Active, Passive, and Active-Assistive Range of Motion (ROM)

Exercise to Improve Muscle Strength in Post Stroke Clients: A

Systematic Review

Indrawati

, I Ketut Sudiana

and Muhammad Sajidin

Faculty of Nursing, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia

Faculty of Medicine, Universitas Airlangga, Dharmahusada, Surabaya, Indonesia

STIKES Bina Sehat PPNI, Mojokerto, Indonesia

Keywords: Post Stroke, Muscle Strength, Passive ROM, Active ROM, Active-Assistive ROM.

Abstract: Stroke can cause various levels of disorders, such as decreased muscle tone, loss of sensibility in some parts

of the body, decreased ability to move sick limbs and incapacity in certain activities so that exercise therapy

is one way to accelerate the recovery of patients from injuries and diseases in governance using active or

passive movements. This systematic review focuses on giving Range of Motion exercise therapy to muscle

strength, with journal search through Science Direct database, Ebscho, Pro Quest, E-Resources, Sage

Journal and Google Scholar. The year limit used is 10 years (2007-2017). In general, all of the review 14

journals provide results that the Range of Motion exercise provides benefits as an intervention to increase

muscle strength in post-stroke clients because exercise therapy is one way to speed the recovery of patients

from paralysis. The goal of Range of Motion exercise therapy is to maintain muscle flexibility and strength,

maintain joint mobility and prevent deformity, stiffness and muscle contractures. Some of the Range of

Motion exercises describe useful interventions for increased post-stroke client muscle strength. So hopefully

stroke patients and families can be motivated to perform activities of exercise therapy for the improvement

of self-sufficiency post-stroke patients. The success of exercise therapy is strongly influenced by the

patient's own compliance. The recovery therapy should be lived with patience and sincerity as well as

motivation to give the result of reovery from the maximum paralysis of stroke.

1 BACKGROUND

Stroke is a clinical syndrome with symptoms of

local or global brain dysfunction, which can lead to

persistent abnormalities over 24 hours or death

without other causes except for cardiovascular

disorders (WHO, 1982 in Ahmad, 2000). Based on

data from the National Center of Health Statistics

(NCHS) 2010, stroke ranks third cause of death in

the United States after heart disease and cancer

(Heart Disease and Stroke Statistics 2010 Update: A

Report from the American Heart Association),

explains that from 2008, around 795,000 people in

the United States suffer a stroke every year, with

610,000 people getting strokes for the first time and

185,000 people with recurrent stroke (NCHS,

2010).

According to Yayasan Stroke Indonesia

(YASTROKI, 2012) the number of stroke patients

in Indonesia is the largest and ranks first in Asia.

Stroke is also a cause of serious disability settling

number 1 worldwide. The results of Basic Health

Research (Rikesda) data in 2013 found stroke

prevalence in Indonesia of 12.1 per 1000

population. That number rose by 8.3% compared to

Rikesda in 2007. The high rates of death and

disability caused by stroke are related to the

pathophysiological processes occurring within the

cerebral tissue. Reduced blood flow to the cerebral

blood flow (CBF) may affect cerebral

hemodynamics. Changes in cerebral blood flow

lead to disturbances in the central nervous system

and cranial nerves. Such interference may result in

permanent disability of the paralytic device.

Physical changes as often experienced by clients are

paralysis partial motion, loss of swallowing ability,

cognitive impairment, and psychological disorders

(Black & Hawks, 2005). This will impact on the

ability of clients in their daily activities.

Indrawati, ., Sudiana, I. and Sajidin, M.

Active, Passive, and Active-Assistive Range of Motion (ROM) Exercise to Improve Muscle Strength in Post Stroke Clients: A Systematic Review.

DOI: 10.5220/0008324803290337

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 329-337

ISBN: 978-989-758-336-0

329

These conditions will affect the psychology of

the client post stroke. The way to minimize

disability after a stroke is by rehabilitation.

Rehabilitation of stroke patients one of them is with

exercise therapy. Increased exercise intensity is

proportional to improving quality of life. Exercise

therapy is one way to speed the recovery of patients

from injuries and diseases that in governance use

active or passive movements. Passive movement is

motion driven by others and the active motion is the

motion produced by muscle contraction itself. ROM

exercises can be performed on all joints of the body

especially in the head region, upper extremity, and

lower extremities (Doenges, 2002). Thus an early

ROM Practice program on a stroke client that is not

contraindicated is one of the physical mobilization

programs that must be done immediately.

