Restorative Care and Mobility

What Restorative Care Means

Restorative care (also called rehabilitative care) is the philosophy of helping residents regain or maintain the highest possible level of function and independence after illness, surgery, or decline. The CNA's role is to encourage residents to do as much as they safely can — feeding, dressing, walking, and exercising themselves — rather than doing it for them. Doing too much causes deconditioning and learned helplessness.

This content is roughly 8% of the Connecticut written exam, but it ties into safety, transfers, and the clinical skills test, so it carries extra weight in practice.

Preventing the Hazards of Immobility

A resident who cannot move is at risk for three major complications:

1. Pressure injuries (pressure ulcers / bedsores) — skin and tissue damage over bony areas from constant pressure. The CNA repositions a bedbound resident at least every 2 hours and a chair-bound resident at least every hour (or per care plan).
2. Contractures — permanent shortening of muscles/tendons that freezes a joint; prevented with range-of-motion exercises and proper positioning.
3. Other risks — blood clots, pneumonia, constipation, and muscle atrophy.

High-risk pressure points include the sacrum/coccyx (tailbone), heels, hips (trochanters), elbows, shoulder blades, and back of the head. Report any non-blanchable redness (red that does not fade when pressed) — this is a Stage 1 pressure injury.

Use pillows to support the body in alignment, keep linens wrinkle-free, and never drag a resident across sheets (friction and shearing tear skin). Use a draw sheet with two staff to reposition heavier residents.

Pressure injury staging in brief: Stage 1 is intact skin with non-blanchable redness; Stage 2 is a partial-thickness open sore or blister; Stage 3 and Stage 4 are deep wounds into fat, muscle, or bone. The CNA does not stage or treat ulcers, but early reporting of any skin change can stop a Stage 1 from becoming a Stage 4. Other prevention tools include heel-elevation pillows, pressure-relieving mattresses, and keeping skin clean and dry.

Range-of-Motion (ROM) Exercises

Range-of-motion (ROM) exercises move each joint through its full normal motion to keep it flexible and prevent contractures.

• Active ROM (AROM): the resident performs the movements themselves.
• Active-assisted ROM: the resident does what they can; the CNA helps finish the motion.
• Passive ROM (PROM): the CNA moves the joint for a resident who cannot move it.

Rules for ROM: support the joint above and below, move slowly and gently, do each motion the ordered number of times (often 3-5 repetitions), and STOP at the point of resistance or pain — never force a joint. Start at the head/neck and work down, or follow the care plan.

Safe Transfers and Body Mechanics

Body mechanics is using your body safely to avoid injury. The core rules:

• Bend at the knees and hips, not the waist; keep your back straight.
• Keep the object/resident close to your body.
• Use your strong leg muscles to lift, not your back.
• Keep a wide base of support (feet shoulder-width apart) and pivot instead of twisting.

Before any transfer (bed to wheelchair):

1. Lock the wheels on the bed AND the wheelchair.
2. Apply a gait/transfer belt around the resident's waist (over clothing).
3. Have the resident wear non-skid footwear.
4. Transfer toward the resident's strong (unaffected) side.
5. Use a mechanical lift for dependent residents per the care plan.

Ambulation and Falls

When helping a resident walk (ambulate) with a cane or walker, the device and the weak leg advance together first, then the strong leg follows. Walk slightly behind and to the weak side, holding the gait belt.

If a resident starts to fall, do NOT try to hold them up or catch them — you will both get hurt. Instead, ease the resident slowly to the floor, protecting the head, by sliding them down your braced leg. Stay with them and call for help; the nurse assesses before moving the resident.

Assistive Devices and Restraint-Free Care

Common assistive devices include canes (the cane is held on the strong side), walkers, gait belts, mechanical lifts, and grab bars. Match the device to the care plan and check it for safety (rubber tips intact, brakes working).

Under OBRA 1987, residents have the right to be free from unnecessary restraints. A restraint is anything that limits free movement (vest, lap belt, raised side rails used to confine). Restraints are a last resort, require a physician's order, must be released and the resident repositioned/toileted at least every 2 hours, and are never used for staff convenience or punishment. Improper restraint use is abuse. The CNA reports any resident in distress in a restraint immediately.

Common Exam Traps

• Forgetting to lock BOTH the bed and wheelchair wheels before a transfer.
• Transferring toward the weak side instead of the strong side.
• Forcing a joint past pain or resistance during passive ROM.
• Trying to catch a falling resident instead of easing them to the floor.
• Doing everything for the resident instead of promoting independence (the opposite of restorative care).