Practical 3 Flashcards
What bed mobility is used when knees are bent? Client is in supine position.
Hook lying
What bed mobility is used when client is in supine? Bends knees and lifts buttocks, using arms to push down. This skill transfers to scooting up in bed and assisting with bed toileting and hygiene.
Bridging
What bed mobility is used when client bends knees, pushes with arms, lifts buttocks?
Scooting
This technique should be utilized to encourage independence in rolling to the side, transferring to the edge of the bed (EOB), scooting up in bed, and assisting a caregiver to place a draw sheet underneath.
- From supine, instruct the client to bend their knees one at a time into the hook-lying position.
- If available, instruct them to reach across their body to grasp the bed rail.
- Simultaneously, allow the knees to fall to the side while pulling the upper body to the same side. (it is called log rolling due to the objective of the upper body and lower body rolling together and therefore preventing trunk rotation).
Returning to supine is the same steps in opposite order.
Log rolling
- While in side-lying, explain to the client all that will occur and describe what their role is.
i.e. “I will help you bring your feet off the bed, when they fall towards the floor, I will help you sit up. You need to push with this hand and dig this elbow into the bed to help get up. Try to lean towards me and do not lean backward. I will not let you fall.” - Place your hand under the client’s head and around to their upper back, their lower neck should be resting on your forearm (your hand will be in a place where you can help them lean forward towards you).
Do NOT pull on their head or put strain on their neck. - After warning the client, pull their feet forward off the bed at the same time as lifting them to sit.
i.e. “On the count of three, we are going to go. Ready? One, two, three…” - After coming to sit, assess the client’s status. Look into their eyes for signs of confusion or dizziness and assess how much support you are giving them.
i.e. “How are you feeling? Any dizziness?
Side-Lying to Sit at the Edge of the Bed
This is the ideal method for a client who requires little assistance since it is closest to an independent technique?
1. In sitting and if clinically appropriate, don a transfer belt.
- While sitting, explain to the client all that will occur and describe what their role is.
i.e. “I will help you scoot forward to the edge of the bed. Put your hands at the edge and lean forward. I will help you lean forward and lift your bottom off the bed. Once your bottom is nearly off, scoot forward and try to get your feet on the floor. You can immediately sit back down once you have scooted a bit. We will do this a few times until you are right at the edge with your feet firmly on the ground”. - Direct the client to put their hand at the edge of the bed and to lean forward.
- At the same time the client attempts to scoot forward, assist them by pulling forward on both sides of the transfer belt (do not pull up on the belt). Alternatively without a belt, help them lean forward and scoot by reaching over their shoulders.
i.e. “Ready? On the count of three. One, two, three… - Repeat until they are close to the edge and able to get their “nose over toes”.
Near-Stand Method
This is the ideal method for a client who requires moderate to maximal assistance since it does not require getting all their weight off their bottom. Teaching this technique also transfers to teaching weight shift to prevent pressure ulcers for someone who may spend a great deal of time in a wheelchair (i.e. spinal cord injury)
1. In sitting and if clinically appropriate, don a transfer belt.
- While sitting, explain to the client all that will occur and describe what their role is.
i.e. “I will help you scoot forward to the edge of the bed. Put your hands at the edge and lean forward and to the right. When you lean to the right, your weight will shift off the left hip so I can help you slide it forward. Then we will switch and do the same thing on the right side. We will switch sides, back and forth until you are at the edge of the bed.” - Direct the client to put their hand at the edge of the bed and to lean forward and to the right.
- At the same time, the client leans to the right, assist them by pulling their left leg forward pulling behind the knee and behind the pelvis.
i.e. “Ready? On the count of three. One, two, three… - Repeat on the other side and alternate until they are close to the edge and able to get their “nose over toes”.
“Walk Your Hips” Method
- Getting close to the client and move the client close to you.
- Position your body so that you face the client
- Bend your knees not your back
- Keep a neutral spine
- Keep a wide base of support
- Keep your heels down
- Don’t twist or combine movements.
Proper Body Mechanics for completing a Transfer
- Prepare the environment, where is the client gong to?
- Ensure that the client has appropriate footwear on.
- Ensure each surface is stable (bed wheel locked, wheelchair wheel locked, bed-side commode level).
- Ensure the client is in a neutral or slight anterior pelvic tilt position.
- Ensure trunk alignment
- Shift the client’s weight forward
- Position lower extremities on the floor with knees aligned at 90 degrees of flexion over the feet.
- Ensure UEs are in a safe position and/or are in a position to assist
- Apply gait belt
General Process for Transfers
- Prepare the surface to transfer to
- Be sure that the client has NON-SKID footwear on!
- Apply gait belt
- Place the wheelchair at a 20-30-degree angle
- Lock the brakes
- Remove the armrest on the side you plan to transfer to
- Remove the leg rest
- Remove the W/C seat belt (if applicable)
- Cue the client to scoot (may do side to side to scoot or may lean back on chair and push hips forward. If needed the clinician may assist the client by reaching back and bringing the hips forward one hip at a time)
Process Specific to Wheelchair Transfers
This transfer is typically used when the client is unable to step/walk, and they are able to bear at least partial weight on their lower extremities.
Squat-Pivot Transfers
This transfer is typically used when the client is able to take a few small steps (1-2) to the surface they are transferring to and/or they are able to bear at least partial weight on their lower extremities.
Stand-Pivot (Stand-Turn) Transfers
This transfer allows the client to pivot on their lower extremities.
Squat-Pivot Transfers
This transfer allows the client to take 1-2 steps.
Stand-Pivot (Stand-Turn) Transfers
- The clinician should prepare the environment and prepare the client.
- Be sure that the client has NON-SKID footwear on!
- Apply the gait belt
- Place the wheelchair at a 20-30-degree angle
- Lock w/c breaks
- Remove the w/c arm rest (if applicable)
- Remove the w/c seat belt (if applicable)
- The clinician should cue the client to scoot with feet placed on the floor. Assist the client with scooting as indicated.
- Indicate where the client is to transfer to, using cues as indicated
- Transfer the client to the non-affected side (if there is an affected side) when you initially begin transfer training
- Guide the client to lean forward
- Have the client point their heels in the direction in which they are transferring
- Clinician should stabilize the client’s foot/knee as they come into standing, if indicated
- Have the client push up from the surface they are sitting on (unless contraindicated)
- Count to 3 and rock the client forward as needed in preparation for standing, “nose over toes”. (in some instances, rocking and leaning forward is contraindicated)
- Once in standing allow the client to acclimate to standing and to get their balance
- Direct the client to reach with one hand for the armrest before sitting.
- Assist the client in lowering slowly into the wheelchair by maintaining support on the transfer belt.
Stand-Pivot (Stand-Turn) Transfers
