Range of Motion, Restorative Care, and Assistive Devices

Range of Motion, Restorative Care, and Assistive Devices

The final Domain III cluster for this chapter ties movement quality to long-term function. On the Delaware Prometric exam, expect written items on effects of immobility, passive versus active exercise, and restorative goals, plus clinical skills that may include passive range of motion (ROM) for the shoulder and for elbow and wrist or hip, knee, and ankle (confirm the exact skill sheet in the current Delaware Candidate Information Bulletin). Your purpose is not to replace physical therapy—it is to maintain the motion and independence the care plan assigns to nursing assistant care.

Range of Motion Concepts

Range of motion is how far a joint can move in each available direction. Types of exercise:

Goals of ROM exercises include preventing contractures (permanent shortening of muscle/soft tissue), reducing stiffness, supporting circulation, and preserving function for ADLs. ROM does not replace walking orders or treat acute fractures—follow activity restrictions after surgery or injury exactly.

Critical safety rule

Never force a joint past the point of resistance or pain. Stop that movement, support the joint in a comfortable position, and report pain, swelling, redness, or new limitation to the licensed nurse.

Other rules:

• Explain each exercise; expose only the limb you are working on
• Use good body mechanics; raise the bed
• Support the joint above and below (for example, support elbow and wrist when moving the shoulder carefully; support the limb segments per training)
• Move slowly and smoothly—no bouncing or jerky motions
• Perform the number of repetitions in the care plan (teaching often uses about three to five repetitions per movement, but follow the order)
• Watch the resident’s face for pain grimacing even if they cannot speak clearly
• Do not perform ROM on a limb with acute DVT suspicion, unhealed fracture without clearance, or other contraindications noted by nursing/therapy

Passive ROM Skills Emphasized in Delaware Training

Shoulder

Typical movements (names appear on exams):

• Flexion / extension — arm forward and up, then back to side
• Abduction / adduction — arm out to the side and back
• Horizontal abduction/adduction and rotation (internal/external) as taught on your skill sheet

Support the arm fully so the shoulder joint is never left hanging. Move only within comfort.

Elbow and wrist

• Elbow flexion / extension (bend and straighten)
• Forearm pronation / supination (palm down / palm up) if included
• Wrist flexion / extension and gentle ulnar/radial deviation if on the checklist

Support the forearm; do not twist fingers aggressively.

Hip, knee, and ankle

• Hip and knee flexion (toward the chest as tolerated) and extension back to bed
• Hip abduction / adduction (out and in) with support—do not drag the heel harshly across sheets
• Ankle dorsiflexion / plantar flexion (toes toward nose / pointed) and gentle rotation if ordered

For lower-extremity ROM, watch for hip replacement precautions when present (for example, no crossing legs, no excessive flexion past a set degree, no internal rotation—only as the care plan states). When precautions exist, therapy and nursing define allowed movements; do not improvise.

After ROM, leave the resident aligned and comfortable, replace covers, place the call light, and report incomplete sessions due to pain.

Effects of Immobility

Extended bedrest or inactivity harms nearly every system—high-yield written content:

Understanding these effects explains why “just let them rest in bed all day” is rarely good care unless medically required.

Restorative Philosophy: Encourage Independence

Restorative nursing care focuses on maintaining or improving the resident’s highest practicable level of function—aligned with OBRA expectations in long-term care. For CNAs, restorative thinking means:

• Encourage, don’t take over — allow extra time for the resident to button a shirt or walk partway to the dining room
• Break tasks into steps — cue one step at a time for cognitive impairment
• Use adaptive equipment — long-handled sponges, plate guards, built-up utensils, sock aids, reachers when on the care plan
• Practice skills daily — transfers, walking, self-feeding, dressing weak-side first with resident participation
• Set up for success — place items on the strong side, reduce noise, ensure glasses and hearing aids are on
• Coordinate with therapy — reinforce the same techniques PT/OT taught; do not invent conflicting methods
• Document participation and change — declining ability to transfer is a clinical signal, not a personal failure

Restorative care is not optional cheerfulness—it is skilled assistance that prevents disability from disuse. On exam items, the best answer usually maximizes safe independence rather than doing everything for the resident “to be faster.”

Prosthetic and Orthotic Care

Prostheses replace a missing body part (for example, lower-limb prosthesis after amputation). Orthoses support a body part (AFOs, braces, splints). CNA responsibilities commonly include:

Before application

• Inspect skin on the residual limb or under-brace area for redness, blisters, breakdown, or drainage—do not apply over open damaged skin without nurse direction; report findings
• Ensure the device is clean and dry; clean per manufacturer/facility instructions
• Use correct socks or liners in the correct number of layers as ordered (prosthetic sock ply matters for fit)
• Check that the resident’s residual limb shrinkage or swelling has not made the fit dangerous—report poor fit

Application and wear

• Apply the prosthesis/orthosis the way therapy and the care plan taught—orientation of the foot, strap sequence, locking pins
• Ensure clothing and shoes work with the device
• Observe gait once the resident stands—report instability
• Follow wear-time schedules (gradual increase after new fittings is common)

After removal

• Re-inspect skin
• Clean and store the device safely where it will not be damaged or lost
• Report pain, clicking, looseness, skin marks that do not blanch/resolve, or refusal to wear

Never adjust prosthetic alignment screws or cut orthotic plastic yourself. Never use lotion on a residual limb right before donning if policy says lotion makes the limb slide unsafely—follow the specific care plan (some limbs use prescribed products only at certain times).

Other Assistive Devices That Support Restorative Goals

• Canes — held on the strong side in common teaching; advance cane with weak leg patterns per therapy
• Crutches — height and gait pattern set by therapy; watch for axillary pressure injuries
• Grab bars, elevated toilet seats, shower chairs — keep dry and stable; report loose mounting
• Hearing aids / glasses / dentures — “assistive” for function; without them, restorative goals fail

Treat all devices as part of the person-centered plan, not clutter.

Linking ROM and Restorative Care to Delaware Exam Performance

Written stems may ask: “The nurse aide is performing passive ROM and the resident reports pain. The nurse aide should…” The correct path is stop the painful movement, do not force, and report—not “push a little farther for better results.” Skills sheets reward smooth support, correct joint sequence, privacy, and communication. Restorative items reward answers that let the resident do what they can.

Combine this section with positioning/transfers: you turn to protect skin, walk to protect lungs and mood, perform ROM to protect joints, and coach independence to protect identity. That whole package is Domain III in action—about a quarter of the written exam and much of daily CNA practice in Delaware long-term care settings overseen under federal quality standards and DHCQ expectations.

Shift Application

A practical restorative shift might include: morning ROM for a hemiplegic arm while dressing the weak side first with resident effort; toileting walk with gait belt instead of a brief change in bed when walking is ordered; lunch setup with adaptive utensils; afternoon inspection of residual limb skin before prosthetic wear for a dining-room visit; evening report that the resident completed 40 feet with moderate assist versus 20 feet last week. Those observations fuel care-plan updates and prove that mobility care is measurable, not vague encouragement alone.