2 METHODS

The method used in this systematic review begins

with topic selection, then the keyword is determined

to search the journal using English on the giving of

Range of Motion exercise therapy to muscle

strength, by searching the journal through Science

Direct database, Ebscho, Pro Quest, E-Resources,

Sage Journal and Google Scholar. The year limit

used is 10 years (2007 -2017) and got 14 journals.

This search is limited to journals from January 2007

to October 2017. Keywords used are post stroke,

rehabilitation, passive ROM, active ROM, active-

asistive ROM.

Articles were selected for review based on

studies appropriate to the inclusion criteria. The

inclusion criteria in this systematic review are Range

of Motion (ROM) active, passive and active-asistive

for increased muscle strength in post-stroke patients.

Search using the above keywords found 25 journals.

From all journals obtained in accordance with the

theme is 14 journals, then observed and done critical

appraisal.

3 RESULTS

This review system reviewed 14 journals, all

journals discussed the incidence of muscle weakness

(immobilization) which is often called hemiparesis

that occurs in stroke patients. Research conducted by

Fajar Yudha (2014) in the journal The influence of

Range of Motion (ROM) on muscle strength of post-

stroke patients illustrates the effect of intervention

Range of Motion that maintains or maintains muscle

flexibility and strength, maintains joint mobility and

prevents deformities, stiffness and contractures. The

results showed an increase in the average value of

muscle strength first day and day 28 amounted to

0.45. There was an increase in the average value of

the joints on the first day and the 28th day of 6.65.

Proven dg The results of muscle strength statistics

test shows p-test results = 0,001. There is an

influence Range of Motion (ROM) to muscle

strength of patients post-care stroke. This study was

conducted for 4 weeks.

Similar research was also conducted by Kun Ika

Nur Rahayu (2015) with the title describing the

effect of ROM exercises on motor skills that

increase flexibility and wide range of joint motion in

stroke patients because ROM exercises can induce

rangsangn thus increasing the activity of

neuromuscular and muscular chemistry. Stimulation

through the neuromuscular will increase the

stimulation of the stimulating parasympathetic

nerves for the production of asethylcholin resulting

in contraction. This is proved by the results of the

study found that there is influence of Range of

Motion (ROM) training on motoric ability that is

result of data analysis by using Paired Sample T-

Test statistic obtained p-value <0,05 it can be

concluded that H0 is rejected and H1 failed to be

rejected. given Range of Motion 2x exercise a day

for 7 days. The evaluation of this research was done

on the first and the seventh day.

Research with Range of Motion exercise therapy

is the effect of Range of Motion (ROM) exercise on

muscle strength in stroke patients by Claudia

Agustina Sikawin, et al (2014) where the data is

taken through direct observation on the respondents

to look for pre test and post test data. Previously the

patient measured his muscle strength level, after

ituresponden given Range of Motion exercises 5

times a day within 10 minutes and performed as

much as 8 days of exercise. Next will be re-

measured muscle strength levels and proven The

existence of the effect of Range of Motion exercise

on muscle strength in stroke patients. showed

muscle strength score before and after exercises

Range of Motion had an average score increase of

3.87. It is explained that Range of Motion exercise

therapy is one of the advanced therapies in stroke

patients aimed at improving cerebral blood flow,

minimizing defects caused to improve motor sensory

function.

Similar research is also conducted by Irene H.L.,

et al (2016), where researchers explain that there is a

significant association of weight support exercises

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

330

arms and is beneficial for subacute stroke patients

with moderate to severe arm disorders, particularly

to improve vertical control such as shoulder flexion,

and no side effects on the muscles. Training is done

for 45 minutes every day, 5 days a week for 5

weeks. Exercise therapy is done in rehabilitation,

arms will neutralize the weight of one arm's arm and

use both arms where a healthy arm is assisted to

support. Furthermore, the movement follows the

direction and the gabar by pressing the button of the

existing screen then it will deliver a signal to the

brain to do movement/ ROM move the hands and

arms. In this study explained that through this

exercise therapy the patient has his own initiative to

move the sick arm. The Interobserver Reliability and

Sources of Variation explain that the Range of

Motion exercise therapy is done passively (PROM)

so that the ROM assessment with standard protocol

hydrogoniometer and performed by 2 trained

physical therapists resulting in a high interobserver

reliability index for all arm movements. Error

variance makes a major contribution to the variety of

measurement results. Exercise therapy is done 2

times a day for 1 week showing significant

improvement.

