Range of Motion, Ambulation, and Assistive Devices

Active vs. Passive Range of Motion

Range of motion (ROM) exercises keep joints flexible and prevent contractures. Indiana CNAs perform ROM as ordered in the care plan.

• Active ROM: The resident performs the movements themselves. The CNA encourages, supervises, and positions, but does NOT move the resident's limbs. Used for residents who can move independently but need prompting. Active ROM maintains muscle strength AND joint mobility.
• Passive ROM: The CNA moves the resident's limbs through the full pain-free range. The resident does NO work. Used for residents who cannot move independently (paralysis, weakness, coma). Passive ROM maintains joint mobility only — it does NOT build or preserve muscle strength.

ROM principles

• Move each joint through its full pain-free range — STOP if pain, resistance, or spasm occurs and report to the nurse
• Support the joint above and below the moving joint
• Move slowly, smoothly, gently — never force
• Repeat each movement 3-5 times unless the care plan states otherwise
• Perform head-to-toe in the order of the care plan
• Encourage active ROM whenever possible — even partial active movement preserves strength

TRAP: Passive ROM does NOT maintain muscle strength — only active ROM builds muscle. A question asking "what preserves muscle strength" wants ACTIVE ROM. Passive ROM only prevents joint stiffness and contracture.

Ambulation with Walker and Cane

Walker technique

1. Resident stands, walker brakes locked if rolling, walker placed in front
2. Resident moves walker forward 6-10 inches
3. Resident steps INTO the walker
4. Resident bears weight on the walker AND uses leg muscles (not arms alone)
5. CNA stands on the resident's weaker/affected side, slightly behind, with a gait belt secured
6. Repeat for the prescribed distance

Cane technique

• Cane goes on the resident's stronger side (opposite the weak leg)
• Resident moves cane forward with the weak leg together — "cane + weak leg, then strong leg"
• The cane takes weight off the weak leg while the strong side provides stability

TRAP: Cane goes on the STRONG side, opposite the weak leg. Many exam questions try to trick you into placing the cane on the weak side — that would increase strain on the weak leg.

Gait belt use

• A gait belt is applied around the resident's waist SNUG (two fingers fit underneath)
• Used for transfers and ambulation — gives the CNA a secure handhold
• Grasp the belt itself, not just the buckle or handles
• Apply OVER clothing, NEVER on bare skin
• Contraindicated on residents with recent abdominal surgery, feeding tubes, ostomies, fractures, or pregnancy — check with the nurse

Fall during ambulation

• If the resident starts to fall, do NOT try to catch and hold them upright — you will both be injured
• Widen your stance, bend your knees, support the resident's slide to the floor
• Lower them gently, protect the head, stay with them, call for help
• Do NOT move them until assessed — notify the nurse and document

Assistive Devices — CNA Role and Safety

Wheelchair safety

• Lock BOTH brakes before any transfer
• Swing away or remove footrests; remove the armrest on the transfer side
• Position the wheelchair at a slight angle to the bed or chair so the resident can pivot
• Never let a resident stand on the footrests — they flip and cause falls
• Push from behind, not from the side; watch doorways and thresholds
• For long downhill slopes, back the wheelchair down in REVERSE so the resident leans back into the chair

Prosthetics, hearing aids, artificial eyes, dentures, compression stockings

Prosthetics

• The CNA may help a resident don/doff a prosthesis per the care plan
• Observe the stump for redness, breakdown, swelling — report immediately
• Do NOT adjust alignment — that is the prosthetist's role
• Store the prosthesis within reach, clean per manufacturer instructions
• Wash the stump daily and dry thoroughly

Hearing aids

• Turn OFF and open the battery door at night to preserve the battery
• Clean with a dry cloth — never water
• Store in a labeled container, never a pocket or tissue (lost easily)
• Insert with volume LOW, then increase; remove before shower, hair washing, or hair spray

Artificial eyes

• Clean per care plan — usually daily with sterile saline or as ordered
• Wash hands, wear gloves; never use alcohol or harsh chemicals
• Store in a labeled container with saline — never let it dry out
• Report discharge, redness, or swelling to the nurse

Dentures

• Handle over a towel or basin of water (they break if dropped)
• Brush daily with denture cleaner — NOT toothpaste, which is abrasive
• Store in cool water in a labeled cup — never hot water (warps the plastic)
• Offer after meals and at ADL times; clean the mouth even when dentures are out

TRAP: Dentures are the resident's personal property — never throw them away, never wrap them in a tissue or paper towel (they get thrown out). Always store in a labeled container.

Compression stockings (TED hose / anti-embolism)

• Apply BEFORE the resident gets out of bed, while legs are still flat and non-dependent
• Remove per care plan (often q8h or per shift) and reapply
• Inspect skin and circulation before, during, and after — check toes for color, warmth, sensation
• Never fold or roll down the top — this causes a tourniquet effect and cuts circulation
• Wash per manufacturer instructions, air dry
• Report numbness, tingling, color change, or pain immediately