7.3 Mobility & Restorative Care

The Restorative Mindset

Restorative care (rehabilitative care) helps residents keep or regain the ability to do tasks themselves: walking, eating, dressing, grooming, or transferring. The goal is independence, not speed. Doing everything for a resident is faster but causes deconditioning, weakness, learned helplessness, and loss of dignity. Give the resident time, encouragement, and the least amount of assistance that is still safe. ADL retraining breaks a task into steps and rebuilds it: a resident relearning to dress may start by pushing one arm through a sleeve, then add steps as ability returns. Praise effort and progress, even small gains.

Immobility causes serious complications the CNA actively helps prevent:

Range of Motion and Positioning

Range of motion (ROM) is moving a joint through its full normal movement to keep it flexible and prevent contractures (permanent shortening and tightening of a muscle or joint that leaves it frozen and often painful).

ROM rules the Florida exam tests:

• Support the joint above and below during passive ROM.
• Move slowly and smoothly; never force a joint past the point of resistance or pain.
• Repeat each movement the number of times in the care plan (often 3-5 times per joint).
• Stop and report increased pain, swelling, redness, or new stiffness; do not exercise a hot, swollen joint unless the nurse directs it.

Body Positioning

Correct positioning prevents pressure injuries and contractures and supports breathing, eating, and comfort.

For meals, raise the head of bed to high Fowler's (about 90 degrees). When repositioning a side-lying resident, support the back, place a pillow between the knees, and keep the spine aligned. Use pillows to keep heels off the bed, and a footboard or high-top shoes per plan to prevent footdrop (a plantar-flexion contracture of the ankle). Keep the resident in good body alignment as if standing, and never leave a body part dangling or twisted.

Common ROM Joint Movements

Use the correct terms when charting or answering questions: flexion (bending a joint), extension (straightening it), abduction (moving away from the body's midline), adduction (moving toward the midline), and rotation (turning around an axis). Begin at the head and work down, doing each joint the ordered number of repetitions while supporting it above and below.

Ambulation, Walking Aids, and Devices

Ambulation is assisting a resident to walk. Use safe technique on the skills test and the unit:

• Check the care plan and apply a transfer (gait) belt snugly over clothing, unless contraindicated.
• Provide non-skid footwear and a clear, dry, well-lit path.
• Stand slightly behind and to the weaker side, holding the gait belt with an underhand grip.
• Walk at the resident's pace and watch for dizziness, weakness, shortness of breath, or color change.
• If the resident starts to fall, do not try to hold them upright. Ease the resident down your leg toward the floor, protecting the head, then stay, call for help, and report. Do not move the resident until the nurse checks for injury.

Walking Aids

• Cane: held on the strong side; advance cane, then weak leg, then strong leg ("COAL": Cane Opposite Affected Leg).
• Walker: all four points stable on the floor before stepping; the resident steps into the walker, never pushing it far ahead.
• Crutches: the therapist instructs; the CNA reinforces and watches for safety.

Prosthetics and Orthotics

A prosthetic replaces a missing body part (such as an artificial limb). An orthotic (brace or splint) supports or aligns a weak joint. The CNA applies and removes these per the care plan, keeps the device and skin clean and dry, inspects the skin underneath each shift, and reports redness, sores, swelling, odor, or poor fit. Never adjust or repair the device beyond the care plan, and apply a limb prosthesis over a clean, wrinkle-free stump sock.

Exam Tip

Florida items reward independence and safety: encourage the resident to do what they can, never force a joint, apply the gait belt, support the weak side, hold the cane on the strong side, and lower a falling resident gently to the floor.