Results of research conducted by Prok,

Winona.et al (2016) where the study included in a

Range of Motion active-asisitive study where the

study used 18 stroke patients given treatment in the

form of motion exercises active, ie holding a rubber

ball for one (1) month, then muscle strength

measured using handgrip Dynamometer. The results

showed that there was significant effect of active

motion exercises gripping rubber balls on hand

muscle strength of stroke (p=0.000) because the

training of gripping exercises was a mood of the

sensory stimuli and the pressure on the end organ

receptor encapsulated in the upper ekstermitas.

Treatment of excitatory will cause a rapid response

to sarf to perform action on the stimulus. This

mechanism is called feedback.

The results are supported by research conducted

by Ni Made Dwi et al (2016) obtained a significant

difference between the value of handheld muscle

strength before and after being given a ROM

exercise with rubber ball for 10 minutes. It can be

said that ROM exercise with rubber ball can increase

handheld muscle strength of non hemorrhagic stroke

patients who experience weakness if done by the

therapist in accordance with the operational standard

of ROM exercise procedure with rubber ball as well

as the cooperation between the patient and the

therapist in the treatment therapy process.

Andika Sulistiawan (2014) mentions in the

results of this study found that all stroke patients

who do therapy grasping the ball slowly get a

recovery of stroke disease they suffered in which the

distribution of respondents about grasping the ball

before being given numerous interventions among

stroke patients who find difficulty in moving their

hands. Miftahul Cilia et al (2016) mention the effect

of ROM exercise on the degree of stroke joint

motion of stroke patients. Another study of ROM

exercises on top extermity is Effectifity Range of

Motion (ROM) on powers stroke patients limb

muscles by Havid et al (2012) where prior to ROM

therapy, the degree of patient's muscle strength is

classified as degree 1 (only tone change) degree 3

(able to move joints, can defy gravity, not strong

against prisoners). After ROM therapy, the degree of

patient's muscle strength is classified as 2 degrees

(able to move the joints, can not go against gravity)

to 4 degrees (capable of moving the joints, can defy

gravity, strong against mild resistance). There is a

difference (increase) degree of muscle strength of

patients before and after therapy ROM with p value

= 0.003 <0.05. ROM therapy is effective in

increasing the muscle strength of the stroke of the

stroke patients because ROM therapy effectively can

improve the degree of muscle strength ekstermitas

non hemorrhagic stroke patients because the goal of

ROM exercise it self is to maintain or maintain

muscle strength, joints and stimulate blood

circulation and prevent deformity. However,

unstable patient conditions such as vital signs that

often change during illness also become one of the

obstacles.

Similar research is also conducted by Murtaqib

(2013) showed that there was a difference in the

average range of elbow joint motion before the

active ROM, ie 125.27 degrees of flexion and

extension of 28.27 degrees, after exercise of flexion

movement of 136.37 and extension of 8.47 degrees.

or in other words there is a significant influence

between active ROM exercises against elbow joint

motion in stroke patients. Active ROM exercises are

performed 3 times a day because ROM exercises can

stimulate blood circulation, maintain muscle

elasticity and reduce pain and joint stiffness. This is

reinforced by Wahyudin's research., et al. (2008)

The effect of PNF on the strength of prehension

function in hemorrhagic and non-hemorrhagic stroke

patients in which this study studied differences in

the effect of PNF method on the strength of

prehension in hemorrhagic stroke and non-

haemorrhagic stroke . Treatment of PNF method

therapy therapy to hemorrhagic stroke patients is

Active, Passive, and Active-Assistive Range of Motion (ROM) Exercise to Improve Muscle Strength in Post Stroke Clients: A Systematic

Review

331

beneficial to the enhancement of strength of

prehension function.

Research from IB Putu Putrawan., et al (2011)

said that the measuring tool to measure handheld

muscle strength is handgrip Dinamometer which

will be used to determine the strength of the hand

grip which will require a combination of action from

a number of muscles of the hands and forearms and

this action is very important for daily activities. The

strength of hand grip is a common method used to

estimate the strength of upper ekstremity muscle.

