Week 2- Functional Mobility Flashcards
what is functional mobility aimed at?
In-bed mobility
Transfers – to and from surfaces
Performing occupations during:
* standing/sitting,
* walking (ambulation)/wheeling
* Using devices, e.g. wheelchair, powered mobility, canes
what is community mobility?
Moving around in the community
* Walking, Wheeling, Bicycling
* Driving, busing, taxis, and other
transportation system
looking at the hierarchy of mobility what is considered community mobility?
car transfers
functional ambulation for community mobility
community mobility and driving
looking at the hierarchy of mobility what is considered functional mobility?
bed mobility
mat transfers
wheelchair transfer
bed transfer
functional ambulation for ADL
toilet and tub transfer
what do people do in bed?
sleeping
intimacy
ADLS
skin inspections
what is bed mobility?
rolling from Side to side
rolling from supine to prone
ability to sit up in bed
Ability to handle upper and lower
extremities during all of the above
Performance in short and long leg
sitting
what are some devices to assist with bed mobility?
- Rope ladder
- Overhead trapeze bar
- Bed rail
- Mechanical Lif
what are the different types of transfers?
stand-step
stand pivot
squat pivot
transfer board
total assist
what are the different levels of assistance?
stand by
minimum
moderate
maximum
what are some preparation steps for log rolling on a bed?
Easier to have bed flat; but may raise bed to comfortable height to
facilitate trunk from side-lying to sitting
* Ask client to assist/participate as able e.g. reach across to you to help
“roll” into side lying
* Position client in side lying
* Bend hips and knees to 90 degrees
* Place your arm under client’s thighs and bring knees out over edge of bed
to act as counterweights while simultaneously reaching under
shoulder/scapula to raise the upper trunk
* If able the client may assist by using the top arm to push up
what do sit to stand transfers require?
intact balance with the integration of:
* adequate mobility at pelvis, hips, knees
* postural alignment, postural adjustments, weight shifting
* and strength in core and lower extremitie
when may we choose to do a stand step transfer?
Client is able to weight bear, but may be unsteady or weak
what are the steps to a stand step transfer?
- Position chair in relation to bed: minimize “travel” during and after transfer
completion - Client to lean forward and scoot to edge of chair surface (assist as required)
- Ensure your feet and knees are prepared to support client’s feet and knees
- Client to lean forward “Nose over toes” and push on thighs to come to
standing (‘un-folds”) - Stand-by closely OR support client at waist & scapulae
- When fully standing, client to step and turn until in line with bed
- Ensure client feels bed behind knees
- Client to put hands on thighs and bend knees to ease down onto bed
as a therapist how should you body mechanics be?
- Wide base of support
- Bend knees
- Lift with the legs
- Fixate the trunk
- Back straight
- Tuck the chin in
- Shift weight from one
leg to the other (turn
with the feet) - Keep the load close
when may we choose a stand pivot transfer?
Client is able to weight bear through one leg only
what are the steps to a stand pivot transfer?
- Position chair in relation to bed: minimize “travel” during and after transfer completion
- If one arm is paralyzed, ensure this arm is protected e.g. tucked in lap or in sling
- Ensure your feet and knees are prepared to support client’s feet and knees; your
knees should be ready to support by positioning on each side of affected leg’s knee - Client to lean forward “Nose over toes” and push on thighs to come to standing
- Support client at waist and scapulae
- When fully standing, pivot/slide the affected leg until client is in line with bed;
supporting (unaffected) leg is able to step/hop, while pivoting (affected) leg
pivots/slides - Ensure client feels bed behind knees
- Client to put hands on thighs and bend knees to ease down onto bed
when may we choose a squat pivot transfer?
Client is unable to completely weight bear and/or stand uprig
what are the steps to a squat pivot transfer?
- Position chair in relation to bed: minimize “travel” during and after transfer completion
- Client to lean forward and scoot to edge of surface (assist as required).
