Passive range of motion exercises for stroke patients have many benefits, including reducing spasticity and improving mobility. These exercises involve using an external force, such as a therapist or healthy limb, to move the affected joints.

Because passive range of motion exercises for stroke patients do not require the patient to be able to move independently, these exercises may be particularly effective in helping people with limited mobility and strength. In fact, performing passive range of motion exercises can even help stroke patients who have experienced paralysis regain the ability to move without assistance.

The article defines passive range of motion and describes the benefits of participating in passive exercises. Also included are examples of various passive range of motion exercises that can be tried with stroke patients.

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What is passive range of motion?

Range of motion refers to how much a joint can move in a certain direction. For example, a person with full range of finger movement can fully straighten the fingers and close them into a closed fist. Range of motion is often impaired after a stroke due to side effects such as spasticity or weakness.

There are two types of range of motion: passive and active. Learning the difference between active and passive movement can help stroke survivors understand which exercises will work best for them and what role each type of exercise can play in their recovery.

Passive range of motion exercises refer to movements during which the survivor exerts no effort on the target muscles. These exercises can be performed on your own, using your uninjured limbs, or with the help of another person, such as a therapist or trained caregiver.

Active range of motion exerciseson the other hand, they refer to any movements performed without assistance in which the joints move part or all of their range of motion. Although active range of motion exercises do not involve weights, resistance bands, or other strengthening equipment, controlled movements with or against gravity can help improve muscle strength.

Some people benefit from exercises that include a combination of active and passive movements. These are the so-called range of movement exercises with active supportand refer to a situation where the victim engages selected muscles and performs a specific movement with some assistance.

Therapists may prescribe active, actively assisted, and/or passive range of motion exercises for stroke patients to improve their mobility. Although passive range of motion exercises may be most beneficial for a survivor with very limited mobility, they may progress to actively assisted range of motion exercises or even fully active range of motion exercises as they continue to regain mobility.

Benefits of passive range of motion exercises

Passive range of motion exercises have many benefits for stroke patients. Although passive range of motion exercises can even be beneficial years after strokeresearch has shown this early Passive range of motion exercises beginning within the first 48 hours after stroke may result in improved mobility outcomes.

In addition to improving mobility, passive movement exercises can:

• Improve circulation
• Reduce the risk of pressure ulcers, especially in bedridden people
• Prevent muscle/joint stiffness and contractures
• Reduce swelling (swelling)

Recently, Robot-assisted therapies were developed to help survivors complete passive range of exercises on their own. The use of a robotic device may promote increased participation in passive exercises in those who would not be able to perform these exercises without continuous assistance.

Although passive range of motion exercises do not require full commitment from the survivor, there are many benefits to active participation. Research has shown that mental practice, the process of visualizing yourself while performing a movement, can result in improved functional outcomes. Therefore, combining passive range of motion exercises with mental practice can optimize adaptive changes in the brain, resulting in lasting improvement.

Adaptive reprogramming of the brain is stimulated by repetitively performing tasks such as passive exercises and mental exercises. This rewiring process, referred to as neuroplasticity, involves creating and strengthening neural pathways to improve functional performance. Therefore, consistent and repetitive performance of passive range of motion exercises in stroke patients may be an effective way to aid recovery.

Passive upper body range of motion exercises

Here are some of the best passive upper body exercises for stroke patients. While these are great passive exercises to try, consulting a physical or occupational therapist can help survivors determine exactly which exercises will be best for their condition. Each exercise should feel like a stretch, but should never be painful.

1. Hand stretching

Put your hands together. Then push with the fingers of your good hand to gently straighten and stretch the fingers of your other hand. Relax, then use your good hand to bend the affected fingers into a closed fist position.

2. Wrist stretch

Start by interlocking your fingers. Then gently push the affected wrist back towards your forearm. This should feel like a pleasant stretch, but should not be painful.

3. Elbow stretching

Again, start with your fingers intertwined. Then, with your intact arm, bend your elbows up until your hands touch your chest (if possible). Then relax and stretch your arms to straighten your elbows. For an extra challenge, after bending your elbows, try pushing your arms straight out of your chest, using your intact arm to focus on shoulder and elbow mobility.

4. Stretching the tabletop

Clasp your hands and then place them on the table. Then slide your arms across the table, reaching straight ahead. If your hands are sticking to the table, place a washcloth or towel under them to make them easier to move. Lean forward to stretch your arms, then return to the upright position.

To further improve shoulder mobility, start again with your hands clasped on the table. This time, work on creating large circles on the table by switching between clockwise and counterclockwise directions.

5. Stretching the cane

Starting in a lying or sitting position, grasp both ends of the cane and then push the affected arm outward as if the affected arm was making a snow angel. Again, this should feel like a stretch but should not cause pain.

To work on shoulder rotation, start with both hands holding the cane. With the affected elbow resting at your side, push the affected forearm outwards. Expect stretching but much less movement in this exercise.

Perform each of these passive upper body exercises for stroke patients at least twice daily, repeating each exercise 5 times. Holding the stretch for 5-10 seconds can help maximize mobility.

Passive range of motion exercises for the lower body

Often, upper body passive range of motion exercises are easier to perform independently because the intact hand can easily reach and grab the affected arm to move it. However, passive lower body range of motion in stroke patients can still be very beneficial. Here are some of the most effective passive lower body exercises.

1. Ankle stretch

Starting in a seated position with your feet flat on the ground, wrap a strap or strap around the forefoot. Pull the strap to lift your toes up, then release. If this is too difficult, ask a qualified caregiver to grab the front of your foot and bend it up and down to stretch the ankle.

2. Knee bends

Start by lying flat on your bed or floor. Ask a qualified caregiver to grasp under the heel and just behind the knee of the affected leg, and then bend the knee toward the ceiling. Relax to bring your knee back to the extended position.

3. Hip stretch

Start by sitting in a chair with your feet flat on the floor. Using your hands or a strap, grab your hip under your thigh and lift your hip up as if you were walking. For an extra challenge, start by sitting on the floor with your legs straight out in front of your body, then bring the affected thigh towards your chest.

Again, it’s important to practice lower body passive range of motion several times a day, holding each stretch for 5-10 seconds to increase mobility. Stopping each stretch before the pain point is essential to prevent further injury. It’s best to consult with a physical or occupational therapist to ensure proper form and determine which exercises will be most effective.

Understanding passive range of motion exercises in stroke patients

Performing passive range of motion exercises, alone or with the help of another person, is an excellent way to support your recovery from a stroke. Passive range of motion exercises can be used for almost all stroke survivors, but may be especially beneficial for people with very limited active movement.

While there are many passive movement exercises for stroke patients, the best options are those that focus on the affected areas of the body. Although survivors should feel as if they are stretching when performing passive range of motion exercises, these exercises should never be painful. For further passive range of motion exercise recommendations, consider consulting with a physical or occupational therapist to establish a customized exercise plan.