From the results of this study explained that in

elderly women have hand grip strength is lower than

in men. The strength of hand grips is positively

associated with weight and waist circumference,

there is an increasingly thinness of the elderly will

lower the grip of his hand, and this will lead to the

consequent decline in functional quality for basic

daily living activity. Most importantly, the results of

this study indicate that the elderly population who

are in a state of poor nutritional status will

experience greater difficulties in independently

beraktives in society. The strength of hand grips is

positively related to nutritional status. Although

once controlled for other variables in the regression

analysis, poor nutritional status remains a significant

factor determining the strength of hand grips in both

men and women.

Another study was also conducted by Gehan A.

Younis and Safaa E. Sayed Ahmed (2015)

explaining that the results of this study indicate that

50% of patients with ventilation experience pain

which is severe before starting a passive motion

exercise program. But after 60 minutes of

intervention about two-thirds (60%) of critical

patients have no pain. Slight changes in the mean

score of physiologic parameters after 5 and 20

minutes after intervention compared with the mean

score before the intervention was observed. After 60

minutes of intervention, this average score returns to

their baseline. Also, the intensity of behavioral pain

decreased after 60 minutes compared before the

intervention. Based on the findings of this study, it is

advisable to conduct early passive motion exercises

for ventilated patients in the context of the

mobilization protocol. A Journal also mentioned that

the effect of duration of stretching of the hamstring

muscle group for increasing range of motion in

people aged 65 years or older by J Brent Feland ,. Et

al (2001) where the stretching protocol for elderly

people (65 years) has not been studied to determine

the effectiveness of increasing Range of Motion

(ROM). The purpose of this study was to determine

which of the 3 stretching durations would yield and

retain the greatest advantage in ROM knee extension

with the femur held at 90 degrees of hip flexion in a

group of elderly individuals.

The Range of Motion is measured once a week

for 10 weeks to determine treatment and residual

effects. The 60 second stretch yields a higher level

of ROM gain (clash 60 seconds52.4° per week,

stretching 30 seconds 51.3° per week, stretching 15

seconds 50.6° per week), which lasts longer than

Profits in other groups (group 4 still had ROM 5.4°

more 4 weeks after treatment than in pretest

compared to 0.7° and 0.8° for groups 2 and 3,

respectively). Extremity can experience weakness or

paralysis in different degrees depending on the

disrupted part. Stroke patients with long-term

immobilization conditions will facilitate the

formation of DVT, muscle atrophy, contractures and

joint pain and decubitus. Range of Motion (ROM)

exercise is one form of rehabilitation exercise that is

considered very effective to prevent disability in

patients with stroke, whether it is active ROM,

passive ROM or active-asistive ROM.

4 DISCUSSION

In general, all of the reviewed journals provide

results that range of motion (ROM) exercise therapy

both active, passive and active-assistive provide

significant benefits to increased muscle strength and

range of upper extremity motion and or articles

explaining if ROM exercise therapy is accompanied

PNF is a ROM exercise therapy that is structured

and sequential with the therapy therapist by the

therapist so that the results obtained more leverage.

Stroke disorder function of the nervous system

that occurs suddenly and caused by blood circulation

disorders in the brain either the clogging of blood

vessels of the brain or rupture of blood vessels in the

brain where the brain that should get the supply of

oxygen and nutrients to be disturbed. Stroke can

cause various degrees of disturbance, such as

decreased muscle tone, loss of sensibility in some

parts of the body, decreased ability to move sick

limbs and incapacity in certain activities. Stroke

patients who experience weakness on one side of the

limb due to a reduction in muscle tone, so unable to

move his body (immobilization). The way to

minimize disability after a stroke is by rehabilitation.

Rehabilitation of stroke patients one of them is with

exercise therapy (Mubarak, 2008).

This is in accordance with the Decree of the

Minister of Health (KepMenKes) No.1363 /

MENKES / SK / XII / 2001, Article 1 that exercise

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

332

therapy by physiotherapy is a form of health service

aimed at individuals and or groups to develop,

maintain and restore motion and function the body

throughout the life cycle by using manual handling,

improvement of motion, equipment (physical,

electrotherapy and mechanical) function and

communication training (Menkes, 2001).

Therefore, ROM and early treatment is

necessary. According to some studies, the success of

motion exercise therapy (ROM) is strongly

influenced by the patient's own compliance. As for

ROM and treatment should be endured with patience

and sincerity, self-motivation of family and close

friends is also needed to give healing result from

maximal paralysis of stroke, try to adapt to the

situation as well as undergo therapy exercises

performed by physiotherapy regularly. Previous

research has shown that adherence to exercise

therapy increases muscle strength and range of

paralyzed motion in post-stroke patients. ROM

exercises on motor skills include increased

flexibility and wide range of joint motion in stroke

patients because ROM exercises can induce

rangsangn thus increasing activity from

neuromuscular and muscular chemistry.

