RANGE-OF-MOTION EXERCISES

CLINICAL GUIDELINES
 A registered nurse (RN), licensed practical nurse (LPN), physical therapist (PT), or
physical therapy technician may complete range-of-motion (ROM) exercises.
 ROM exercises are used when all or some of the normal physical activities are not able to
be completed due to the physical condition of the child. Attention is given to the joint not
being used through provision of active or passive ROM exercises. Active ROM exercises are
those that the patient does for himself or herself. Passive ROM exercises are those performed
by the family member or the healthcare provider without the participation by the child.
 ROM exercises are completed twice a day, with three to five repetitions of each
movement unless otherwise prescribed by the PT.
 ROM exercises are completed as appropriate to the child’s physical condition (Table 95-
1 and Figures 95-1, 95-2, 95-3, 95-4, 95-5, 95-6, 95-7, 95-8, 95-9, 95-10 and 95-11).

EQUIPMENT
 Non-sterile gloves
 Bed with firm mattress or padded table
 Blanket for privacy

CHILD AND FAMILY ASSESSMENT AND PREPARATION

 Review the child’s history for contraindications to ROM exercises, determining
limitations of joint movement and impact on function. In cases of joint inflammation,
dislocation, or fracture, ROM exercises may be contraindicated.
 Review the child’s medical record to determine whether a specific ROM exercise plan
has been provided in the interdisciplinary patient orders.
 Explain to the child and family the purpose and the plan of ROM exercises.
 Initiate pain control measures if needed 30 minutes before beginning ROM exercises.
 Provide antispasmodic medications, if ordered, 30 minutes before beginning ROM
exercises.

CAREMINDER
Children with conditions such as cerebral palsy or hemiplegia will be more comfortable during
ROM activities when given muscle relaxants before the procedure.
 Provide for privacy.
 Schedule ROM activities to coincide with routine care. An ideal time to do the exercise is
during morning care or bath time. Include the child and the family in planning for ROM
activities (e.g., when and where to perform).
 Dress the child in nonrestrictive loose-fitting clothing.
 Assess vital signs to provide a baseline for comparison if changes occur during the
procedure.
 Determine the baseline activity and condition for the child.
 Observe the equality of movement of each joint. The movement of the joints should be
equal bilaterally.
 Note the condition of the the child’s joint that will undergo ROM. The joint should be
free of pain, spastic movement, deformity, and crepitation. There should be no limitation of
movement.

Movement Definition Use

Circumduction Movement of the joint in a full circle Used in movement of

the shoulder

Hyperextension Movement of the joint in the direction of Used in movement of

extension beyond a straight line the arms, legs, hands,
and wrists

Flexion The bending of the joint in which the two Used in the shoulder,
adjacent parts move toward each other, thus elbow, knee, and
reducing the angle of the joint between two parts. finger joints
Decreasing the angle between two bones

Extension Movement increasing angle between two Used in the shoulder,

adjoining bones elbow, knee, and
finger joints

Internal Turning away from the midline Used in movement of

rotation the head from side to
side

Abduction Movement away from the midline of the body Used in movement of
the legs, arms, and
fingers

Adduction Movement toward the midline of the body Used in movement of

extremities; legs,
 arms, and fingers

Pronation Turning the forearm so that the palmar surface of Used in movement of
the hand is facing downward the hand and wrist

Supination Turning the forearm so that the palmar surface of Used in movement of
the hand is facing upward the hand and wrist

Deviation Abduction or adduction of the wrist Used in movement of

the wrist

Opposition Placement of the palmar surface of the thumb so Used in movement of

that it touches the base of the fingers the hand