Range of Motion, Ambulation & Mobility
Key Takeaways
- Active ROM is performed independently by the resident; active-assistive and passive ROM are CNA skills following care plan—never force painful movement.
- ROM exercises move joints through flexion, extension, abduction, adduction, and rotation in smooth, slow motions without bouncing.
- Ambulation with gait belt uses stand on strong side, support at waist, encourage normal heel-to-toe pattern, and watch for orthostatic hypotension after dangling.
- Assistive devices include canes (strong side), walkers (lift slightly with each step), and crutches—resident must be ordered and trained before CNA assists.
- Prometric may assign ROM for one extremity or ambulation with gait belt; both require privacy, explanation, and safety checks.
Quick Answer: Perform ROM slowly, gently, within comfort—stop if pain and report. For ambulation, use gait belt, stand on weak side, support at waist, and never leave resident alone mid-walk without secure seating nearby.
Types of Range of Motion
| Type | Who Moves | CNA Role |
|---|---|---|
| Active | Resident alone | Encourage; supervise |
| Active-assistive | Resident + aide help | Guide weak areas |
| Passive | CNA moves joint | Full support for paralyzed residents |
ROM maintains joint flexibility, circulation, and prevents contractures (permanent shortening).
ROM Principles
- Explain; provide privacy; wash hands
- Support joint above and below movement
- Move head to toe or toe to head consistently
- Smooth, slow motions—no bouncing or forcing
- Compare to care plan orders (hip precautions, weight-bearing limits)
- Stop and report pain, resistance, or new swelling
Joint Movements
| Movement | Definition |
|---|---|
| Flexion | Decreasing joint angle |
| Extension | Straightening |
| Abduction | Away from midline |
| Adduction | Toward midline |
| Rotation | Turning around axis |
Hip Precaution Awareness
Post–hip replacement residents may have precautions limiting flexion past 90°, internal rotation, or crossing legs. ROM and transfers must follow the care plan—violating precautions is an exam and safety failure.
Ambulation Safety
Before walking:
- Dangle at bedside; assess dizziness (orthostatic hypotension)
- Apply non-skid footwear
- Gait belt snug at waist over clothing
- Clear path; call light accessible
During walk:
- Stand on weaker side (catch fall toward strong side)
- Grasp gait belt at back/sides—not resident neck or arms
- Match resident pace; encourage even steps
- Use transfer belt only if trained
After walk:
- Return to chair/bed; lock wheels; call light; remove belt with permission
Assistive Devices
| Device | Key Point |
|---|---|
| Cane | On strong side; move cane with weak leg |
| Walker | Lift or roll per type; resident inside frame |
| Wheelchair | Lock brakes before transfer |
CNAs assist only when resident is ordered and trained on device.
Walker Types
| Type | Technique |
|---|---|
| Standard pickup walker | Lift and place all four legs before stepping |
| Two-wheeled walker | Roll forward; weight-bearing per order |
| Rollator | Brakes locked when resident sits |
Fall Prevention
- Bed in low position when unattended
- Call light within reach
- Non-skid socks
- Adequate lighting; clutter-free paths
- Report new weakness or confusion immediately
Post-Fall Protocol (NY Practice)
If a resident falls: do not move if spinal injury suspected unless immediate danger; call for help; stay with resident; report to nurse immediately; complete incident report per policy. CNAs do not lift fallen residents alone without assessment.
Worked Scenario
Resident becomes dizzy after dangling. Continue ambulation?
Stop; lower back to seated position safely; report to nurse; do not insist on walking to "build strength."
Prometric Skills
ROM one extremity and ambulation with gait belt are common NNAAP skills. Critical elements include explanation, privacy, hand hygiene, pain check, and safe completion.
ROM Documentation
Note which extremity was exercised, active vs passive, and any pain or limitation. Restorative nursing uses your observations to adjust care plans.
Exam Traps
- Forcing ROM through pain (never)
- Walking on wet floor without reporting hazard
- Gait belt around chest or neck
- Leaving resident standing unsupported while opening door
- Ambulating resident without dangling assessment first
Restorative Nursing and ROM in New York
ROM exercises are a restorative nursing function when documented and performed per care plan. CNAs support restorative programs by encouraging active participation and reporting resistance.
Contracture Prevention Schedule
| Body Area | Common Contracture | Prevention |
|---|---|---|
| Shoulder | Frozen shoulder | Active or passive ROM |
| Elbow/wrist | Flexion contracture | Splinting per therapy |
| Hip/knee | Flexion deformity | Side-lying positioning |
| Ankle | Foot drop | Footboard, ROM |
Weight-Bearing Status
Never ambulate a resident beyond ordered weight-bearing status (full, partial, non–weight-bearing). Crutch and walker use requires therapy clearance. Report residents who attempt to stand without orders.
Gait Belt Fit and Safety
| Correct | Incorrect |
|---|---|
| Snug over clothing at waist | Over ribs or chest |
| Buckle in front or side | Under resident where you cannot see |
| Remove after seated safely | Leave on in wheelchair all day |
Ambulation Distance and Fatigue
Start with short distances. Watch for increased shortness of breath, cyanosis, or diaphoresis—stop and report. Cardiac and pulmonary residents may have limited tolerance not visible on care plan until tested at bedside.
ROM Pain Scale Reporting
Ask residents to rate pain 0–10 before and during ROM. Stop at resident request. Report pain ≥4 that is new or worse than baseline—nurse may need to adjust analgesia before therapy continues.
Prosthetic and Amputee Awareness
Residents with prosthetic limbs require specific donning order per therapy. Report skin breakdown at stump site. Do not adjust prosthetic fit—that is therapy or nursing.
Wandering and Elopement Risk
Report exit-seeking behavior immediately. Do not restrain at door. Follow facility elopement protocol—notify nurse, search assigned areas, never leave other residents unattended unsafely.
Skills Exam ROM Sequence
Typical order: explain, privacy, hand hygiene, support joint, move through full comfortable range without pain, ask about pain, lower extremity, document if required, call light. Bouncing at end range fails skills and injures residents.
NY Exam Review Takeaway
Master the NYSDOH/Prometric decision rules for this topic: stay in scope, protect dignity, use standard precautions, and report changes to the licensed nurse before finishing non-urgent tasks. Practice until safe steps are automatic on skills day and written traps feel predictable.
Passive range of motion means:
When ambulating a resident with a gait belt, the nurse aide should stand:
During ROM exercises, the nurse aide should stop and report when the resident:
Orthostatic hypotension after dangling at bedside is best managed by: