micu early mobility jess trappe - doccdn.simplesite.com
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Why?
Attempt to maintain and/or restore optimal mobility.
Decrease hazards r/t immobility
▪ i.e. frequent repositioning, deep breathing & coughing, muscle & joint exercises (ROM).
Types of ROM
Active
▪ Pt able to perform the exercise independently
Passive
▪ ROM performed by the caregiver
Active assisted
▪ ROM performed by pt with assistance
Active and Active-assisted ROM help to prevent muscular atrophy and joint contracture.
Passive ROM help to maintain joint function
ROM can be incorporated into ADL’s!
Joint exercised ADL Movement
Neck Nodding head yesShaking head noMoving right ear to right shoulderMoving left ear to left shoulder
FlexionRotationLateral flexionLateral flexion
Shoulder Reaching to turn on overhead lightReaching to bedside tableRotating shoulders toward chestRotating shoulders toward back
Flexion, extensionHyperextensionAbductionAdduction
Elbow & Wrist Eating, bathing Flexion, extension
Fingers & Thumb All activities requiring fine motor coordination Flexion, extension, abduction, adduction, opposition
Hip WalkingMoving to side laying positionRolling feet inwardRolling feet outward
Flexion, extension, hyperextensionFlexion, extension, abductionInternal rotationExternal rotation
Knee WalkingMoving to and from side-laying position
Flexion, extensionFlexion, extension
Ankle Walking Moving toe toward head of bedMoving toe toward foot of bed
Dorsiflexion, plantar flexionDorsiflexionPlantar flexion
Toes WalkingWiggling toes
Extension, hyperextensionAbduction, Adduction
When performing active-assisted or passive ROM exercises support joint by holding distal portion of extremity or using cupped hand to support joint.
Complete exercises in head-to-toe sequence, each movement should be repeated 5 times during an exercise period
Body Part Type of Joint
Type of Movement
Neck, Cervical spine
Pivotal Flexion: Bring chin to rest on chestExtension: Return head to erect positionHyperextension: Bend head back as far as possibleLateral flexion: tilt head as far as possible toward each shoulderRotation: Turn head as far as possible in circular movement
Body Part Type of Joint
Type of Movement
Shoulder Ball & Socket
Flexion: Raise arm from side position forward to position above headExtension: Return arm to position at side of bodyHyperextension: move arm behind body, keeping elbow straightAbduction: Raise arm to side to position about head with palm away from headAdduction: Lower arm sideways and across body as far as possibleInternal rotation: With elbow flexed, rotate shoulder by moving arm until thumb is inward and palm is facing the backExternal rotation: With elbow flexed, move arm until thumb is upward and lateral to headCircumduction: Move arm in full circle
Body Part
Type of Joint
Type of Movement
Elbow Hinge Flexion: Bend elbow so that lower arm moves toward its shoulder joint and hand is level with shoulder (bicep curl)Extension: straighten elbow by lowering hand
Forearm Pivotal Supination: turn lower arm and hand so that palm is upPronation: Turn lower arm so that palm is down
Wrist Condyloid Flexion: Move palm toward inner aspect of forearm (fingerspoint to the ground)Extension: Move fingers and hand posterior to midline (fingers point to the ceiling)Hyperextension: Bring dorsal surface of hand back as far as possible Radial Deviation: Bend wrist laterally toward fifth fingerUlnar Deviation: Bend wrist medially toward thumb
Body Part Type of Joint Type of Movement
Fingers CondyloidHinge
Flexion: make a fistExtension: Straighten fingersHyperextension: Bend fingers back as far as possibleAbduction: Spread fingers apartAdduction: Bring fingers together
Thumb Saddle Flexion: Move thumb across palm surface of handExtension: Move thumb straight away from handAbduction: Extend thumb laterallyOpposition: Touch thumb to each finger of same hand
Hip Ball & Socket Flexion: Move leg forward and upExtension: Move leg back beside other legHyperextension: Move leg behind body as far as possible.
Body Part
Type of Joint Type of Movement
Hip cont’d Ball & Socket Abduction: Move leg laterally away from bodyAdduction: Move left back toward medial position and beyond if possibleInternal rotation: Turn foot and leg toward other legExternal rotation: Turn foot and leg away from other legCircumduction: Move leg in circle
Knee Hinge Flexion: Bring heel back toward back of thighExtension: Return leg to floor
Ankle Hinge Dorsal flexion: Move foot so that toes are pointed upwardPlantar flexion: Move foot so that toes are pointed downward
Foot Gliding Inversion: Turn sole of foot mediallyEversion: Turn sole of foot laterally
Body Part Type of Joint Type of Movement
Toes Condyloid Flexion: Curl toes downwardExtension: Straighten toesAbduction: Spread toes apartAdduction: Bring toes together
The main points are to move the extremities to promote circulation and decrease entrapment syndromes and neuropathies
It is imperative that the RN assesses the pt to perform the correct ROM exercises. Not all of these exercises will be appropriate for all pts
Performing Range of Motion Exercises, Skill 11-1 (Perry AG, Potter PA: Clinical nursing skills & Techniques, ed 7, St. Louis, 2010, Mosby.)
Tables
Incorporating Active Range of Motion Exercises Into Activities of Daily Living, Range of Motion Exercises (from Perry AG, Potter PA: Clinical nursing skills &t, ed 7, St. Louis, 2010, Mosby.)