MICU Early MobilityJess Trappe

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.)