Passive Range Of Motion Education

Following a referral from a Physician, all patients will be evaluated by a Physical Therapist.

The Physical Therapist will only assess the patients if they are suitable for active rehabilitation. On some occasions, patients may not be deemed suitable to commence Physical Therapy for a number of reasons, including but not limited to, decreased consciousness and/or severe disability or comorbidity.

For example, a person who is disoriented, unresponsive, or bed bound may be better managed with home care nursing or staying in a long-term care facility. In addition, a patient who at first presents with general contraindications for activity may not benefit from rehabilitation. This person can consider rehabilitation at a later time, after an assessment by a Physician.

For patients who are bed bound due to long-term immobility, (for example: paralysis, altered mental status, severe stroke, end stage Alzheimer’s or Parkinson’s, multiple sclerosis or severe obesity), Passive Range of Motion (PROM) exercises are appropriate and play an important role to prevent other problems or comorbidities, improving the patient’s overall quality of life.

Problems that can develop from immobility

• Loss of muscle mass, strength and endurance
• Pressure sores
• Muscle pain
• Osteoporosis
• Pneumonia
• Constipation
• Incontinence and urinary tract infections
• Blood clots in lower extremities
• Contractures
• Depression
• Social isolation
• Loss of independence

Benefits of PROM exercises

• Maintain joint mobility and elasticity of muscle
• Improve blood flow
• Increase nutrition to cartilage
• Prevent contractures that may interfere with movement, ADLs (activities of daily living) or cause pain

General instructions for PROM

One of the main goals of this brochure is to educate and empower family members, private caregivers and home care nurses to continue using PROM exercises with the patient both during their stay at the hospital, and after they are discharged home.

• PROM exercises should be performed to prevent the development of muscle contractures, which are the shortening of muscles or tendons, often leading to deformities and rigidity of joints.
• The patient should be in a comfortable position with good body alignment.
• The patient should be positioned so that he or she may use proper body mechanics.
• Move the joint through the available range of motion without causing pain. Do not force movement.
• Move in a straight line from the starting position to ending position.
• Move extremities and joints in a slow, gentle motion.
• Ask the patient (if possible) if they feel pain while performing PROM exercises.
• Perform 10 repetitions of each exercise. Repeat two to three times per day.
• For patients with increased tone or spasticity, slowly pull against muscles that seem especially tight. Gentle, continuous stretching of a muscle will help relax it.
• Your Physical Therapist will teach you how to perform these movements and exercises.

If you have any questions or concerns, please ask the Physical Therapist to assist and provide further education.

Shoulder Flexion

• Starting position. Bringing the arm forwards and up. Hold the hand and upper arm.
• Bring the arm up while turning the palm of the hand towards the head.
• Bring the arm as close to the ear as possible.

Shoulder Abduction

• Starting position. Bringing the arm out to the side and up. Hold the hand and upper arm.
• Bring the arm out to the side and up while turning the palm of the hand towards the head.

Shoulder Horizontal Adduction

• Starting position. Moving the arm across the chest. Move the upper arm out to the side. Hold the hand and under the elbow.
• Move the arm across the chest.

Shoulder External Rotation

• Starting position. Rotating the shoulder outwards. Hold the hand. With your other hand, hold the elbow.
• Hold the upper arm against the side while you bring the hand out, away from the body.

Shoulder Internal Rotation

• Starting position. Rotating the shoulder inwards. Move the upper arm out to the side. Hold the hand. With your other hand, hold the elbow.
• Keep the upper arm still while you move the hand towards the feet.

Elbow Flexion, Forearm Supination

• Starting position. Bending the elbow and rotating the forearm. The arm is close to the side. Hold the hand. With your other hand, hold just above the elbow.
• Bend the elbow while turning the palm of the hand towards the head.

Forearm, Supination

• Starting position. Rotating the forearm. The upper arm is against the side. Hold the thumb. With your other hand, support the forearm.
• Turn the hand and the forearm so that the palm of the hand points towards the head.

Forearm, Pronation

• Starting position. Rotating the forearm. The upper arm is against the side. Hold the palm of the hand and the thumb. The other hand supports the forearm.
• Turn the hand and the forearm so that the palm of the hand points towards the feet.

Wrist, Radial Deviation

• Bending the wrist towards the thumb. Hold below the wrist. With your other hand, hold the hand and thumb. Bend the wrist towards the thumb.
• Bending the wrist towards the little finger. Hold below the wrist. With your other hand, hold the hand and thumb. Bend the wrist towards the little finger.

Wrist, Flexion

• Bending the wrist. Hold below the wrist. With your other hand, hold the fingers and hand. Bend the wrist forwards.

Wrist Extension

• Straightening the wrist. Hold below the wrist. With your other hand, hold the hand and the fingers. Bend the wrist backwards.

Fingers, Flexion

• Bending the fingers. Hold the wrist and fingers. Bend the fingers.

Fingers, Extension

• Straightening the fingers. Hold the wrist. With your other hand, hold the fingers. Straighten the fingers.

Knee and Hip, Flexion

• Starting position. Bending the knee and hip. Hold the foot and place your other hand under the knee.
• With your hand, lift the knee and then slide that hand to the top of the knee. Push the sole of the foot with your other hand.

Hip, Abduction

• Starting position. Bringing the leg out to the side. Hold the heel and place your other hand under the knee.
• Bring the leg out to the side and then back to the starting position.

Hip, Adduction

• Starting position. Bringing the leg across the other leg. Hold the heel and place your other hand under the knee.
• Bend the knee a little and move the leg across the other leg. Bring the leg back to the starting position.

Hip, External Rotation

• Starting position. Rotating the hip outwards. Hold the heel and place your other hand under the knee.
• Bend the hip and knee. Support the thigh against your body. Move your hand on top of the knee. With your other hand, bring the foot inwards.

Hip, Internal Rotation

• Starting position. Rotating the hip inwards. Hold the heel and under the knee.
• Bend the knee and hip. Support the lower leg against your body. Hold your hand on the knee. Move the foot outwards.

Ankle, Inversion

• Turning the foot inwards. Hold the heel and place your other hand on top of the foot.
• Turn the heel and the foot towards the other foot.

Ankle, Eversion

• Turning the foot outwards. Hold the heel and place your other hand on the top of the foot.
• Turn the heel and foot away from the other foot.

Ankle, Plantarflexion

• Straightening the ankle. Hold the heel. Support the sole of the foot on your forearm. Place your other hand on the foot and push down to straighten the ankle.

Ankle, Dorsiflexion

• Bending the ankle. Hold the heel. Support the sole of the foot on your forearm. Place your other hand above the ankle. Pull the heel as you push your forearm against the sole of the foot.

Toes, Abduction

• Moving the toes apart. Hold the big toe and the toe next to it. Move the toes apart. Repeat with the other toes.

Toes, Extension

• Straightening the toes. Place both your thumbs under the toes. Push the toes up.

Ankle, Dorsiflexion

• Bending the ankle. Hold the heel. Support the sole of the foot on your forearm. Place your other hand above the ankle. Pull the heel as you push your forearm against the sole of the foot.

Toes, Flexion

• Bending the toes. Place both your thumbs over the toes. Bend the toes. Make sure you bend all the toes together.