BROCKTON AREA MULTI-SERVICES, INC. MEDICAL PROCEDURE GUIDE. Date(s) Reviewed/Revised:

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Marshall Powers
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1 Page 1 f 6 Subject: Range f Mtin Exercises Date Develped: 4/2010 PROTOCOL FOR: All trained staff PURPOSE: Range f Mtin (ROM) exercises are very imprtant if an individual has t stay in bed r in a wheelchair. A physician s rder must be btained. These exercises help keep the jints and muscles as healthy as pssible. Withut these exercises, bld flw and flexibility (mving and bending) f an individual s jints can decrease. Jints, such as knees and elbws, can becme stiff and lcked withut ROM exercises. Passive ROM exercises help keep jint areas flexible, but d nt build up muscles r make them strng. GUIDELINES: ROM exercises may be active, active-assisted, ismetric, r passive. Active ROM is dne when an individual can d the exercises by themselves. Active-assisted ROM exercises are dne by the individual and a helper. Ismetric exercises can be perfrmed by an individual wh has an immbilized extremity r part f the bdy, t help maintain muscle strength when jints r bdy segments cannt be mved. Passive ROM exercises are dne fr the individual by a helper. The helper des the ROM exercises because the individual cannt d them by themselves. D nt d passive ROM exercises n an individual withut first talking t the individual s physician. Tgether yu can decide what exercise plan is best fr the individual. Raise the individual s bed t a height that is cmfrtable fr yu. This will help keep yu frm hurting yur back r ther muscles. Make sure the wheels f the bed r wheelchair are lcked befre yu start the exercises. D all ROM exercises smthly and gently. Never frce, jerk, r ver-stretch a muscle. This can hurt the muscle r jint instead f helping. Mve the jint slwly. This is especially imprtant if the individual has muscle spasms (tightening). Mve the jint nly t the pint f resistance. This is the pint where yu cannt bend the jint any further. Put slw, steady pressure n the jint until the muscle relaxes. Stp ROM exercises if the individual feels pain. Ask the individual t tell yu right away if he feels any pain. Watch fr signs f pain if the individual is unable t talk. The exercises shuld never cause pain r g beynd the nrmal mvement f that jint.

2 Page 2 f 6 Subject: Range f Mtin Exercises Date Develped: 4/2010 Make ROM exercises a part f the individual s daily rutine. D ROM exercises at the same time every day. D them while bathing the individual r while the individual watches TV. This will make the time g faster and help the individual relax mre. Yu may want t break the exercise prgram int 2 r 3 sessins. Yu can then d the sessins at different times f the day instead f ding them all at nce. Fllw the caregiver's rders. The persn's caregiver will tell yu hw many times per day yu shuld d ROM exercises. The caregiver will tell yu hw many repetitins (number f times) yu shuld d exercises n each jint. D the exercises in the same rder t keep it simple and easy t remember. Start exercises at the individual s head and wrk dwn tward tes. Use gd psture while ding ROM exercises fr the individual. Standing r sitting as straight as pssible will help yur breathing while ding the exercises. It will als make yur back, neck, and stmach muscles strnger. Keep yur stmach muscles tight and pull yur hips int a straight line under yur shulders. Leave the individual in a cmfrtable psitin after yu finish each exercise. Always wash yur hands befre and after ding ROM exercises fr an individual. PROCEDURE: Active: Perfrmed by the individual withut assistance Observe the individual mve the jint thrugh full range f mtin. Observe exercises perfrmed t ensure they are being perfrmed crrectly. Active-Assist: Perfrmed by the individual with supprt and assistance frm staff. Supprt the distal part and encurage the individual t mve the jint thrugh its range f mtin. Give as little assistance as necessary t accmplish the actin. Prvide adequate rest perids between activities. Ismetric: Perfrmed by the individual withut assistance and can be perfrmed several times per day.

3 Page 3 f 6 Subject: Range f Mtin Exercises Date Develped: 4/2010 Instruct individual t cntract and tighten a muscle withut jint mvement; hld cntractin fr several secnds and then let g. Breathe deep and repeat. Passive: Exercises are perfrmed by trained staff withut individual s assistance. Head and neck exercises: Lay the individual n his back with his head as flat (n pillw) as pssible. Supprt the back f the individual s head with ne f yur hands. Supprt the chin with yur ther hand. Chin-t-chest: Raise the back f the head up frm the bed. Gently tip chin tward chest. Try t rest the chin n chest if pssible. Head turns: Put ne hand n each side f the individual s face. Turn the head tward the right as if were lking ver right shulder. Then slwly turn the head s lking ver left shulder. Turn the head nly far enugh s that the nse is lined up abve their shulder. Head tilts: Put ne f yur hands n each side f the individual s face. Tilt the head t the side, bringing the right ear tward the right shulder. Then slwly tilt head t bring the left ear tward the left shulder. Shulder and Elbw exercises: Put ne hand under the individual s elbw and hld wrist with yur ther hand. Keep the persn's elbw straight, r bend the elbw slightly if necessary. Shulder mvement, up and dwn: Turn the individual s palm in tward the bdy. Bring the right arm frward and upward ver the head until the inner arm tuches ear. Bring the arm back dwn t side. Shulder mvement, side t side: Raise the right arm ut t the side t shulder level. Raise it upward ver the head as far as pssible. Bring the arm back dwn t the side and then swing acrss the bdy tward the left shulder. Swing the arm back dwn t the side. Shulder rtatin: Bring the right arm ut t the individual s side. Bend the elbw s the thumb and fingers are pinting up. Rtate (turn) the arm s the thumb and fingers pint dwn tward the tes.

