Bed mobility and early trunk control Flashcards
Bed mobility tasks include:
Rolling from supine to sidelying/prone
Moving in bed (scooting/bridging)
Moving from supine to sit and sit to supine
Prone on elbows
What are the general characteristics of Hookyling?
Protects low back
Very stable, has large BOS, COM is low
Involves lower trunk, hip, and knee control
Lead up activity for bridging, kneeling, and gait
Pt has a L sided stroke and needs help with flexing her R leg into hooklying. What are some things to consider and what could you do to help her R leg stay flexed?
The bed/mat may be slick, put socks on pt that has bumps on the bottom to provide friction/traction, or shoes.
Also can put pt’s legs flexed against wall to keep their legs from slipping
What are some interventions you can perform in hookyling?
Rhythmic Initiation Rhythmic Stabilizations Active holding positions Stabilizing Reversals Combo of Isotonics Use irradiation
How would you set pt up to improve rolling?
Supine & hooklying
For rhythmic stabilizations, what is the PT working on?
PT is resisting with both hands in rotation direction which is working Stabilization.
If pt has a R side stroke, PT will progress them to use that side how?
Progress to unilateral holds and do stabilization reversals, or can increase the holding time to 30 seconds.
*Make time go by faster by communicating with pt(what they did on the weekend, etc)
What does stabilizing reversals do?
Works on stabilizing in 1 plane. PT melts hands/contact on and off.
Used for an EARLY intervention.
Pt is continuously contracting
If you are moving pt’s knees side to side. What is that working on?
Works on rolling and trunk dissociation
What are some other progressions or activities you can do with the pt in hooklying?
Bridging --> ball squeezes ADD/ABD --> Pelvic tilts-->ROM Bilateral-->Unilateral Increasing hold time T-band around thighs
What are the general characteristics for Bridging?
Important pre-req for moving in bed and to edge of bed
Important lead up for functional activities such as sit to stand, gait, stair climbing
Stable, large BOS, low COM
Allows early weight bearing at foot and ankle
Promotes selective control (out of synergy combo of hip ext with knee flexion) and may be indicated for CVA with extension synergy
Glute max primary responsible for hip extension
BOS may be altered to increase/decrease challenge by position of UE (out to side, close to body, on stomach, shoulder flexed to 90), LE can be brought closer and moved farther from buttocks
How do you facilitate bridging?
Start in hooklying with BLE flexed
If pt is total/max assistance: use a sheet/belt above and below the pelvis
Proximal facilitation: key point of control at posterior pelvis inferior to PSIS, with an open hand increase tension to facilitate lifting the hips
If pt is min assist, PT is providing ______ assistance. Once pt becomes more independent w/ PT’s hands proximal..how can you progress them?
1-25%.
Progress by going more distal or using less assistance
If bridging is too hard for pt, what can you do to regress it?
Work on side-lying strengthening exercises first*
What can unilateral bridging holds work on?
Helps with rolling and strengthening
If pt needs less assistance with bridging , what can you do?
Long axis facilitation: key point control at distal femur, and guide distal femur inferiorly and downward to increase WB into the heels and cue to lift hips;
- Consider therapist position to block LE extension (lean back)
- *If pt has a stroke, PT can do this unilaterally as well
You have a stroke pt w/ R side affected. What can you do to work on their R side with bridging? How can you make it harder?
Extend R leg out straight and bridge with L leg.
Make it harder: put pillows, inflated ball, PT put leg under pt’s uninvovled side
Unilateral bridging will challenge the pt the most
What are some interventions to perform with bridging?
COI: strengthening(concentric,iso,ecc)
Stabilizing reversals: holding pt in bridge position. Resistance applied in opposite directions, pt must be able to maintain position of bridge.
Resistance can be applied Ant/Post/Med/Lat (contacts on pelvis and medial aspect of 1 ASIS with other on lateral ASIS)
Rhythmic Stabilization: PT’s hands in opp position. Isometric contractions agst resistance that is in a rotary motion. *In order to be performed, pt must be able to maintain the position & remember to gradually build up the resistance
Bridging with irradiation- resist ASIS of stronger side
Progression: Unilateral Bridging & Unstable surface (ball under foot from bilateral to unilateral)
Foam pad–>bosu ball–>whole round ball
Have pt put arms up
PT position: half kneeling alongside pt’s hips or on side
Pt has a stroke affecting their left side which lags behind during bridging. If PT uses irradiation, where will PT resist?
Anterior ASIS
