9/23c Mobility Lab I Bed Mobility (Examination, Evaluation, Intervention) Flashcards
things to consider with bed mobility
- SAFETY is first and foremost
- Maximize the patient’s independence
- Utilize your observational and assessment skills to identify level of assistance needed
- Accommodate for patient and environmental factors
keys for successful strategies
- Communicate
- Use layman’s turns
- Cuing for patient independence - Simplify
- Break the task down into smaller steps - Positon
- Use patient body positioning to your advantage
- HEAD-HIPS RELATIONSHIP: aka: “seesaw”
Independent (I)
No assistance or cuing required. Performs safely without assistive device, modification or aides, within a reasonable time.
Modified Independent (Mod I)
The presence of another is not required. One or more of the following may be true:
- Patient requires an assistive device/aide
- Patient requires an increased amount of time to complete
- There are safety / risk considerations
Supervision (S)
set up, or stand by assist
Patient requires cuing, coaxing, and/or set-up for successful, safe performance. No manual/physical touch or contact of another required.
Minimal Assist (min A)
Hands on assist where patient is able to perform 75% -99% of the work. Therapist provides no more than 25%.
Moderate Assist (mod A)
Patient requires more physical assist. Patient able to perform 50-75% of the work. Therapist provides no more than 50%.
Maximal Assist (max A)
Therapist provides > 50% of the work load
the participatory patient
- Mild unilateral or bilateral weakness
- Mild cognitive deficits
- Able to follow some % of single step commands
- Receptive to verbal and/or tactile cues
- *modified independent to max A x 1 person
the limited to no participation patient
- Significant unilateral or bilateral weakness
- Severe cognitive deficits
- Low level of arousal
- Unable to follow single step commands
- Impaired motor planning
- *min A x 2 people to max A x 2 people
Key points of contact for assist
- Shoulders
- Posterior hips / buttock
- Anterior knees
AVOID:
- Handling patients from arm pits
- Grabbing onto clothing
- Skin shear / friction / trauma
Scooting in bed: vertical
- optimal bed position: flat
- assistive bed position: trendelenburg (feet elevated) ideal for postural drainage and only under supervision
- patient position = head up chin to chest
Technique: Hook-lying / Bridging head up / chin to chest eliminate pillow for ease of movement press feet in to bed while extending legs elbows / UE’s pressing in to bed to help
variations for patients requiring more assistance with vertical scooting in bed
Generalized weakness Single leg involvement Single upper extremity involvement Hemi body weakness Bilateral lower extremity weakness / paresis
assist verbally and physically
scooting in bed for the patient with limited to no ability to participate
- *At min 2 person job!!
- Make sure there is a draw sheet at least under the patient’s hips. (hips and shoulders is preferable)
- Make sure bed brakes are locked.
- Elevate the bed to waist height of the shorter assistant.
- Bed rails lowered.
- HOB flat / Trendelenburg (as medically appropriate)
- Patient’s arms placed across their chest. If pt is able, instruct them to lift their head bringing their chin to their chest.
- Grasp the sheet just below the buttock and near the shoulders
- Palms up with elbows at your sides
- Neutral spine with feet apart and knees bent
- COMMUNICATE with your partner: 1… 2… 3!
- SHIFT your body weight in the direction you are moving your patient
Bed Mobility: rolling
- Techniques:
- Hook-lying / semi hook-lying log roll
- Segmental technique - Cuing:
- Head and UE position
- Use of adaptive equipment (Bedrail) - Recommendations for therapist hand placement:
- Shoulders
- Ischial tuberosity
- Posterior aspect of hip
- Behind the knees
