9.1 Range of Motion & Pennsylvania’s Two PROM Skills
Key Takeaways
- Active ROM is performed by the resident, active-assistive ROM uses partial help, and passive ROM is moved by the caregiver according to the care plan.
- Pennsylvania tests exactly two modified PROM skills: one knee with one ankle, and one shoulder.
- For knee/ankle PROM, support at knee and ankle, perform knee flexion/extension and ankle dorsiflexion/plantar flexion at least 3 times unless pain occurs.
- For shoulder PROM, support at elbow and wrist, raise the straight arm toward the head only to ear level and move it outward only to shoulder level, at least 3 times unless pain occurs.
- Move slowly and smoothly, never force a joint, and stop immediately when the client verbalizes pain.
Purpose and categories
Range of motion maintains available joint movement, comfort, circulation, and participation in daily activity. It does not restore function by force, and the nurse aide does not independently create an exercise program.
- Active ROM (AROM): the resident moves the joint without physical help.
- Active-assistive ROM (AAROM): the resident moves while receiving the amount of help specified in the plan.
- Passive ROM (PROM): the resident does not move the joint; a trained caregiver moves it through the ordered range.
Follow the care plan for joint, side, movement, repetitions, precautions, and assistance. Recent surgery, fracture, paralysis, contracture, joint replacement, pain, or swelling can change the allowed motion. Stop and report pain, new resistance, spasm, swelling, warmth, a new sound with discomfort, or a change from baseline.
Useful movement words include flexion (decreasing a joint angle), extension (returning from flexion), abduction (away from midline), adduction (toward midline), dorsiflexion (toes toward the head), and plantar flexion (toes downward). These terms help interpret the two Pennsylvania skill cards.
Universal exam approach
For either tested skill, explain the procedure clearly, provide privacy, and tell the client to report pain. Support the limb above and below the moving joint, use a gentle natural grip, and move slowly and smoothly. The official wording is at least three times unless pain is verbalized—not “exactly three regardless of pain.” If pain occurs, discontinue the movement, return the limb to a supported comfortable position, and report it. At the end, put the signal within reach, leave the bed low, and wash hands.
Skill 15: One knee and one ankle
The client is supine. Support the leg at the knee and ankle.
- Bend the knee and return the leg to the normal position—knee flexion and extension—at least three times unless pain is verbalized.
- Keep support at the foot and ankle close to the bed. Push/pull the foot toward the head—dorsiflexion—and then point the toes down—plantar flexion—at least three times unless pain is verbalized.
- Move the joints gently, slowly, and smoothly. Do not twist the knee or force the ankle.
The current PA skill is knee/ankle, not a separate hip-abduction routine. A workplace care plan may include hip exercise, but candidates should not insert unlisted hip movements into this skill.
Skill 16: One shoulder
Support the straight arm at the elbow and wrist.
- From the side of the body, raise the straight arm upward toward the head only to ear level, then return it to the side—shoulder flexion and extension—at least three times unless pain is verbalized.
- Move the straight arm away from the side only to shoulder level, then return it to the side—abduction and adduction—at least three times unless pain is verbalized.
- Keep motion in the natural plane. Do not raise beyond the test endpoint, rotate the joint, or perform elbow/wrist exercises as substitutes.
“Toward the head to ear level” does not mean forcing the arm overhead to the mattress. “To shoulder level” does not mean a full arc over the head. The published limits protect the volunteer and give the evaluator a consistent endpoint.
Workplace ROM
At work, the care plan may include other joints and different repetitions. Encourage active participation and independence first. Do not turn PROM into resistance exercise, add weights, or force a contracted limb. A mechanical restriction can be structural; pushing through it can tear muscle, injure bone, or dislocate a joint. Coordinate with nursing and rehabilitation staff when technique or tolerance changes.
Document the side, joint, type of assistance, repetitions completed, pain or resistance, and reports according to facility procedure. Do not chart the full program when a movement was omitted or stopped.
Distinguish assistance from force
In active-assistive exercise, help only through the portion the resident cannot complete; taking over the whole motion converts it to passive exercise and reduces independence. In PROM, support the limb’s weight continuously so the joint is not pulled by gravity. Watch the resident’s face as well as listening for words—grimacing, guarding, breath-holding, or sudden muscle tightening may signal discomfort even before pain is verbalized. At the exam, the explicit stop trigger is verbalized pain; in real care, any distress or unexpected resistance warrants stopping safely and reporting. Never bounce at the end of range.
What are Pennsylvania’s two tested modified PROM skills?
How far is the straight arm raised during the shoulder flexion/extension skill?
What should the candidate do if pain is verbalized during PROM?