Contractures occur when muscles and tendons contract due to non-use and spastic activity of the muscle. If you have ever witnessed a resident with their knees or arms bent in towards the body and were unable to move them – that is a contraction. Hands that have fingers curled too tight to move – that may also be a contracture.
During your training, you will (or have) learned about how contractures are caused, along with how to prevent them. Range of motion exercises (ROM) are your responsibility. Yes, physical therapy provides range of motion, but residents that are at risk for contractures are often not in therapy enough. These residents are those confined to geri-chairs or are bedridden.
These residents should receive ROM during their morning care and bedtime routine. Many CNAs forget to provide range of motion care to their residents, they may do this on accident or may have been told by other aides that there is not time. While the job is fast paced, it is your responsibility to provide this care, lack of ROM will allow contractures to start or to worsen. Once contractures occur, they cannot be relieved except by surgery.
One way to be sure that you provide proper care is to make it a habit to give your residents ROM during any personal care that requires you to be by their side for more than a few minutes. If you have a resident that must have supervision during toileting, take this time to do ROM for the hands. Bedtime routines provide a perfect opportunity for lower body ROM.
Sometimes your problem is not the lack of time, but the resident refuses ROM. If this happens, the best thing to do is explain what can happen if they consistently refuse range of motion. Remind them of what contractures are and if you must, provide examples. Contractures are painful – most people will allow you to give them the exercises if they understand that even more pain can occur by refusing the ROM every day.
If the resident still refuses the range of motion, speak to your supervisor, perhaps he or she can talk to the resident. Sometimes, hearing the full consequences from what the resident considers a higher authority will tempt them to agree to the proper exercises. If all else fails, if the resident is not combative and the family agrees to physical therapy, the resident can be included in a mandatory therapy program where they are taken into the physical therapy room every day. This usually circumvents any problem that could come from trying to perform ROM on a resistive resident.