Patient Handling - Bed Mobility Flashcards
What is patient handling?
refers to the techniques and practices used by healthcare to safely and effectively move, transfer, reposition, or support patients during various therapeutic activities
What does patient handling involve the use of?
proper body mechanics, equipment, and training to ensure safe and comfortable patient care
What is the GOAL of proper patient handling?
minimize the risk of injury to both the patient and the healthcare provider while facilitating the patient’s mobility and rehabilitation
What model is patient handling rooted in?
Bobath’s Neurodevelopment Treatment (NDT)
What are therapeutic patient handling techniques used for?
to influence the quality of motor response
Handling matches the _____ __________ to use sensory information to adapt movement
patient’s abilities
How do we facilitate and inhibit unwanted movements?
through manual and verbal cues
What are key points of control?
parts of the body that are optimal for control and facilitation or inhibition of movement
What is the goal for therapeutic patient handling using the key points of control?
facilitate efficient and effective postural control and movement
Where do we begin with patient handling?
- know your patient
- assess and prepare your environment
- ask the patient to assist with the movemnt
How can we encourage the patient to assist with movement?
- encourage use of the hemiplegic side
- encourage attention to hemiplegic limbs
- prevent “learned nonuse”
What are intervention goals?
- facilitate proximal stability of the trunk for distal controlled mobility of the extremities
- improve voluntary control and coordination of muscles both within and among patterns
Where you place your ____ MATTERS
hands
What matters about our touch and force?
location of touch, direction of force, and amount of force matters
What can we use to achieve motor performance?
sensory inputs
How can we have manual contact of the muscle you want to facilitate?
- tapping
- stroking
- vibraiton
- quick stretch
Think _____ , ______ hand approach - NOT HARD GRIP
soft and open
What should we prepare for bed mobility?
- bed height, bed rails, bed alarms
- attention to line and tubes
- draping
What should we initally ask the patient when evaluating bed mobility?
perform skills without our intervention
WHAT CAN THEY DO ON THEIR OWN?
What can we observe about movement strategy?
does it differ from one side other the other?
When you give a patient a physical or verbal cue during an evaluation you have performed an intervention and …?
influenced their performance!
What is A as a GG code?
rolle left and right
What is B as a GG code?
sit to lying
What is C as a GG code?
lying to sitting on side of bed
What is 06 score for mobility?
independent
What is 05 score for mobility?
set-up or clean up assistance
What is 04 score for mobility?
supervision or touching assistance
What is 03 score for mobility?
partial/moderate assistance
- helped does less than half the effort
What is 02 score for mobility?
substantial/max effort
- helper does more than half the effort
What is score 01 for mobility?
dependent
What is hooklying?
- feet flat and weight bearing on the supporting surface
- functional position for rolling, bridging and scooting
What motions does hooklying require?
hip and knee flexion with sight ankle PF mobility
What movements can occur from hooklying?
- bridging
- scooting
- lower trunk rotation (LTR)
What should we assess about hooklying?
patients ability to obtain this position
Hooklying requires AROM of ______ muscles to flex knees into position?
hamstring
What may be required during hooklying other stabilize a hemiparetic limb?
pelvic stabilization and/or weight-bearing through foot and ankle
What are we ideally looking for with hooklying?
patient maintains static control without allowing knees to rest together or splay outward
How can hooklying be challanged?
by gradually decreasing amount of flexion moving patient to a more extended LE position
What does lower trunk rotation involve?
crossing the midline
What can lower trunk rotation decrease in a neurological population?
hypertonicity
What are we looking for with lower trunk rotaiton?
- perform without mobility from the upper trunk
What should we cue the patient to do during LTR?
maintain shoulders on mat
What is a progression of LTR?
therapy ball
What is bridging?
extending the hips and elevating the pelvis from the support surface with the lumbar spine in a stable, neutral position
What is important about bridging?