- Ensure your feet and knees are prepared to support client’s feet and knees; your knees should be
ready to support by positioning on each side of the knees to prevent buckling - Client to place hands on armrests and then to transferring surface; if one arm is paralyzed, ensure
this arm is protected e.g. tucked in lap or in sling - Supporting client at waist, scapulae or transfer belt, shift their weight forward from the buttocks
toward and over their feet - At the same time, pivot the client toward the transferring surface
- Ensure client or you feel buttocks are safely on the bed surface
- Re-position on transferred surface as neede
when may we choose to use a transfer board transfer?
client is unable to weight bear (L/E amputations, SCI)
what are the steps to a transfer board transfer?
- Transferring surfaces need to be equal level
- Set-up w/c parallel to bed
- Client leans away from transferring surface and places
board under 2/3 of buttocks. - Client uses upper extremities to lift up and move laterally
- Be prepared to support if balance or weakness challenges
when may we choose to do a total assist transfer?
YOU are not comfortable performing the transfer alone
what are some principles of a total assist transfer?
- Ask the client/caregiver
- Do not grab, pull or twist you or the client; DO NOT pull up under the
axilla - Set up! Communicate!
- Keep center of gravity over base of support if possible
what determines type of transfer and level of assistance required?
Critical Thinking and Assessment Skills
what do we need to know in order to determine type of transfer and level of assistance required?
UE/LE strength
* Mobility
* Endurance
* Cognitive status
* Stability of both surfaces
what are some questions you may as to Assess/Evaluate a Clients ability?
*“Do you need any help?”
* “Can you stand on your own?”
* “Can you take a few steps?”
* “Can you use your arms to
help?”
* “To which side do you prefer to
transfer?”
what is stand by assistance?
supervision, close guarding
what is minimum assistance?
client does 75-100%
what is moderate assistance?
client for 50-75%
what is maximum assistance?
client does 25-50%
what is total assistance?
client has minimal participation
what are some environmental considerations before doing a transfer?
Wheelchair set up
* Brakes on
* angled ~30°, Perpendicular or Parallel,
* Remove armrest on side transferring to
* Remove footplates or swing away
Bed set up
* Height, stable
Client’s set-up
* Footwear on! (bare feet acceptable)
* Heels angled towards the transferring surface
* Client to lean forward and scoot to edge of surface (assist as required)
* “Nose over toes” (center of gravity over base of support)
Guard and ensure final positio
what do crutches require?
upper body strength
what are features of the under am axillary crutches?
*Typically short term; less $$,
* Precaution: provide education to avoid leaning on axillary
crutches
* May incur damage to brachial plexu
what are the features of forearm crutches?
Typically longer term; lighter weight; more ergonomic
how do we measure someone for crutches?
- Shoes on
- Measure from floor to axilla; subtract 2” (5cm) or 2-3 finger widths
- Adjust hand grips to height of waist (~30 degree flex at elbow); ensure wing nuts are secure
what side is a cane held on?
when compensating for a unilateral condition, the cane is held on the unaffected side
what is the purpose of a cane?
Promotes even center of balance
Improves balance
Maintains alignment of hips and shoulders
how do we measure someone for a cane?
- Measure with shoes on
- Stand with arm loose at side
- Measure from floor to
wrist crease - Elbow should be
flexed ~ 20-30 degrees
how do we measure someone for a walker?
- Measure with shoes on
- Stand with arm loose at side
- Measure from floor to wrist
crease - Elbow should be flexed ~ 20-30
degrees - Consider width of walker and
width of doorways - Seat height (4WW
how do you educate a client on how to use a walker?
- Stand straight
- Move the walker ahead first, lifting
all 4 legs; set them down at same
time - Take a step with your affect leg into
the frame of the walker, then step
with unaffected; use arms and
walker to balance during weight
shift - Leave some space between you
and the front of the walker - Use brakes when not actively
engaged in mobility (4WW) - Do not hold on to the walker
when transferring from sit-stand - To go up curbs:
- Place the walker up on the curb with
all 4 legs down flat on the ground - Step up with the unaffected leg first
- To go down curbs:
- Place the walker down to the lower
level - Step down with affected leg
