Week 5. Functional Mobility

Question 1

Functional mobility definition

Answer 1

Moving from one position or place to another (during the performance of everyday activities) such as in bed mobility, wheelchair mobility, transfers (wheelchair, bed, car, tub, toilet, tub/shower, chair, floor). Performing functional ambulation and transporting objects.

Question 2

Evaluation of functional mobility includes?

Answer 2

Client factors and performance skills

Question 3

What are the functional mobility aids?

Answer 3

Orthotic
Ambulation aids; crutches, walkers, canes.
Wheelchairs 
Scooters 
UE aids (mobile arm support)

Question 4

What are ambulation aids?

Answer 4

Crutches
Straight cane
Quad cane
Forearm crutch
Hemi-walker
Walker/Rolling walker 
3 Wheel Walker
Rollator

Question 5

What are weight bearing status?

Answer 5

NWB
TTWB
PWB
FWB

Question 6

What is NWB?

Answer 6

Non-weight bearing- affected foot not touching floor

Question 7

What is TTWB

Answer 7

Toe touch weight bearing - May lightly touch the floor for balance, no to weight bear through the leg (10%)

Question 8

What is PWB

Answer 8

Partial weight bearing 30%-50% of body weight on affected side

Question 9

What is FWB

Answer 9

Full weight bearing - Full body weight allowed.

Question 10

What are some safety concerns during functional ambulation?

Answer 10

Know your patients (precautions, orthosis, status, fatigue, endurance)
Use appropriate footwear
Monitor physiologic responses
Use gait belt
Plan for unexpected
Do no leave patient unattended 
Clear potential hazards
Work closely with PT

Question 11

True or False. One forth of people 65-79 and one half of those over 80 fall every year?

Answer 11

True

Question 12

What hazards include both environmental and intrinsic factors are there when considering falls?

Answer 12

Throw rugs 
Poor lighting 
Inadequate bathroom grab bars
Inadequate stair rails
Electrical cords
Items on the floor
Medications
Weakness
Balance disorder
Health

Question 13

When considering Transfers what does therapist must know?

Answer 13

The patient status (physical, cognitive, perceptual, behavioral abilities and limitations)
Their own limitations
Correct techniques

Question 14

What therapist should consider during transfers

Answer 14

Precautions
How many people are need to complete the transfers safely
How much times will it take
Does the patient understand what is happening
Hight and position of both transfer surface
Is the equipment in the correct place and everything else out of the way
Transfers belt or other equipment needed.

Question 15

What are proper body mechanics during transfers?

Answer 15

Close to the patient 
position your body to face the patient 
Bend your knees 
Keep a neutral spine
Keep a wide base of support
Keep your heels down 
Ask for help if you need it 
dont combine movements

Question 16

What equipment might be involved in the transfers?

Answer 16

Wheelchairs 
Walkers
Grab bars
Slide Board
Trapeze
Shower chair/tub bench
Raised toilet seats 
Mechanical lifts

Question 17

What are possible transfers surfaces?

Answer 17

Bed
chair
wheelchair 
toilet 
in/out of tub/shower
care 
floor

Question 18

How to prepare patient for transfer?

Answer 18

Educate patient on transfer process
Positioning of wheelchairs (0-30 degree angle)
Lock breaks on device
Place both the patients feet directly on the floor, hip width apart, knees over feet
Remove wheelchair armrest on the side you are transferring to
Make sure any lines or cords are out of the way
Stabilize the patients involved foot/knee with your foot/knee
Have the patient reach for surface you are transferring to or help push up with intact UE’s

Question 19

What kinds/types of transfers are there?

Answer 19

Stand pivot 
Stand step
Slide board
bend pivot
dependent 
mechanical lift

Question 20

Transfers Levels what are they?

Answer 20

D - dependent - client not able to assist at all or <25% transfer is completed entirely by one or two other people, and /or with use of sliding board or mechanical lift.
Max (A) client performs 25%-49%
Moderate (A) - client performs 50%-74%
Minimum (A) - client performs >75%
CG - Contact Guard- client requires close physical presence of another.
Supervision - client requires close supervision, verbal cueing
Modified (I) - client completes transfer (i) w/assistance of equipment.
(I) - Independent: Client performs transfer safety w/out need for (A).

Question 21

How could you remediate or modify a treatment to improve patient ?

Answer 21

strength 
ROM gains
balance
AE
AT

Question 22

How can we grade a transfers?

Answer 22

decreased assistance provided 
Decrease cueing 
reduce reliance on AE
Very transfer surface
Vary transfer approach (left/right)
change environemnt 
Use of caregiver to assist

Question 23

Home Evaluations ?

Answer 23

Often done prior discharge home 
Patient should have stabilized 
OT/PT to perform assessment together if possible 
Caregiver/family should be present 
Home safety checklist are available

Question 24

In the home evaluation what report should identify ?

Answer 24

Environmental barriers
functional limitations
recommendations for adaptive equipment and assistive devices
Recommendations for home modifications and future goals.

Question 25

What are common recommendations for home ?

Answer 25

Install ramps or railings at entrance 
Remove throw rugs, extra furniture 'clutter'
Remove door thresholds and door jams 
Install grab bars around toilet and in tub/shower 
Rearrange furniture for wheelchair 
Rearrange kitchen storage 
Lower clothing rods in closets 
Tub transfer bench 
Shower chair 
Three in one commode.

Question 26

Ramps set up ?

Answer 26

For every 1 in of rise you need 1 foot of run

Question 27

OT and Driving

Answer 27

OT makes up the majority of professionals providing driver rehabilitation
Considered a specialty practice area
Need for specialist continues to grow