Range of Motion exercise therapy is one of the

advanced therapies in stroke patients aimed at

increasing brain blood flow, minimizing defects

caused to improve motor sensory function. Influence

of intervention range of motion is to maintain or

maintain flexibility and muscle strength, maintain

joint mobility and prevent deformity, stiffness and

contractures. Exercise therapy is one way to speed

the recovery of patients from injuries and diseases

that in pentalaksanannya use active or passive

movements. Passive movement is motion driven by

others and the active motion is the motion produced

by muscle contraction itself. The movements in

ROM exercise therapy include flexion, extension,

hyper extension, circumcision, abduction, adduction

and opposition.

5 CONCLUSIONS

Range of Motion (ROM) Exercise Therapy is an

effective way of treating muscle weakness or

prolonged paralysis, therefore nursing or

rehabilitation services should schedule and provide a

special place for stroke patients with hemiparesis

especially in the rehabilitation process of ROM

activity or exercise. As for the family to always

supervise, motivate and encourage patients to

perform continuity of ROM exercises, regularity of

activities and medical visits. Because the way to

minimize disability after a stroke is by rehabilitation.

Rehabilitation of stroke patients one of them is with

exercise therapy. Increased exercise intensity is

proportional to improving quality of life.

All the studies that have been in the study of

ROM exercises on post stroke clients can be one

alternative rehabilitation intervention in post stroke

clients. Where the ultimate goal of client care with

stroke itself is to restore physical and psychological

abilities. In order for the client is able to adapt to the

new conditions, able to adjust and improve quality

of life in post-stroke clients. Stroke patients who

have hemiparesis are treated immediately to be

curative measures such as treatment and

hospitalization, rehabilitative action by

physiotherapy in the form of Range Of Motion

exercise therapy whether active, passive or active-

asistive.

ACKNOWLEDGEMENTS

Thanks to the Institute for Research and Community

Service, University of Jenderal Soedirman that has

provided research grants under contract number

4869 / UN23.14 / PN / 2017.

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INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

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Tabel 1: Summary of studies include.

Author /

Year

Sample size Study Design Intervention Outcome

Articles

Quality

Fajar

Yudha,

2014

Kun IKa

Nur

Rahayu,

2015

Claudia

Agustina

Sikawin,

et al. 2014

Irene H.L

.,et al.

2016

Lex D de

jong .,et

all. 2012

Prok,

Winona.et

al. 2016

Ni Made

Dwi et al :

2016)

consecutive

sampling

20 respondents

Respondents.

Purposive

Samling

Purposive

Sampling

Respondents

Prospective

single-group

cohort study.

48 classified

into 3 groups

Respondents

with Purposive

sampling

13 respondents

Non Probabilty

sampling with

Purposiv

sampling

Respondents

Total Sampling

Quasy

Experiment

(pre and post

test design)

Cross

Sectional (Pre

Ekeperimental

Pre-post Test

One Group

Design)

Quasi

Eksperimen

with

Nonequivalent

Control Group

Design

method

RCT

Cross

Sectional (Pre

Ekeperimental

Pre-post Test

One Group

Design)

Quasi

Experiment

(pre and post

one group

design)

pre-

eksperimental

One Group

PreTest-

PostTest and

Paired T-test

Exercise range of

motion to measure

muscle strength of

patients

Exercise range of

motion to measure

muscle strength of

patients

Exercise range of

motion to measure

muscle strength of

patients

ROM exercise

therapy on

ArmeoSpring is

done for 45 minutes

every day, 5 days

once a week,

ROM exercise

therapy with

measurement on

range of motion of

joints with

Hydrogoniometer

Active motion

exercises, ie holding

a rubber ball for one

(1) month, then

muscle strength

measured using

handgrip

Dynamometer.

ROM exercises with

rubber balls for 5 to

10 minutes in non

hemorrhagic stroke

patients

The results showed an

increase in the average value

of muscle strength first day

and day 28 amounted to 6.65.

Which means There is

influence Range Of Motion

(ROM) to muscle strength of

patients post-care stroke.

Patients were given range of

motion 2x daily exercise for 7

days. The evaluation of this

research was done on the first

and the seventh day.

