Passive range of motion exercises are traditionally used for individuals who cannot move their extremities on their own. This may be as a result of injury, surgery or progressive neurological disease. Passive range of motion exercises often require someone to assist the patient. If passive range of motion has been prescribed by your physician or physical therapist, based on a particular injury or surgery, you should follow those directions exclusively. For patients with a neurological disease or loss of motor function, the rule of thumb is that you should move all of your joints in every direction that they should move. Exercises should be completed to the maximum range of motion and should be performed gently. They are not designed to be aggressive or for extensive stretching. They should not cause pain and should be performed daily to maintain motion.
Shoulder and Elbow Range of Motion
Upper body exercises should include the shoulder, elbow, wrist and hand. The patient should be seated in an upright position with her low back supported. Start with ranging the shoulder overhead by bringing the arm straight out in front and back down. You also need to raise the arm straight out to the side and as far overhead as is comfortable to the patient. For shoulder rotation, lift the arm out to the side to 90 degrees or as far as the person can tolerate. Bend the elbow and rotate the hand so it points to the ceiling and then down to the floor. The elbow has two main motions that you want to range. First is bending and straightening the elbow. The second is a rotation motion and can be completed with the elbow bent. Turn the hand so the palm faces the ceiling; then turn the hand until the palm faces the floor.
Wrist and Hand Range of Motion
For the wrist, the patient should be sitting in a chair with arm support. Bend the elbow and rest it on the chair arm with the palm facing downward and the hand unsupported. Bend the wrist so the fingers point to the ceiling, and then bend the wrist so the fingers point down to the floor. You can also rock the hand side to side in the same position and do wrist circles. Fingers need to be ranged into both a bending and straightening position. The thumb should be moved toward the pinky finger so that it touches the palm and back out so that the letter “L” is formed between the thumb and forefinger. Thumb circles should also be completed.
Hip Range of Motion
Lower body range of motion exercises can be completed in the chair, but hip motions are more successfully ranged in the bed with the patient lying flat. In the chair, the hip can be ranged into flexion by lifting the leg toward the belly. This can be done with the knee bent or straight. There is typically more motion available with the knee bent. With the knee straight, the hamstrings will limit motion if they are tight. The hip can also be moved from side to side with the knee held straight. Rotation can be completed by sitting with the knee bent and swinging the foot inward as if crossing the legs and then swinging it outward. Hip extension cannot be completed in a seated position.
Knee and Ankle Range of Motion
Knee range of motion consists of flexion and extension. From sitting, straighten the knee as far as the patient can tolerate and bend it as far as possible without aggressively stretching. Again if the hamstrings are tight, knee straightening may be limited in a seated position, and may be better performed with the patient lying in bed. You may need to adjust the seated position by scooting the patient to the edge of the chair to bend the knee adequately. The ankle should be flexed toward the face and pointed down. You can also rock the ankle from side to side and perform ankle circles. Toes should be ranged up to the face and flexed down toward the sole of the foot.
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