercises that a nurse aide will encounter. Active range of motion (AROM) is performed independently by the resident, allowing them to move their own joints freely without physical assistance. During active-assistive range of motion, the resident moves the joint with help from the nurse aide as directed by the care plan. Passive range of motion (PROM) is when the nurse aide moves a resident's joint without the resident actively helping, as directed by the care plan.
In addition to planned exercise sessions, nurse aides support joint mobility throughout the day during routine care. Encouraging residents to perform activities of daily living independently promotes active joint movement. For example, when a resident reaches for their own washcloth, brushes their own hair, or raises a cup to drink, they are actively moving their joints through their natural span of movement.
| Type of Range of Motion | Who Performs the Movement | Nurse Aide Role |
|---|---|---|
| Active (AROM) | Resident performs the movement independently | Encourage independence during daily care and observe for discomfort |
| Active-Assistive | Resident performs the movement with assistance | Provide physical help to move the joint as directed by the care plan |
| Passive (PROM) | Nurse aide performs the movement for the resident | Support and move the joint slowly and gently as directed by the care plan |
Common mistakes
- Gripping the resident's joint directly over the joint itself rather than supporting the limb with one hand placed above and one hand below the joint.
- Attempting to push past resistance or continuing to exercise when a resident grimaces, stiffens, or expresses pain.
- Failing to check the care plan for the required number of repetitions and working unsystematically instead of following the care plan's designated order.
- Applying splints, braces, or supportive rolls without checking the care plan, or forgetting to inspect the underlying skin for redness and breakdown.
Key points
- Range of motion exercises move joints through their normal span of movement and include active, active-assistive, and passive techniques.
- Always consult the care plan for the systematic order and exact number of repetitions, position the resident in proper alignment, and expose only the body part being exercised.
- Support limbs by placing hands above and below the joint, never gripping directly over the joint, and move slowly, smoothly, and gently.
- Stop exercises immediately if the resident shows verbal or nonverbal signs of pain or if joint resistance is felt, and never force a joint.
- Contractures are shortenings or tightenings of tissue that limit joint movement and may eventually hold joints in abnormal positions; immobility and lack of joint use are common causes.
- Prevent contractures through regular range of motion, proper body alignment, scheduled repositioning, and care-plan-directed devices such as hand rolls, trochanter rolls, and footboards.
- Promptly report pain, limited mobility, swelling, warmth, redness, or joint clicking to the nurse, and document completed or skipped exercises according to facility policy.
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