The document discusses the importance of early mobility for MICU patients through range of motion exercises to prevent immobility-related issues like muscular atrophy and joint contracture. It provides details on different types of range of motion including active, passive, and active-assisted exercises and examples of incorporating range of motion into activities of daily living. Guidelines are given for properly performing range of motion exercises on each major joint in the body.

1. MICU Early Mobility
Jess Trappe

2.  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).

3.  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

4.  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!

5. Joint exercised ADL Movement
Neck Nodding head yes Flexion
Shaking head no Rotation
Moving right ear to right shoulder Lateral flexion
Moving left ear to left shoulder Lateral flexion
Shoulder Reaching to turn on overhead light Flexion, extension
Reaching to bedside table Hyperextension
Rotating shoulders toward chest Abduction
Rotating shoulders toward back Adduction
Elbow & Wrist Eating, bathing Flexion, extension
Fingers & Thumb All activities requiring fine motor coordination Flexion, extension, abduction, adduction, opposition
Hip Walking Flexion, extension, hyperextension
Moving to side laying position Flexion, extension, abduction
Rolling feet inward Internal rotation
Rolling feet outward External rotation
Knee Walking Flexion, extension
Moving to and from side-laying position Flexion, extension
Ankle Walking Dorsiflexion, plantar flexion
Moving toe toward head of bed Dorsiflexion
Moving toe toward foot of bed Plantar flexion
Toes Walking Extension, hyperextension
Wiggling toes Abduction, Adduction

6.  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

7. Body Part Type of Type of Movement
Joint
Neck, Cervical Pivotal Flexion: Bring chin to rest on chest
spine Extension: Return head to erect
position
Hyperextension: Bend head back as
far as possible
Lateral flexion: tilt head as far as
possible toward each shoulder
Rotation: Turn head as far as possible
in circular movement

9. Body Part Type of Type of Movement
Joint
Shoulder Ball & Flexion: Raise arm from side position forward to position
Socket above head
Extension: Return arm to position at side of body
Hyperextension: move arm behind body, keeping elbow
straight
Abduction: Raise arm to side to position about head with
palm away from head
Adduction: Lower arm sideways and across body as far as
possible
Internal rotation: With elbow flexed, rotate shoulder by
moving arm until thumb is inward and palm is facing the
back
External rotation: With elbow flexed, move arm until thumb
is upward and lateral to head
Circumduction: Move arm in full circle

12. Body Type of Type of Movement
Part Joint
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 up
Pronation: Turn lower arm so that palm is down
Wrist Condyloid Flexion: Move palm toward inner aspect of forearm (fingers
point 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 finger
Ulnar Deviation: Bend wrist medially toward thumb

14. Body Part Type of Joint Type of Movement
Fingers Condyloid Flexion: make a fist
Hinge Extension: Straighten fingers
Hyperextension: Bend fingers back as far as possible
Abduction: Spread fingers apart
Adduction: Bring fingers together
Thumb Saddle Flexion: Move thumb across palm surface of hand
Extension: Move thumb straight away from hand
Abduction: Extend thumb laterally
Opposition: Touch thumb to each finger of same hand
Hip Ball & Socket Flexion: Move leg forward and up
Extension: Move leg back beside other leg
Hyperextension: Move leg behind body as far as possible.

15. Body Type of Joint Type of Movement
Part
Hip cont’d Ball & Socket Abduction: Move leg laterally away from body
Adduction: Move left back toward medial position and
beyond if possible
Internal rotation: Turn foot and leg toward other leg
External rotation: Turn foot and leg away from other
leg
Circumduction: Move leg in circle
Knee Hinge Flexion: Bring heel back toward back of thigh
Extension: Return leg to floor
Ankle Hinge Dorsal flexion: Move foot so that toes are pointed
upward
Plantar flexion: Move foot so that toes are pointed
downward
Foot Gliding Inversion: Turn sole of foot medially
Eversion: Turn sole of foot laterally

19. Body Part Type of Joint Type of Movement
Toes Condyloid Flexion: Curl toes downward
Extension: Straighten toes
Abduction: Spread toes apart
Adduction: 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

21.  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.)