chapter 10 adl Flashcards
Bed mobility basics
- Stability precedes mobility
- Maintaining a position precedes attaining a position
- Static and dynamic stability with large BoS precedes static and dynamic stability with smaller BoS
- Attaining a position with a low CoM precedes attaining a position with a high CoM.
Activities that are therapeutic that can be done in bed
Supine on elbows
prone on elbows
hooklying
Rolling, sidelying
Bridging
Sitting
Bed wheels should be
locked
bed should be raised to
level of top of clinician’s pelvis
IV poles, oxygen and anything hooked to patient
should be moved to same side of the bed to which you are mobilizing the patient.
TLSRO
Thoracic lumbar sacral orthosis
hooklying position
hips are flexed between 45 and 50 degrees and knees are flexed 90 degrees.
Bridging
Patient begins in hooklying. Stabilizes abdominal muscles and lifts hips and lower back up off the bed by pushing down through feet and arms. May wear shoes.
When scooting in bed
make gravity work better by lowering HOB
Scooting up in bed
start in hooklying position
Lifting hips up and toward HOB by pushing down into the bed with the feet and elbows.
Relax head and upper body.
Repeat as needed
Scooting down inbed
start in hooklying position with heels farther from hips than scooting up.
Head and shoulders are lifted by forearms and push down with feet and upper arms to lift hips up.
Scooting sideways
From supine and done segmentally.
Fron hooklying bridge and move hips to the desired side
use arms to shift upper body to the desired side.
Scooting using bed rails
patient can pull upper body using bed rails.
Trapeze bar
The location overhead can be adjusted to help with mobility.
Rolling from supine
A) Turn head in desired direction
B) abduct the turning side shoulder
C) bend knee opposite direction of turn.
D) reach with arm and bent knee across body to turn trunk.
E) the roll is complete next adjust for comfort.
Assistance with rolling from supine
may help bending knee and stabilizing
may help moving off side arm but do not pull.
Control central mass for more dependent patients.
Return to supine from sidelying
Turn head and look away from direction you are lying
Retract off scapula and extend left shoulder back toward the bed
Flex the hip and knee of one or both legs
Lay the legs over toward the side
as the trunk returns to supine, extend the legs and bring UE down to side.
supine to prone
Move through sidelying
don’t abduct the down shoulder
continue to bring upper body forward to arrive in prone position
Long sitting
sitting up in bed with legs extended
Short sitting
sitting with the hips and knees flexed such as when seated on the side of the bed
supine to long sitting (I’m not sure version)
lift head and upper body and position elbows posterior to the trunk
Push down into the bed while placing the other hand on the bed and pushing the trunk upright.
Supine to sitting through sidelying
Rolls from supine to sidelying
Moves both legs off EOB for counterweight
Pushes down through hand in front of body extending the elbow
abduct and press down with down elbow.
come to full sitting position.
Providing assistance to sitting through sidelying from supine
CCDD. Be careful of shoulder and use more scapula.
Block patient from unwanted movement. Use force couples. (knee and shoulder.)
Sidelying to sitting with two clinicians for the dependent patient
Primary clinician on side patient is rolling too
Secondary clinician behind patient on shoulder duty
Primary clinician moves patient’s legs off the EOB
Secondary clinician assist bringing patient’s upper body upright.
When upright, secondary clinician stabilizes the patient
The primary clinician focuses on helping the patient scoot into a safe and functional position.
moving from sitting to sidelyng to supine
Lower upper body sideways down to the bed or mat, controlling descent with hand of upper most arm and the elbow of the down arm.
Lift both LEs onto bed and roll supine.
Begin 1/3 way down from HOB.
moving from sitting to sidelyng to supine physical assistance
Most normally legs and maybe some control for upper body descent. Hooking weak leg with stronger leg is a strategy.
Tilt table
padded table with footplate and restraint straps that can be adjusted for HOB high or EOB high.
Follow POC and check and recheck vitals.
Scooting Sideways when seated
Abduct arm in direction of intended movement.
Push down with both hands into bed raising hips off the mat and over. Using fisted hand extends lifting range.
repeat until desired position.
increasing trunk flexion and turn head in opposite direction of travel further unweights the buttocks.
Scooting forward or back seated
Push down through the feet while pushing down with UE.
Lifts torso up and shifts forward or back.
May have to do one hip at a time.
For assistance, the clinician may reach under ischial tuberosities to help lift hips up and over, forward or back.
For THA sitting up (initial book steps)
Can’t go through sidelying
rise up on arms and elbows and pivots on the bed until LE are off the bed.
Modify sitting position with hands propping posteriorly to avoid excess hip flexion.
For supine to sit following posterior THA
- Remove wedge used preventing hip adduction
- slightly abduct hip
- patient props both elbows in slightly supine position
- Patient pivots on bed while clinician supports post-surgery leg and prevents adduction.
- As patient scoots forward, clinician prevents trunk flexion
- As patient sits on EOB, use posterior lean propping with both hands and extended knee of involved leg.
Rolling from supine to Sidelying on weaker side hemiparesis
Before rolling make sure weaker arm is abducted
patient flexes stronger hip and knee and pushes down into the bed with the foot, laying the leg over toward the EOB while reaching across the body with the stronger arm.
Sitting up from sidelying on the weaker side
- flex hip at knee and push down with foot while reaching stronger arm across body to roll into sidelying
- patient slides both feet off EOB
- push down with stronger hand (possibly fisted) into bed and extend elbow then hand of the weaker ue Arm is placed across chest if unable to assist with weaker UE. Move strong hand closer to body each push.
Lying down on weaker side
- abduct shoulder of weaker arm. If unable, place arm on chest. reach across body with strong arm and place hand or fist on bed on the far side of the body.
- Patient lowers the upper body onto the bed into sidelying, sliding the elbow of the assisting weaker arm forward to prevent it from being trapped.
- Patient lifts both LE onto bed, hooking the weaker LE with the stronger LE.
- From sidelying, the patient rolls to supine, leading with the stronger side.
Rolling from supine to sidelying on the stronger side
- In supine, the patient flexes the stronger hip and knee and lays the leg down on the bed, rotating the pelvis toward sidelying
- patient can reach across with weaker arm if able, or grab the weaker arm with the stronger arm and pull it across.
Sitting up from sidelying on stronger side
It’s generally easier
1. patient places the hand of the hemiplegic or hemiparetic arm on the bed just above the hip level (or across chest)
- hooking the weaker leg moves both legs off the end of bed.
- moves stronger arm underneath torso and presses down into the bed with elbow and forearm raising upper body off the bed.
Lying Down on the stronger side
- Stronger foot is hooked under weaker.
- Weaker arm is placed across the front of the body
- Patient abducts shoulder of the stronger side and leans down toward the bed. Supports upper body on elbow and forearm.
- Using the stronger LE, the patient lifts both LEs on the bed.
- Patient rolls into supine.
To move from supine to sidelying without thoracic rotation after spinal surgury.
Logroll. hips and shoulders must move simultaneously.
tetrapelegia
formally called quadriplegia. injury above T1
parapelegia
injury below T1
ring sitting
circle sitting. Hips are abducted and externally rotated with the bottom of the patient’s feet touching, increasing the patient’s BOS.
