7.3 Mobility & Restorative Care
Key Takeaways
- Restorative care helps residents keep or regain function and independence rather than doing tasks for them.
- Active ROM is performed by the resident; passive ROM is performed by the CNA when the resident cannot move the joint.
- Range-of-motion exercises and frequent repositioning prevent contractures and muscle atrophy from immobility.
- During ambulation, use a transfer/gait belt, walk slightly behind and to the weak side, and lower a falling resident to the floor.
- Apply prosthetics and orthotics per the care plan, inspect the skin underneath, and report redness, sores, or poor fit.
The Restorative Mindset
Restorative care focuses on helping residents keep or regain the ability to do tasks themselves, such as walking, eating, dressing, or transferring. The goal is independence, not speed. Doing everything for a resident may be faster but causes deconditioning, weakness, and loss of dignity. Give the resident time, encouragement, and the safest level of assistance needed.
Immobility causes serious complications the CNA helps prevent:
| Complication | CNA prevention |
|---|---|
| Pressure injury | Reposition at least every 2 hours, keep skin clean and dry |
| Contracture | Range-of-motion exercises, good positioning, splints per plan |
| Muscle atrophy and weakness | Encourage activity and prescribed exercises |
| Pneumonia | Reposition, encourage deep breathing, keep head of bed up for meals |
| Constipation, blood clots | Encourage fluids, activity, and ordered exercises |
Range of Motion (ROM)
Range of motion (ROM) is moving a joint through its full normal movement to keep it flexible and prevent contractures.
| Type | Who moves the joint | When used |
|---|---|---|
| Active ROM (AROM) | The resident moves the joint themselves | Resident is able to move independently |
| Active-assisted | Resident moves with some CNA help | Partial ability |
| Passive ROM (PROM) | The CNA moves the joint for the resident | Resident cannot move the joint themselves |
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.
- Stop and report increased pain, swelling, or new stiffness.
- Do not exercise a swollen, reddened, or painful joint unless directed by the nurse or care plan.
Contracture Prevention
A contracture is permanent shortening and tightening of a muscle or joint from lack of movement, leaving the joint frozen and often painful. Prevent contractures with regular ROM, frequent repositioning, proper body alignment, and the use of splints or positioning devices ordered in the care plan.
Safe Ambulation
Ambulation is assisting a resident to walk. Use safe technique on the Florida skills test and on 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 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, 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 call for help and report.
Walking Aids
- Cane: held on the strong side; advance the cane, then the weak leg, then the strong leg.
- Walker: all four points stable before stepping; do not let the resident climb stairs with a standard walker.
- Crutches: check the care plan; the CNA reinforces, the therapist instructs.
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 devices 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 a poor fit. Never adjust or repair the device beyond the care plan.
Exam Tip
Florida items reward independence-focused, safe answers: encourage the resident to do what they can, never force a joint, apply the gait belt, support the weak side, and lower a falling resident gently to the floor.
A resident cannot move the right shoulder at all. The CNA moves the joint gently through its normal range for the resident. This is an example of:
While ambulating a resident with a gait belt, the resident becomes dizzy and starts to fall. What should the CNA do?