Bed mobility and early trunk control

Question 1

Bed mobility tasks include:

Answer 1

Rolling from supine to sidelying/prone
Moving in bed (scooting/bridging)
Moving from supine to sit and sit to supine
Prone on elbows

Question 2

What are the general characteristics of Hookyling?

Answer 2

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

Question 3

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?

Answer 3

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

Question 4

What are some interventions you can perform in hookyling?

Answer 4

Rhythmic Initiation
Rhythmic Stabilizations
Active holding positions
Stabilizing Reversals
Combo of Isotonics
Use irradiation

Question 5

How would you set pt up to improve rolling?

Answer 5

Supine & hooklying

Question 6

For rhythmic stabilizations, what is the PT working on?

Answer 6

PT is resisting with both hands in rotation direction which is working Stabilization.

Question 7

If pt has a R side stroke, PT will progress them to use that side how?

Answer 7

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)

Question 8

What does stabilizing reversals do?

Answer 8

Works on stabilizing in 1 plane. PT melts hands/contact on and off.
Used for an EARLY intervention.
Pt is continuously contracting

Question 9

If you are moving pt’s knees side to side. What is that working on?

Answer 9

Works on rolling and trunk dissociation

Question 10

What are some other progressions or activities you can do with the pt in hooklying?

Answer 10

Bridging --> ball squeezes
ADD/ABD --> Pelvic tilts-->ROM
Bilateral-->Unilateral
Increasing hold time
T-band around thighs

Question 11

What are the general characteristics for Bridging?

Answer 11

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

Question 12

How do you facilitate bridging?

Answer 12

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

Question 13

If pt is min assist, PT is providing ______ assistance. Once pt becomes more independent w/ PT’s hands proximal..how can you progress them?

Answer 13

1-25%.

Progress by going more distal or using less assistance

Question 14

If bridging is too hard for pt, what can you do to regress it?

Answer 14

Work on side-lying strengthening exercises first*

Question 15

What can unilateral bridging holds work on?

Answer 15

Helps with rolling and strengthening

Question 16

If pt needs less assistance with bridging , what can you do?

Answer 16

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

Question 17

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?

Answer 17

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

Question 18

What are some interventions to perform with bridging?

Answer 18

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

Question 19

Pt has a stroke affecting their left side which lags behind during bridging. If PT uses irradiation, where will PT resist?

Answer 19

Anterior ASIS