Range-of-Motion Exercises

CLINICAL GUIDELINES

A registered nurse (RN), licensed practical nurse (LPN), physical therapist (PT), or physical therapy technician may complete range-of-motion (ROM) exercises.
ROM exercises are used when all or some of the normal physical activities are not able to be completed due to the physical condition of the child. Attention is given to the joint not being used through provision of active or passive ROM exercises. Active ROM exercises are those that the patient does for himself or herself. Passive ROM exercises are those performed by the family member or the healthcare provider without the participation by the child.
ROM exercises are completed twice a day, with three to five repetitions of each movement unless otherwise prescribed by the PT.
ROM exercises are completed as appropriate to the child’s physical condition (Table 95-1 and Figures 95-1, 95-2, 95-3, 95-4, 95-5, 95-6, 95-7, 95-8, 95-9, 95-10 and 95-11).

CHILD AND FAMILY ASSESSMENT AND PREPARATION

Review the child’s history for contraindications to ROM exercises, determining limitations of joint movement and impact on function. In cases of joint inflammation, dislocation, or fracture, ROM exercises may be contraindicated.
Review the child’s medical record to determine whether a specific ROM exercise plan has been provided in the interdisciplinary patient orders.
Explain to the child and family the purpose and the plan of ROM exercises.
Initiate pain control measures if needed 30 minutes before beginning ROM exercises.
Provide antispasmodic medications, if ordered, 30 minutes before beginning ROM exercises.

Provide for privacy.
Schedule ROM activities to coincide with routine care. An ideal time to do the exercise is during morning care or bath time. Include the child and the family in planning for ROM activities (e.g., when and where to perform).
Dress the child in nonrestrictive loose-fitting clothing.
Assess vital signs to provide a baseline for comparison if changes occur during the procedure.
Determine the baseline activity and condition for the child.
Observe the equality of movement of each joint. The movement of the joints should be equal bilaterally.
Note the condition of the the child’s joint that will undergo ROM. The joint should be free of pain, spastic movement, deformity, and crepitation. There should be no limitation of movement.

TABLE 95-1 Range-of-Motion Terminology

Movement	Definition	Use
Circumduction	Movement of the joint in a full circle	Used in movement of the shoulder
Hyperextension	Movement of the joint in the direction of extension beyond a straight line	Used in movement of the arms, legs, hands, and wrists
Flexion	The bending of the joint in which the two adjacent parts move toward each other, thus reducing the angle of the joint between two parts. Decreasing the angle between two bones	Used in the shoulder, elbow, knee, and finger joints
Extension	Movement increasing angle between two adjoining bones	Used in the shoulder, elbow, knee, and finger joints
Internal rotation	Turning away from the midline	Used in movement of the head from side to side
Abduction	Movement away from the midline of the body	Used in movement of the legs, arms, and fingers
Adduction	Movement toward the midline of the body	Used in movement of extremities; legs, arms, and fingers
Pronation	Turning the forearm so that the palmar surface of the hand is facing downward	Used in movement of the hand and wrist
Supination	Turning the forearm so that the palmar surface of the hand is facing upward	Used in movement of the hand and wrist
Deviation	Abduction or adduction of the wrist	Used in movement of the wrist
Opposition	Placement of the palmar surface of the thumb so that it touches the base of the fingers	Used in movement of the hand

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