passive range of motion exercises are performed by the caregiver for the patient to help maintain independence and mobility verify the health care providers orders before you get started after performing hand hygiene and ensuring privacy introduce yourself to the patient then identify the patient using to identify errs your name Vickie Beals your date of birth 12:11 54 ok it's helpful to keep a few guidelines in mind expose only the limb being exercised move each joint slowly and gently support the joint in the extremity being exercised by holding the distal portion of the extremity or by using your cupped hand to support it work from head to toe don't exercise any joint beyond the point of resistance or to the point of fatigue or pain repeat each movement 5 times in this video we'll demonstrate using just 2 or 3 repetitions and finally measure the joint motion as needed it's also useful to recall the major types of joints pivotal joints allow for rotation and are located in the neck and forearms ball and socket joints are formed when the ball shaped end of one bone fits into the cup-shaped socket of another they are located in the shoulders and hips hinge joints allow movement like the hinge on a door they are located in the knees ankles elbows and fingers condyloid joints allow for flexion extension adduction abduction and circumduction they are located in the wrists fingers and toes saddle joints permit flexion extension adduction and abduction they are located in thumbs gliding joints permit only gliding movements and are located in the spine hands and toes remember to wear clean gloves if necessary for example if the patient has a draining wound or an open skin lesion or if the patient is on isolation precautions stand on the side of the bed closest to the joint to be exercised cover her with a bath blanket and fold down the top linens to the foot of the bed help her into a comfortable position preferably sitting or lying down in bed for the first exercise move the patient's neck and deflection by tipping her chin toward her chest then move her neck into extension by positioning her head erect and finally hyperextend her neck by tipping her head back as far as she can comfortably tolerate move the neck through lateral flexion by tilting her head toward each shoulder as far as possible then rotate her head as far as possible in a circle you'll be doing these kind of activities at home when you wash your hair answer questions next exercise the shoulder begin with the patient's arm at her side and perform flexion by raising the arm forward and above her head reaching up into the cabinet to get a clasp down extension is the opposite movement returning the arm to her side for extension its reaching back behind to pull your pants up good I'm gonna have you sit up for me a little hyper extension is accomplished by moving her arm behind her body keeping the elbow straight and I'm gonna bring your arm back this is to help you with getting dressed putting a coat on okay now move her shoulder into abduction by raising her arm to the side and overhead with her palm facing out and into abduction by lowering the arms sideways and across the body as far as possible like putting deodorant on or getting a coat sleeve on perform internal rotation by moving the patient's arm elbow flexed at the shoulder until her thumb is down and her elbow is lateral to or parallel to her side and now we're going to go ahead and go into some external rotation then perform external rotation by moving the arm again with the elbow flexed until the thumb is up and the elbow is lateral to the head circumduction circumduction is performed by moving the patient's straightened arm in a full circle watching TV now move to her elbow performing flexion so that the elbow bends and the patient's hand touches her shoulder brushing your teeth perform extension by straightening her elbow and lowering her hand move the patient's forearm to accomplish supination by turning the lower arm and hand palm up that's what if you're opening a door handle and pronation by performing the opposite movement a goniometer is a useful tool for measuring joint range of motion the goniometer measures improvement in the patient's flexibility as rehabilitation progresses explain to the patient that the goal of therapy is to increase the angle or range of motion for the joint next work the patients wrist through flexion moving her palm toward the inside of her forearm then we're going to say an extension moving her fingers into the same plane as her hand and forearm then hyper extend her wrist by moving the dorsal surface of the hand back as far as possible we do a lot of these arrest exercises to help you with playing cards cutting food move the wrist into radial deviation by bending it medially toward the thumb and into ulnar deviation by bending it laterally toward the fifth finger good now exercise the fingers start with flexion by closing the patient's fingers to make a fist close your fingers finger flexion like we're gonna make a fist [Music] then practice extension by straightening the fingers and hyperextension by gently bending them back as far as the patient can tolerate good abduct the fingers by spreading them apart I'm just gonna open your fingers good adduct them by bringing them together again close together to complete your exercise of the upper extremities perform range of motion exercise for the thumb for flexion move the patient's thumb across her palm for extension move her thumb directly away from her hand for abduction extend her thumb laterally for adduction move the thumb back toward the hand and for opposition touch the patient's thumb to each finger on the same hand this helps us make our grips to hold on to the hairbrush toothbrush and the phone now passively exercise the patient's hip moving it through flexion by lifting her leg forward and up hip flexion then move the hip through extension by returning that leg to its original position good with the patient prone lying on her side or standing hyper extend her hip by moving her leg back beyond the normal range of extension continue exercising the patient's hip by performing abduction moving her leg laterally away from her body adduction requires moving her leg back toward the midline and beyond good so you can cross your legs when you're you can externally rotate the foot and leg by turning them out internal rotation is accomplished by turning the foot and leg in circumduction is performed by moving the leg in a full circle your leg all around in circles okay now exercise the knee with the patient prone side lying or standing for flexion bend the knee by bringing her heel toward the back of her thigh going upstairs good and some knee extension for extension return the leg to a straight position when you're doing your exercises make sure that you're walking a lot because that's going to help get the mobility of your knee with the patient once again supine perform range of motion exercises for the ankle for dorsiflexion move her foot so that her toes point up toward her head for plantar flexion move it so the toes point down away from her head 3 this is to help you with walking finally do passive range of motion exercises for the feet inversion of the foot is turning the sole medially or toward the middle eversion is turning the sole laterally or outward circumduction is performed by moving the foot in a full circle and that'll get all those motions into it passive range of motion exercises for the toes begin with flexion by curling the toes down to an extension by straightening them and what you're gonna do this one for move the toes through abduction by spreading them apart an abduction by bringing them together again three so you're going to do these motions at home you want to curl your toes bring them up open your toes and close them to help with walking remember as you exercise your patient it's important to recognize her physical limits I'm too tired I can't do anything now maybe later okay let me go ahead and make you comfortable okay when you're finished make sure the patient is comfortable perform hand hygiene and document expected or unexpected outcomes