- prerequisite for moving in bed
- allows for early weight bearing through foot and ankle
- delays atrophy caused by prolonged bed rest
How can we increase the challange with bridging?
narrow BOS, decrease the stability of the surface, limit the use of UEs for support
What kind of contraction is bridging?
concentric
Where are the hips during a bridge?
fully extended (0 degrees or less)
Where is the lumbar spine during a bridge?
neutral position
What is an intervention for bridging?
tapping (quick stretch) over the glut max to stimulate muscle contraction on the involved side
When coming down from the bridge the patient ….
slowly controls lowering the hips and pelvis back to the mat
What kind of contraction is coming out of a bridge?
eccentric
What is an intervention for coming out of a bridge?
stabilizing LEs using traction through the femurs and approximation toward the feet
What can we do with BOS and arms as an intervention strategy for a bridge?
- reduce the width of BOS and have the patient hold hands out above them
What can we facilitate with a hemiparetic glut with bridging?
- right vs left, “lift up and over towards me”
- resisted movement in hemiparetic direction
What can be used for stability in bridging?
resisted isometrics
What does scooting involve?
active lateral pelvic shifts with progression to repositioning the whole body on the supporting surface
What do the hips and pelvis do when scooting?
hips are raised into a bridge and the pelvis is shifted laterally to one side then lowered to new position
What is scooting needed for?
patient repositioning in bed
What is an intervention strategy to initate bridging?
- guide the movement (“let me help you lift your hips up and move them toward me and then away from me”
- can be used to initiate and instruct sequence of movement
How can we do resisted isotonics with scooting?
- “lift your pelvis up, push your hips toward me. Now hold it here. Now slowly let me win and move you back to the middle”
How can we do dynamic isotonics with scooting?
“lift your pelvis up, push your hips towards me, now push your hips away from me”
What is rolling?
an early functional activity achieved in normal growth and development to move from sidelying to supine to sidelying
What does rolling integrate?
all body segments
Transition from supine to sidelying is resisted by _________ and can be difficult
gravity
What kind of neurological patients may have problems with rolling?
those with increased tone or weakness in core stabilizers
When rolling, use task analysis to obeseve?
- patients preferred strategy
- compensatory movements
- rolling patterns vary due to patients level of ability
What are restorative movment strategies for rolling?
- where does impairment occur in the activity - intervene on impairment
- hooking, bridging interventions applicable
What are compensatory movement strategies for rolling used for?
achieve functional bed mobility when a patient does not have active movement
What kind of patient often uses rolling interventions?
patients with complete SCIs or true weakness where a compensatory strategy is required for independent function
What is the therapeutic goal of rolling compensatory strattegies?
function, recognizing that proper proximal stability with controlled mobility is not available to these patients
why should we preposition the limbs for rolling?
uses weight of limb to assist with functional movement
Why should we use the hemiplegic side for transitioning to sitting?
restorative benefits
Why should we use the stronger side for transitioning to sitting?
protect limb and facilitate successful movement
What should the therapist observe and document about transitional movements?
- Patient ability to initiate movements
- strategies utilized and overall control of movements
- pts ability to terminate movement
- level and type of assistance required (manual cues, verbal cues, assisted movements)
- environmental constraints that influenced performance
When going from supine to sitting we should be careful to protect the _______
affected upper extremity in the sidelying position and providing support at the the shoulder and elbow during transfer
Where should we place hands for supine to sit?
behind shoulders to facililate abdominal muscles during the transition
How can we help the patient have an easier time going from supine to sitting?
place the affected LE off the bed prior to sitting up
What should we encourage the patient to use when going from supine to sitting?
the limb to press up from bed to participate with transfer
When does the pateitn bring the less affected LE off of the bed during supine to sit?
during transition
What should we encourage the patient to do when going from supine to sitting on the unaffected side?
protect the affected UE, visually watch, and attend
What should we NOT do to the affected UE during a transfer?
pull on it
What should we teach families?
not to pull on affected limbs and how to position patients in bed!!