Previously the patient

measured his muscle strength

level, after which respondents

were given range of motion

exercise 5 times a day within

10 minutes and performed as

much as 8 days of exercise.

Muscle strength score before

and after exercises range of

motion had an average score

increase of 3.87.

There is a significant

association Weight-weight

support exercises are

beneficial for subacute stroke

patients with moderate to

severe arms disorders,

especially to improve vertical

control such as shoulder

flexion, and no adverse

muscle effects

The ROM assessment by

standard protocol,

hydrogoniometer, and 2

trained physical therapists

resulted in a high

interobserver reliability index

for all arm movements.

The results showed that there

was significant effect of

active motion exercises

gripping rubber ball against

hand muscle strength of

stroke (p = 0,000)

Strong

Moderate

Strong

Moderate

Strong

Moderate

Active, Passive, and Active-Assistive Range of Motion (ROM) Exercise to Improve Muscle Strength in Post Stroke Clients: A Systematic

Review

335

Andika

Sulistiawa

n, 2014

Miftahul

Cilia et

all,2016

Havid et

all, 2011

Murtaqib.

2013

Wahyudin

., et al.

2008

IB Putu

Putrawan.,

et al. 2011

Gehan A.

Younis

and Safaa

E. Sayed

Ahmed,

2015

50 respondents

with 25 control

groups and 25

intervention

groups Total

Sampling

Non

Probability

with accidental

Sampling

method

Respondents

Total Sampling

Respondents

Purposive

sampling

Respondents

Consist of 38

males, 53

females

Random

Sampling

Respondents

pre experiment

(pre-post test

design)

Pre

experiment

Purposive

sampling

(pre-post test

design)

pre

eksperimental

one design

pretest-postest

non random

Experiment

(two group

pretest post

test)

Quasi

eksperimental

with pre test

and post test

design

approach

Quasi

eksperimental

Exercise therapy

holds a rubber ball to

assess muscle

strength

ROM exercise

therapy to measure

range of motion of

the joints

ROM exercise

therapy to measure

muscle mass

disorder

Exercise ROM

Therapy Exercise

Flexion Extension

ROM exercise

therapy with PNF

method to measure

Prehension Function

in Hemorrhagic

Stroke and

Stroke Non

Hemoragic

ROM exercise

therapy for the

elderly to mnegukur

handheld with

Handgrip

Dynamometer

Passive ROM

exercise therapy

From result of research got

average value of handheld

muscle strength of non

hemorrhagic stroke patient

before given ROM training

with rubber ball that is 8,46.

And the average value of

handheld muscle strength

after being given ROM

exercise with rubber ball for 5

to 10 minutes has increased ie

11.23. Based on result of

paired t-test shows that result

p value = 0.0001

The results of this study

found that all stroke patients

who do therapy grasping the

ball slowly get a recovery

against stroke that they

suffered in the distribution of

respondents about holding the

ball before the intervention

was given many among stroke

patients who find difficulty in

moving his hands.

The result of this research is

that the pre test of motion

range of respondents most of

the category dg not at all have

the ability to do joint motion

of 87.5%, and perform the

range of motion of joints with

partial category (12,5%).

showed that most

respondentst dg category did

joint motion of equal to

81,3% and dg tdk totally have

ability to do range of motion

of joints is equal to (18,8%)

After ROM therapy, the

degree of patient's muscle

strength is classified as 2

degrees (able to move the

joints, can not defy gravity) to

4 degrees (capable of moving

the joints, against gravity

The results showed that there

was a difference in the

average range of elbow joint

motion before the active

ROM, ie 125.27 degrees of

flexion and extension of

28.27 degrees, after exercise

Strong

Moderate

Strong

Moderate

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

336

quasi

experimental

design.

of flexion movement of

136.37 and extension of 8.47

degrees. Or in other words

there is a significant influence

between active ROM

exercises against elbow joint

range in stroke patients

There was no significant

difference in the effect of

PNF treatment on

hemorrhagic stroke and non-

hemorrhagic healing stroke

phase to increase the strength

of prehension function.

From the results of this study

can be concluded that in

women elderly women have a

lower hand grip hand than

men

These results indicate that

50% of ventilated patients

experience severe pain before

starting a passive motion

exercise program. But after

60 minutes of intervention

about two-thirds (60%) of

critical patients have no pain.

Active, Passive, and Active-Assistive Range of Motion (ROM) Exercise to Improve Muscle Strength in Post Stroke Clients: A Systematic

Review

337