4 Page 4 f 6 Subject: Range f Mtin Exercises Date Develped: 4/2010 Elbw bends, up and dwn: With the individual s right arm at his side, turn the palm f hand face up. Bend the arm at the elbw s that the fingers are pinting tward the ceiling. If pssible, cntinue bending the elbw and tuch the hand (fingertips) t the frnt f the right shulder. Mve the hand back dwn t the side. Elbw bends, side t side: Hld the right arm ut at shulder level with the palm facing up. Bend the elbw. Try t make the fingertips tuch the tp f right shulder. Repeat the abve exercises with the left arm. Frearm and Wrist exercises: Start with the arms at sides. Hld just belw the wrist with ne f yur hands. Hld the hand with yur ther hand. Wrist rtatin: Hld the wrist and hand f the right arm with the palm face dwn. Keeping the elbw n the bed, lift the frearm up. Hld the hand and bend it back tward the wrist. Then bend the hand dwn nly until yu feel resistance. Rck the hand back and frth sideways. Gently rtate the hand in smth circles. Palm up, palm dwn: Keep the elbw and frearm n the bed and raise hand. Gently twist it s his palm is up. Then twist it s his palm is dwn. Repeat the abve exercises with the left arm. Hand and Finger exercises: Hld the wrist t keep it straight. Use yur ther hand t d the hand and finger exercises. Finger bends: Place yur hand n the back f the fingers. Gently bend hand int a fist. Straighten the fingers again. Finger spreads: Gently straighten ut fingers. Spread the fingers wide apart, ne at a time. Then bring the fingers back tgether. Finger-t-thumb tuches: One at a time, bring each fingertip t tuch the thumb. Thumb-t-palm: Mve the thumb acrss his palm. Bring it back ut again. Thumb circles: Use the thumb t make wide circles. Repeat the abve exercises with the left thumb and fingers.

5 Page 5 f 6 Subject: Range f Mtin Exercises Date Develped: 4/2010 Hip and Knee exercises: If individual has had a hip injury r surgery, nly d hip exercises with instructins frm a caregiver. T start, place the right leg flat n the bed. Put ne hand under the ankle and yur ther hand under the knee. Straighten the leg and return it t a flat psitin n the bed after each exercise. Hip and knee bends: Slwly bend the hip and knee up tward the chest as much as pssible. Slide yur hand ut frm under the knee and tward the upper thigh (leg). D this t help the knee bend cmpletely. Leg mvement, side t side: Mve the right leg ut t the right side as far as pssible. Then return the leg t the middle and crss it ver the left leg. Leg rtatin, in and ut: With the leg flat n the bed, rll the leg tward the middle s the big te tuches the bed. Rll the leg utward s the little te tuches the bed. Knee rtatin, in and ut: Bend the knee s the bttm f the right ft is flat n the bed. Rll the leg inward as far as pssible. Try t tuch the bed with the big te. Rll the leg utward as far as pssible. Try t tuch the bed with the small te. Repeat the abve exercises with the left leg. Ankle and ft exercises: Hld the right ankle with ne hand. Put yur ther hand n the bttm f the ft. Ankle bends: Push the ft s tes pint up tward the ceiling. Then put yur hand n tp f the ft and push the ft dwn again. Ankle rtatin: Hld the ankle with ne hand. Hld the upper ft with yur ther hand. Gently turn the ft and ankle in circles. Te bends: With yur palm n tp f the ft, curl the tes dwn tward the sle (bttm) f the ft. Then straighten and stretch the tes. Te spreads. Use yur fingers t spread the tes apart ne at a time. Then bring them tgether again. Repeat the abve exercises with the left ankle and ft.

6 Page 6 f 6 Subject: Range f Mtin Exercises Date Develped: 4/2010 Ntify Physician, Nurse r Prgram Manager if the individual has pain in a jint area that des nt g away r has redness r swelling at a jint area. Dcument: Evaluate individual s ability t perfrm exercises and dcument any adverse effects in Medical Recrd r as required by yur prgram.

Active elbow motion is when your own muscles move the elbow back and forth.

Active elbow motion is when your own muscles move the elbow back and forth. Initial Pstperative Shulder Care and Exercise: **Can be dne if a biceps tendesis has been perfrmed. If a biceps tendesis prcedure has been perfrmed, active elbw mtin is delayed up t 6 weeks. Please clarify