Restorative Care and Mobility

What Is Restorative Care?

Restorative care (rehabilitation/restorative nursing) helps a resident regain or maintain the highest possible level of function and independence after illness, injury, or with chronic conditions. Instead of doing everything for the resident, the CNA supports them in doing as much as they safely can. In a Massachusetts LTC facility, restorative goals and progress must be documented in the resident's care plan / medical record, consistent with 105 CMR 150.000 nursing-facility regulations.

Why it matters for the exam: restorative care, mobility, transfers, and pressure-injury prevention span the Physical Care (35%) and Basic Nursing/Safety (25%) domains, and transfers/ROM/ambulation are frequent clinical skills stations.

Range-of-Motion (ROM) Exercises

Range of motion (ROM) is moving a joint through its full normal movement to prevent contractures (permanent shortening/stiffening of a muscle or joint), maintain mobility, and improve circulation.

• Active ROM (AROM): the resident does the exercises themselves.
• Active-assisted ROM: the resident does part, the CNA helps.
• Passive ROM (PROM): the CNA moves the joints because the resident cannot.

Key rules: support the joint above and below, move slowly and gently, and stop at the point of pain or resistance — never force. If the resident says "stop, that hurts," you stop and report it. Common terms: flexion (bending), extension (straightening), abduction (away from midline), adduction (toward midline).

Body Mechanics and Safe Transfers

Body mechanics is using the body efficiently to prevent injury. The basics:

• Keep a wide base of support (feet shoulder-width apart) and bend your knees, not your back.
• Lift with your legs, hold the load close, and never twist — pivot your whole body.
• Push or pull rather than lift when possible.

Transfer (gait) belt procedure — a frequent skills item:

1. Explain, lock the bed and wheelchair wheels, lower the bed.
2. Apply the gait belt over clothing, snug at the waist (two fingers should fit).
3. Position the wheelchair on the resident's strong (unaffected) side at a slight angle.
4. Have the resident dangle (sit on the edge of the bed) to prevent dizziness, then stand on a count.
5. Grasp the belt with an underhand grip, block the resident's weak knee/foot, and pivot — do not lift under the armpits (risks shoulder injury).

For a mechanical (Hoyer) lift: the most critical safety check is confirming the sling is the correct size and the hooks/straps are securely attached before lifting; two staff are required.

Ambulation and Fall Response

When helping a resident ambulate (walk): apply the gait belt, walk slightly behind and to the weak side, and let the resident set the pace. For a resident with a shuffling, hesitant gait (e.g., Parkinson's disease), use cues — a rocking start, a line on the floor, or counting "1-2" — to help initiate steps.

If a resident starts to fall, do NOT try to hold them upright. Instead:

• Keep a wide stance, ease the resident down your body/leg to the floor.
• Protect the head, lower them gently, and stay with them.
• Call for help; do not move them until the nurse assesses for injury.

This protects both you and the resident from greater injury — fighting a fall causes back injuries and worse resident harm.

Preventing the Complications of Immobility

Immobile residents are at risk for pressure injuries (pressure ulcers/bedsores), contractures, pneumonia, blood clots, and constipation.

Highest-risk pressure points in a back-lying (supine) resident: the sacrum/coccyx (tailbone) and heels; side-lying adds the hips and shoulders. Use pillows, repositioning, and pressure-relieving devices; report any non-blanchable redness (Stage 1) immediately.

Positioning and Body Alignment

Good body alignment keeps the spine and limbs in their natural position, prevents contractures, and relieves pressure. Know the common positions:

• Supine: flat on the back; support the head, arms, and a small pillow under the lower legs to float the heels.
• Fowler's: head of bed raised 45–60° — used for eating, breathing comfort.
• Lateral (side-lying): on the side with a pillow between the knees and behind the back for support.
• Prone: on the stomach (used less often in elders).

Use trochanter rolls to keep hips from rotating outward, hand rolls to prevent finger contractures, and footboards to prevent foot drop. Reposition gently — slide on a draw sheet, never drag, to avoid shearing the skin.

Assistive and Mobility Devices

Restorative care often involves equipment that maintains independence:

• Gait/transfer belt: used for transfers and ambulation, applied over clothing at the waist.
• Cane: held on the strong side; advance the cane and weak leg together, then the strong leg.
• Walker: move the walker forward, then step in — all four legs/wheels stable before stepping.
• Wheelchair: lock both wheels before a transfer; keep feet on footrests while moving.

Never rush a resident using a device, and keep walkways clear of clutter and wet spots to prevent falls — a leading cause of injury in Massachusetts LTC facilities.

Common Exam Traps

• Lifting a resident under the armpits — never; it can dislocate the shoulder.
• Transferring toward the weak side instead of the strong side.
• Forgetting to lock wheels before a transfer.
• Continuing ROM through pain, or skipping the every-2-hour turn schedule.