6.5 Range of Motion, Positioning, and Contracture Prevention
Key Takeaways
- Range of motion helps maintain joint flexibility, circulation, comfort, and function when performed gently and exactly as assigned.
- Active range of motion is done by the resident, while passive range of motion is done for the resident by the caregiver.
- Contracture prevention depends on movement, positioning, splints or devices as ordered, skin checks, and reporting pain or resistance.
- The aide should never force a joint, move beyond the assigned range, or continue exercises when new pain, swelling, redness, or distress appears.
Protecting Joints Through Daily Care
Range of motion, often called ROM, means moving joints through their available movement. ROM can be active, passive, or active-assisted. Active range of motion means the resident moves the joint independently. Passive range of motion means the caregiver moves the joint for the resident. Active-assisted range of motion means the resident helps while the caregiver supports the movement. The nurse aide performs only the type, joints, repetitions, and frequency assigned by the care plan.
ROM supports function because joints and muscles can stiffen when not used. A resident who stays in one position may lose shoulder movement, hand opening, hip extension, knee movement, ankle flexibility, or neck comfort. Stiffness can make bathing, dressing, transfers, walking, toileting, and positioning more difficult. The goal is not athletic stretching. The goal is safe maintenance of comfort, circulation, and usable movement.
A contracture is a permanent or semi-permanent shortening of muscle, tendon, or other tissue that limits joint movement. Contractures can affect hands, elbows, shoulders, hips, knees, ankles, and feet. They may develop after stroke, immobility, neurologic disease, pain, poor positioning, or lack of use. Prevention includes gentle movement, good alignment, splints or positioning devices when ordered, and avoiding long periods with joints bent in the same position.
ROM and Positioning Safety
| Care action | Safe approach | Stop or report when |
|---|---|---|
| Passive ROM | Support the limb above and below the joint and move slowly | Pain, resistance, swelling, redness, warmth, or spasm appears |
| Active ROM | Encourage resident to move independently as assigned | Resident becomes dizzy, short of breath, or unusually fatigued |
| Hand care | Open fingers gently and clean/dry between them as allowed | Fingernails dig into palm, odor, skin breakdown, or pain appears |
| Foot positioning | Keep feet aligned and use devices as ordered | Foot drop, heel redness, device pressure, or new numbness appears |
| Splints or braces | Apply only as trained, check skin, follow schedule | Redness, swelling, tightness, numbness, or resident distress appears |
Technique matters. Support the body part, move slowly and smoothly, and avoid jerking. Never force a joint. Movement should stay within the assigned range and should not cause sharp pain. If a resident resists, ask what is wrong. Resistance may come from pain, fear, confusion, fatigue, or misunderstanding. Stop and report rather than overpowering the resident.
Positioning reinforces ROM. A resident lying with knees constantly bent may develop hip and knee stiffness. A hand left clenched around a washcloth without proper instruction may trap moisture or worsen pressure. A foot unsupported in bed can point downward and contribute to foot drop. Pillows, heel protectors, hand rolls, splints, wedges, and footboards may be used only as directed by the care plan and facility policy.
Skin checks are essential because devices can create pressure. Braces, splints, shoes, oxygen tubing, wheelchair footrests, and bed positioning supports can rub or press. The aide should report redness, blisters, swelling, indentations, coolness, numbness, tingling, drainage, odor, or complaints of pain. Do not add padding, remove a prescribed device permanently, or change the wearing schedule without nurse or therapy direction.
ROM can be included in ordinary care. During bathing, the resident may raise arms, open hands, bend knees, or turn the head within the care plan. During dressing, the aide can encourage safe arm movement and gentle participation. During meals, the resident may practice hand-to-mouth movement. These small repetitions can help preserve ability when done consistently.
On exam questions, choose the answer that is gentle, planned, and observant. The aide should explain the task, provide privacy, support the limb, move only as assigned, stop for pain or resistance, and report changes. Avoid answers that force motion, invent exercises, ignore skin problems, or continue because the routine must be completed.
A resident grimaces and says the shoulder hurts during passive range of motion. What should the nurse aide do?
Which description best defines active range of motion?
A splint is removed as scheduled, and the aide notices red marks and swelling under one strap. What is the best action?