› Passive Range of Motion

Passive Range of Motion Is Under Rated

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It is a simple nursing skill and as with other nursing procedures, it has definite benefits. It also needs to be done regularly in order to have any effectiveness at all.

You can make it part of the bed bath routine and kill two birds with one stone.

When muscles aren’t used, they atrophy (waste away) and contract (shrink). The phrase: “if you don’t use it, you lose it.” Is right on the money with this situation.

Patients with diagnoses such as strokes, MS, ALS, etc. have less and less control over their muscles as time goes on and passive range of motion (PROM)is usually initiated. 

These exercises are not meant to build muscle. They are meant to maintain the limbs’ ability to flex and extend normally for as long as possible. 

While you may feel that this nursing skill doesn’t show many benefits, NOT doing it will definitely allow problems that are difficult or impossible to reverse.

The term passive refers to the movement of a joint through its range of motion by a healthcare worker, not the patient themselves. This is as opposed to active range of motion, where the individual moves his or her own body.

therapist doing PROMPassive Range of Motion

Contractures

Contractures of the joint occur when a muscle is not stretched or extended for long periods of time. You will find people in the fetal position where the legs cannot be pulled straight. Fingers will be clenched into a fist; Arms permanently bent at the elbow.

Difficulties arise when joints are continually in this position. When skin on skin is constant, it creates a warm, moist area for fungus to take hold.

Fingernails can grow long and cut into the palm of the hand that is permanently fisted.

It is beneficial to place some sort of padding or sometimes an individually built prosthetic on the limb that helps maintain an extended position. You may see the familiar washcloth rolled up and placed in the patient’s hand to attempt to keep the fingers from digging in to the hand.

However, over extension can be very painful for the patient so be gentle in your placement of apparatus.

Once contractures occur it can be difficult to reverse, so keeping on top of it by following up with PROM is a good thing. 

Related Disciplines

In just about any healthcare situation, there are always the related disciplines to help with the specifics of when, how often, and if any apparatus can be used on the patient. Both Physical Therapy and Occupational Therapy are extremely helpful in deciding the patient's plan of care.

Use these disciplines. They have a great deal of knowledge. Ask for referrals to these experts from the doctor. 

In the meantime, as a nurse, you need to be familiar with the basics of PROM.

The videos below show how to do some simple passive range of motion exercise. (Make sure you raise the bed for easy access to the patient.)

Passive Range of Motion Video for Shoulder

Elbow and Wrist PROM

PROM for Leg

Basic Nursing Skills

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