Restorative and Rehabilitation Care
Key Takeaways
- Restorative care helps a resident keep or regain function and independence after illness, surgery, or decline; the CNA carries out the plan but never invents new exercises or therapy goals.
- Immobility causes contractures, pressure injuries, blood clots, pneumonia, constipation, muscle atrophy, and depression, so the CNA's daily prevention work is the heart of restorative care.
- Range-of-motion exercises are active (AROM, resident moves), active-assistive (AAROM, resident plus CNA), or passive (PROM, CNA moves the joint); move slowly to the point of resistance, never past pain.
- Bowel and bladder retraining, ADL retraining, and walking with prosthetics or orthotics all follow a written schedule the CNA supports with praise, patience, and accurate reporting of progress and setbacks.
- Idaho's Prometric outline places restoration and maintenance of function inside Promotion of Function and Health (24%), and passive range of motion is a common randomly assigned skills-test item.
What Restorative Care Actually Means
Restorative (rehabilitative) care helps a resident keep the function they have and regain function lost to illness, surgery, a stroke, or general decline. The Idaho Prometric outline places "health maintenance and restoration" inside Promotion of Function and Health (24% of the written test), so this is high-yield, not optional. The goal is the resident's highest practicable level of independence — doing with the resident, not for them.
The difference between restorative and acute care is the mindset. In acute care the staff does tasks quickly. In restorative care the CNA slows down, allows extra time, and lets the resident complete the steps they can. A resident who buttons one shirt slowly is doing rehabilitation, not wasting time. The CNA's job is to follow the written restorative or care plan, encourage, supervise for safety, and report progress or decline. A CNA never designs a new exercise program, raises or lowers a therapy goal, or decides a resident no longer needs a device — those are nursing and therapy decisions.
Complications of Immobility and the CNA's Prevention Role
Most restorative exam questions come from one idea: immobility harms every body system, and the CNA prevents that harm daily. Memorize the complication and the matching prevention.
| Body system | Complication of immobility | CNA prevention (per care plan) |
|---|---|---|
| Musculoskeletal | Contractures, muscle atrophy, weakness | Range-of-motion exercises, proper positioning, splints if ordered |
| Skin | Pressure injuries over bony areas | Reposition every 2 hours in bed, every 1 hour in a chair; keep skin clean and dry |
| Circulatory | Blood clots (DVT), swelling | Encourage movement, apply ordered anti-embolism stockings, never massage the calf |
| Respiratory | Pneumonia, shallow breathing | Reposition, raise the head of the bed, encourage deep breathing |
| Gastrointestinal | Constipation, poor appetite | Encourage fluids and fiber, toileting routine, activity |
| Urinary | Stones, infection, retention | Encourage fluids, regular toileting, perineal care |
| Psychosocial | Depression, withdrawal, loss of identity | Offer choices, encourage activity and socializing, support hobbies |
A contracture is the permanent shortening and tightening of a muscle or tendon that freezes a joint, usually from being held bent and unused. Once a contracture forms it is often irreversible, which is why daily range of motion is treated as prevention, not optional comfort.
Range of Motion: Types, Rules, and Worked Steps
Range of motion (ROM) is moving a joint through its full normal movement. Know the three levels:
- Active ROM (AROM): the resident performs the movement alone. Most independent, best when possible.
- Active-assistive ROM (AAROM): the resident moves as far as they can and the CNA helps complete the motion.
- Passive ROM (PROM): the resident cannot move the joint, so the CNA moves it for them. PROM keeps joints flexible but does not build muscle strength, because the resident's own muscles are not working.
Safety rules the skills evaluator and written test both check:
- Support the joint above and below with cupped hands; never grab over the joint itself.
- Move slowly and smoothly to the point of resistance, then stop. Never force a joint or push into pain — pain is a stop signal to report.
- Do each motion the number of repetitions in the care plan, usually 3 to 5 times per joint.
- Begin at the head or shoulders and work downward, and keep the resident covered for privacy and warmth.
The joint movement terms appear as distractors: flexion (bending), extension (straightening), abduction (moving away from the body's midline), adduction (moving toward midline), rotation (turning), dorsiflexion (foot up), and plantar flexion (foot down). For a Prometric PROM skill on one arm or leg, you typically support the limb, exercise the shoulder or hip, then elbow or knee, then wrist or ankle, then fingers or toes — proximal to distal — repeating each move gently.
Ambulation, Devices, Prosthetics, and Retraining Programs
Ambulation is assisted walking, a core restorative task. Apply non-skid footwear, use the assigned gait (transfer) belt snugly over clothing, and walk slightly behind and to the weak side. With a cane, the resident holds it on the strong side and moves the cane and weak leg together. With a walker, the resident moves the walker first, then steps in; the walker should not be pushed out front while leaning. If the resident starts to fall, do not yank them upright — guide a controlled descent, protecting the head.
Prosthetics and orthotics restore function and must be applied correctly. A prosthesis replaces a missing body part (such as an artificial leg); an orthosis or brace (orthotic) supports a weak part. Check the skin under any device for redness or breakdown, keep the stump or limb and the device clean and dry, apply it exactly as the care plan and therapist direct, and report a poor fit, sores, or a device the resident refuses — never adjust the fit yourself.
Retraining programs need patience and a schedule:
| Program | CNA support role | Report |
|---|---|---|
| Bladder retraining | Offer the toilet on a set schedule, encourage fluids during the day, keep a voiding record | Incontinence pattern, burning, no output |
| Bowel retraining | Toilet at the same time daily (often after a meal), encourage fiber and fluids, allow privacy and time | No bowel movement, hard or loose stool, pain |
| ADL retraining | Set out adaptive devices (built-up spoon, button hook, sock aid), break tasks into steps, allow time | Frustration, decline, new inability |
Throughout restorative care the CNA praises effort, never scolds a setback, allows the resident to do as much as possible, and reports both gains and losses so the nurse and therapist can adjust the plan. Doing a task for a resident because it is faster undermines rehabilitation and is the wrong exam answer almost every time.
A resident on the restorative program is slowly buttoning their own shirt and the CNA is running behind on the morning routine. What is the best action?
While performing passive range of motion on a resident's knee, the CNA feels resistance and the resident winces in pain. What should the CNA do?