CNA Skill: Checking A Patient’s Passive Range of Motion

Performing passive range of motion checks on a patient can indicate the progress of the patient’s recovery and prevent complications from stiff joints.  If practical, range of motion exercises should be performed as you give a patient his or her bath.  Before you begin, wash your hands.  Greet your patient, and explain that you will be checking his or her range of motion by performing several exercises.  Then, follow these steps:

1. Raise the height of the bed until you can comfortably reach the patient to assist if necessary.
2. Start with range of motion tests on the head.  As the patient to turn the head from one side to the other.  This check should not be performed on a patient who has a neck or spinal cord injury as it could aggravate the problem.
3. Next, move to the arms.  Have the patient flex and extend both arms at the elbow.  Then, have the patient move the arms in a crossing motion toward the body and then away.  Ask the patient to move all fingers and flex their wrists.  Perform each test ten times per arm.
4. Move to the legs, and ask the patient to flex and extend each knee, then move the leg toward the centerline of the body and back.  Perform ten times on each leg.  Ask the patient to flex and extend feet at the ankles, and then move or wiggle the toes.

For a bed-bound patient, checks should be performed once or twice per day to ensure that joints do not become contracted.  If the patient experiences stiffness or an inability to move a joint, it may be an indication of contractures and should be reported immediately.  As you perform each test, observe the patient for signs of swelling or inflamation in any of the joints.  If your patient reports severe pain or shows signs of respiratory distress while performing tests, notify nursing staff right away.  There are six different positions that you can use to perform checks:

Supine Position – the patient lies on the back with arms extended to each side.
Sims Position – the patient is positioned on either side with both legs straightened.
Lateral Position – the patient is lying on one side with the top leg flexed, and the flexed leg and top arm are elevated on a pillow for support.
Semi-Fowler Position – the patient lies on the back with the head of the bed elevated to a 45 degree angle.
High-Fowler Position – the patient lies with the head of the bed raised to a 90 degree angle.

As you perform these checks, monitor the patient for any difficulty completing exercises.  Notify nursing staff of any issues right away.  Range of motion checks will help your patient to remain more comfortable and prevent complications arising from contractures of joints.

Expert Tip by Tanya Glover, CNA
Range of motion exercises is something that is vital for the health and well being of your patients. Even though they sound simple, they must be done correctly for the patient to get exactly what they need from them. While many of your patients will have a physical therapist come in a few days per week to work on this aspect of patient care, it is still part of your job and should be done on a regular basis. You may be thinking that you already have too much to do as it is so how will you fit in ROM exercises. The answer is simple. Do the exercises during your other duties.

When giving bed baths, make sure to do the proper movements during washing. You can also do ROM while dressing your patients. They do not have to do separate duties at all! And remember, while doing ROM for your skills examine, be gentle yet firm. Too soft of a movement shows fear and will not provide the patient with what they need. Too rough or jerky movements will seem uncoordinated and may harm a real patient. Take a deep breath and remember that you DO know what you are doing!

Examiners Checklist For This Skill

1) Performed beginning tasks.
2) Demonstrated three different range of motion movements.
a. Flexion and extension.
b. Abduction and adduction.
c. Pronation and supination.
d. Dorsal and plantar flexion.
e. Opposition.
f. Internal/External rotation.
g. Radial deviation and ulnar deviation.
3) Supported the proximal and distal ends of the extremity or the joint
itself.
4) Observed the resident’s reaction during the procedure.
5) Demonstrated or verbalized the need to stop moving if pain or
resistance was noted.
6) Performed completion tasks.