When a resident enters a facility without range of motion deficits, it is the responsibility of the facility to ensure deficits don’t develop. There are times when the development of contractures or other decrease in range of motion is unavoidable, however, this is not normally the case.
If a resident already has limited range of motion upon entering the nursing home, the facility has an obligation to ensure appropriate treatment is in place to improve that range of motion, or at least prevent further limitations from developing.
As a caregiver, it is important for you to be aware of what the resident’s comprehensive care plan reflects regarding their current range of motion and their goals in this area.
To maintain or improve range of motion, services are provided either by a therapy company or restorative nursing services.
Typically, the physical or occupational therapist is involved in helping to develop a restorative program and then the nursing staff is responsible for implementing and maintain said program. While some nursing homes have specific restorative aides, in which providing restorative services is all they do, many don’t have that luxury and so restorative services become the responsibility of the certified nurse aides, etc.
Common activities that are included in restorative programs include but are not limited to the following:
Walk to dine
Active range of motion
Passive range of motion
Dressing and ADL programs
Walk to dine programs are important in maintaining a resident’s ability to walk for as long as possible, even if assistance is required.
Too often, caregivers get in a hurry and find it’s easier to have the resident in a wheelchair and wheel them down to the dining room. This not only takes away strength and ability from the resident, but studies show that sitting in a normal dining chair promotes better food intake and digestion. When walking with a resident to the dining room, make sure to use a gait belt and walk at a speed that is ideal for the resident. Taking an extra 5 minutes to walk with them safely to the dining room isn’t going to hurt anything. Slow down.
Active range of motion is when the performance of an exercise to move a joint is done without any assistance. In other words- you just instruct the resident what to do but you don’t have to physically help them do it.
Active assisted range of motion is when the resident can perform most of the movement on his or her own but might require minimal assistance from another person.
Passive range of motion is when you as the caregiver must physically move the resident’s joint muscles for them to get the benefit of the action. In other words, they can’t bend their arm on their own, so you must do it for them for it not to get contracted.
When range of motion, whether active or passive, isn’t done on a regular basis, the muscles surrounding the joint start to stiffen, shorten and sometimes are loss in general. When muscle tissue wastes away or is loss, it’s known as muscle atrophy. This is what leads to a decrease in range of motion or contractures. It is painful, debilitating and in some cases embarrassing for the resident.
Check with your charge nurse to find out what your role is in the facilities restorative program and work it into your daily routine, per the president’s plan of care.