Bed Mobility Flashcards
General Functional Mobility Progressions
- Stability precedes mobility
- Maintaining preceds attaining
- Large BoS precedes Small BoS
- Low CoG preceds High CoG
Rolling, Sitting up/laying down, Scooting, Pulling, Shifting
Static Positions
- Supine / supine on elbows
- Prone / prone on elbows
- Hook lying
- Side lying
Dynamic Activities
- Rolling (supine to/from side lying first)
- Bridging
- Scooting
- Supine to/from sitting on edge of bed
Preparation for Bed Mobility
- Ensure bed is locked in place
- Adjust bed height to minimize stress on clinician’s back
- Consider bed rails for assistance or as a hindrance
- Establish location of lines, leads, and tubes
- When transitioning activity from lying in the bed to sitting on edge of bed, ensure that the bed is lowered so the patient’s feet will be on the floor once seated
What position is this
Supine: Hooklying
Hips and knees flexed
A component of bridging, scooting, and rolling
Clinician may need to help position legs initially
What position is this? What is the cue?
- Patient is instructed to “lift hips and low back”
- Patient assists w/upper extremities (UEs), not pushing head into bed
- Clinician may stabilize at patient’s feet or provide assist at hips
- A component of scooting and some activities of daily living (ADLs)
- Important for pressure relief!!
Supine: Scooting Up in Bed Lift, Shift and Lower
- Head of bed (HoB) flat if tolerated
- Begin in hooklying
- Elbows out and back
- Patient is instructed to “push through elbows and feet, lift and shift hips up towards head of bed”
- Clinician(s) may assist using bed pad
Trendelenburg position can be very useful for this!
In Supine: Scooting SidewaysLift, Shift, and Lower
- Begin as if scooting up
- Patient is instructed to “push through elbows and feet, lift and shift hips to the side”
- Patient then instructed to “push through elbows to shift trunk in same direction”
- Repeat as needed
- Clinicians may assist using bed pad and/or manually
Using equipment in supine
- Bed Rails
- Trapeze (Overhead handle)
Need to think about if the patient have these things at home. Not likely, can use this initially but need to move away from them if they don’t have access when they leave.
Rolling: Supine to Side Lying
- Important in prevention of pressure injuries
- Used for bathing and placement of drawsheets,lift slings, incontinence products, and bed pans
- Potential component of supine-to-sitting
- Typically initiated with trunk rotation
Rolling: Supine to Right Side lying - Coaching
- Scoot to the left in the supine / hook lying position.
- Turn your head and look to the right.
- Abduct the right arm ~45°.
- Bend the left hip and knee (or cross left leg over right).
- Reach left arm over and push down with left foot.
- Bring trunk into full side lying.
- Pop up railings if the patient needs more assistance to move.
- Can support centrally with hand on shoulder and hip only helping slightly still want them to do most of the work.
“Reach left arm and left leg across the body, look toward me”
Rolling: Supine to Prone
- Proceed as in rolling into side lying but without abducting the lower arm.
- Continue from side lying into prone.
- Turn head to clear airway.
– May need to remove pillow.
Amputee and SCI patients
Supine to Short Sitting
- Typically, simultaneous upper- and lower-body movement, powered primarily by core musculature
- When mobility is impaired, motion is usually done segmentally through side lying.
Supine to Sitting through side lying on the left
- Roll from supine to left side lying.
- Lift or slide both lower extremities (LEs) off the edge of the bed.
- Push right hand down into the bed, extending the right elbow.
- Abduct the left arm and extend the left elbow, using it to push upright.
- Moving the legs off the bed first creates a force couple, making it easier for the patient to lift the upper body.
Assisting from supine to sitting: Positioning
- Get very close to patients to be able to help
Short sitting to supine
- Lower upper body to the bed, controlling with UEs
- Lift both LEs onto the bed (can also be done one at a time)
- Roll to supine
- When having a patient sit on the edge of the bed before lying down, planning ahead and having the patient sit about 1/3 of the way down from the head of the bed will reduce the amount of reposition necessary in supine. If the patient sits at the middle of the bed, once in supine, he or she will need to move up toward the head of the bed, a move that tends to create shearing forces on the patient’s skin and can be taxing for the patient / clinician.
- Patients often require assistance lifting the LEs onto the bed even when they are able to complete the remainder of the task. This patient is using her stronger leg to assist the weaker leg onto the bed.
Sitting: Scooting Sideways: Lift, Shift, and Lower
- Used for repositioning before lying down
- A component of lateral seated transfers
- A component of preparing to come to standing position
Sitting: Scooting Sideways Toward the Right
- Abduct the right arm and place hand on bed.
- Push down with both hands, lifting hips up and to the right.
- Repeat as needed.
- Preferable to complete with feet on the floor as not all patients have the mechanical advantage to complete without distal support
THA: Supine to Sitting (Posterior Approach)
- Remove abduction wedge (maintain slight hip abduction)
- Have the patient prop up on their elbows
- Scoot / pivot on bed, alternately moving UEs and LEs using ½ hooklying
– May need assist with involved LE or use leg lifter - Sit on edge of bed (EOB) with the trunk leaned back.
Moving from supine into sitting toward the involved side is often preferred to minimize dislocation risk (due to hip adduction)
Using a leg lift strap can help if they are very nervous to have assistance
Acute Back Surgery: Sidelying to Sitting
- Don’t want legs to hang off because that creates a rotational component.
- Have hand close to avoid rotation. Keep things tight and toward the core.
Fluid motion, not fast.
Tilt Table Procedure
- Explain procedure.
- Transfer patient to horizontal tilt table.
- Position feet on foot plate.
- Secure patient with straps.
- Measure vital signs.
- Elevate table per plan of care (typically increasing tilt ~15° to 20° at a time).
- Monitor responses.
- When done, lower table, remove straps, transfer patient.
