Restorative Care and Range of Motion

Restorative Care vs. Rehabilitation

On the New Hampshire Excel Testing exam, restorative care belongs with Personal Care and rehabilitation-support themes. Know the difference:

Restorative philosophy: promote independence. If a resident can button two buttons slowly, you do not finish the shirt for speed. Over-helping causes learned helplessness, muscle loss, and loss of dignity—exactly what Excel Testing items try to catch.

Practical restorative habits

• Ask what the resident can do before you take over
• Break tasks into steps and allow time
• Offer real choices ("blue shirt or green shirt?") without overwhelming
• Praise effort, not only perfect performance
• Follow the care plan's assistance level (independent, supervision, limited, extensive, total)

Adaptive Devices That Support Independence

Adaptive (assistive) devices help residents complete ADLs with less pain or less help:

• Reachers / grabbers for dressing and retrieving items
• Sock aids, long-handled shoehorns, button hooks
• Built-up utensil handles for weak grasp or arthritis
• Plate guards and non-skid mats for self-feeding
• Elevated toilet seats and grab bars for safer toileting
• Walkers, canes, and wheelchairs for mobility (fit and use per care plan)

Always verify that the device is on the care plan, is the resident's assigned equipment, and is in safe working order. Report broken equipment; do not "make do" with unsafe substitutes.

Active vs. Passive Range of Motion

Range of motion (ROM) is the movement of a joint through its available arc.

• Active ROM (AROM): The resident moves the joint using their own muscle power. Best when they can participate safely.
• Active-assistive ROM: The resident starts the movement; the LNA helps complete it.
• Passive ROM (PROM): The LNA moves the joint because the resident cannot. Common after stroke with hemiplegia, during deep weakness, or when ordered for contracture prevention.

Safety rules Excel Testing expects

1. Explain the procedure and provide privacy.
2. Position the resident comfortably; raise the bed to a safe working height, then return it low when finished.
3. Support the joint above and below (never grab mid-muscle belly and yank).
4. Move slowly and smoothly—no bouncing.
5. Stop at the point of pain, resistance that feels forced, or if the resident reports sharp pain. Never force past pain.
6. Repeat each movement the number of times ordered (often three times per exercise on skills checklists—follow the card/care plan).
7. Watch facial expression; residents may not verbalize pain.
8. Report redness, swelling, open areas, or sudden loss of ROM to the nurse before continuing.

Movement Vocabulary You Must Know

Excel Testing skills lists for extremities commonly include hip, knee, ankle and shoulder, elbow, wrist, and fingers. Memorize these terms:

Upper extremity (shoulder, elbow, wrist, fingers)

Typical PROM or AROM sequence themes:

• Shoulder: flexion/extension, abduction/adduction, and ordered rotation
• Elbow: flexion and extension
• Wrist: flexion/extension; sometimes radial/ulnar deviation if ordered
• Fingers: flexion/extension; thumb opposition if ordered

Support the elbow when moving the shoulder. Support the wrist when moving the elbow. Move one joint at a time thoughtfully so you do not twist unsupported joints.

Lower extremity (hip, knee, ankle)

• Hip: flexion (knee toward chest as tolerated), extension, abduction, adduction
• Knee: flexion and extension (often combined carefully with hip support)
• Ankle: dorsiflexion and plantar flexion; inversion/eversion only if ordered and trained

When performing hip abduction, keep the leg supported and move it outward gently—do not drag the heel harshly across the sheet.

Contracture Prevention

A contracture is permanent shortening of muscle/tendon causing a frozen, deformed joint. Immobility after stroke, arthritis pain avoidance, or prolonged bedrest raises risk (classic example: plantar-flexion contracture / foot drop).

Prevention strategies LNAs use every shift:

• Reposition at least every 2 hours (or per care plan)
• Maintain functional alignment with pillows and supportive devices
• Perform ordered ROM
• Encourage out-of-bed activity and ambulation when allowed
• Use footboards/positioning boots only as directed
• Report early stiffness before it becomes fixed deformity

TED Hose / Elastic Stockings (Skill Themes)

Anti-embolism stockings (TED hose / elastic stockings) promote venous return and help prevent blood clots. Excel Testing skill themes usually include:

• Check the care plan and correct size
• Apply to clean, dry legs—typically while the resident is still in bed, when legs are least swollen
• Inspect skin first; do not apply over open lesions unless specifically ordered otherwise—report skin issues
• Turn the stocking inside-out to the heel pocket, place on foot, then ease upward
• Smooth wrinkles and twists (wrinkles create pressure points and impair circulation)
• Ensure heels and toes are positioned correctly in the stocking design
• Check circulation after application: color, temperature, capillary refill, complaints of numbness or pain
• Remove and reapply per facility schedule; report indentation marks, cold toes, or dusky color immediately

LNAs do not decide independently that a resident "needs" compression. Application is a delegated, care-planned skill.

Putting Restorative Care Together on Exam Day

When a skills card includes ROM or stockings, narrate safety: identify the resident, explain, privacy, body mechanics, support joints, ask about pain, leave the call light, and lower the bed. On written items, choose the answer that preserves independence, prevents contractures, and never forces a painful joint. That triad—independence, safe ROM, and observation/reporting—matches how New Hampshire Excel Testing frames Personal Care restorative content.