BED MOBILITY.pptx

Bed mobility and Occupational Therapy

1. FUNCTIONAL MOBILITY Part I- Bed Mobility Shamima Akter B . Sc in Occupational Therapy & M . Sc in Rehabilitation Science Assistant Professor Bangladesh Health Professions Institute Centre for the Rehabilitation of the Paralysed Chapain , Savar

2. Functional Mobility Functional mobility can be defined as, “moving from one position or place to another (during performance of everyday activities) Such as in-bed mobility, wheelchair or powered mobility, and transfers (e.g., wheelchair, bed, car, tub, toilet, tub/shower, chair, and floor). Includes functional ambulation and transporting objects” (AOTA, 2008, p.631, cited in Radomoski and Latham 2013). Bed mobility Transfer mobility Functional ambulation for ADL 2 TS-2_by SHAMIMA_2017 3/4/2018

3. Skill Building for Mobility Moving in the immediate space, such as rolling from a supine to prone position, repositioning the trunk and extremities, or moving from a lying to seated position. Moving in the bed for body positioning or basic ADL such as dressing or skin inspection. Moving out of bed and into the surrounding areas such as into the bathroom for hygiene activities. 3 TS-2_by SHAMIMA_2017 3/4/2018

4. Continue… Moving around the level, accessible environment of the therapy setting for intervention of performance skills or for other ADL such as kitchen activities or feeding Moving on the uneven terrain of the outdoor environment Moving about the chosen community environment 4 TS-2_by SHAMIMA_2017 3/4/2018

5. PATIENT HANDLING TECHNIQUES Guidelines for using proper mechanics during handling. The therapist should be aware of the following principles of basic body mechanics: Get close to the client or move the client close to you. Position your body to face the client. Bend the knees; use your legs, not your back. Keep a neutral spine (not a bent or arched back). Keep a wide base of support. 5 TS-2_by SHAMIMA_2017 3/4/2018

6. Continue… Don’t tackle more than you can handle; ask for help. Don’t combine movements. Avoid rotating at the same time as bending forward or backward. 6 TS-2_by SHAMIMA_2017 3/4/2018

7. BED MOBILITY It is the ability to move the body in bed to perform activities in the various positions of supine, prone, side lying, or sitting. Bed mobility includes all of the tasks of rolling from side to side, rolling from supine to prone and back, and sitting up. It is the ability to roll to sit up in bed, and to handle the upper and lower extremities during these maneuvers. 7 TS-2_by SHAMIMA_2017 3/4/2018

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9. IMPORTANCE Bed mobility is an important skill to learn because: It allows the patient to relive the pressure independently It allows the patient to change the position when they become uncomfortable and changing positions for sleep It is a necessary skill to dressing in bed It forms a component of transferring in and out of bed, or 9 TS-2_by SHAMIMA_2017 3/4/2018

10. Assistive device for bed mobility A person with motor impairment in the trunk or one or more extremities may require an assistive device to pull on in order to begin rolling and then to assist with maintaining a side-lying position or with the movement of toward sitting. Devices are commonly used are a rope ladder, an overhead trapeze bar, a bed rail, or even a wheelchair positioned near the bedside. 10 TS-2_by SHAMIMA_2017 3/4/2018

11. Continue… These devices can be used to give a person something to grasp with the hand(s) or forearm(s) so that rolling can be initiated or pulling to a seated position in a long-or short-leg position in bed can be accomplished. Good scapular, shoulder, and elbow strength are the minimum requirements for using these devices. 11 TS-2_by SHAMIMA_2017 3/4/2018

12. Activities of daily living in bed Some people may be able to, or choose to, dress while sitting on the edge of the bed or while standing. For example: persons with lower extremity paralysis may need to perform BADL such as dressing, skin inspection, self-catheterization, and/or a bowel program while lying in bed. While dressing in bed, it is necessary to reach one’s feet by flexing the hips and kness so that the feet are closer to the hands for preparing to don pants, socks, and/or shoes. 12 TS-2_by SHAMIMA_2017 3/4/2018

13. Continue… Independence in rolling from side to side and reaching one’s buttocks are important for performing manual bowel stimulation and clean up or using a long-handled mirror for skin inspection. Good strength in the deltoid, pectoralis major and minor, biceps, wrist extensors, and scapula muscles is key to support these tasks without assistive device, so strengthening these muscle groups in therapy is preparatory to learning this technique. A sense of balance for sitting and transferring must be developed, practiced, and accomplished during intervention. 13 TS-2_by SHAMIMA_2017 3/4/2018

14. TECHNIQUES OF BED MOBILITY POSITION Bridging Bridging is simply lying supine on a surface and by using the back and hip extensors, the buttocks, upper legs, and lower back are lifted off of the supporting surface so that contact is only made with the upper back, shoulders, head, and feet. The occupational therapist can incorporate these movement strategies while training the patient in self-care activities. 14 TS-2_by SHAMIMA_2017 3/4/2018

15. Continue… The first task to accomplish in bed mobility is bridging the hips. Bridging is a movement strategy that is taught by the occupational therapist to allow the patient to move the buttocks onto a bedpan, to pull pants over the hips, and to assist with moving the body laterally for changing bed positioning. Bridging requires trunk extension, which is necessary at the trunk and hips to assume a functional bridge position. For example, bridging is a mobility function necessary for the use of a bedpan, reduction of pressure on the buttocks, movement within the bed (bed scooting), to move up in the bed and bridging to don/doff pants. 15 TS-2_by SHAMIMA_2017 3/4/2018

16. Rolling Rolling the body is vital for Start with the patient already at one side of the bed. Knee on the bed Turn head Bend knee Place arm across body- other arm out of the body Use shoulder girdle and pelvis key points Have your body square to segment Roll the patient towards you 16 TS-2_by SHAMIMA_2017 3/4/2018

17. Activities for rolling practice Practice rolling on a narrow surface such as sofa Encourage abrupt change in direction, as in reversing the movement in midstream Practice rolling under a heavy quilt Try rolling with an object such as a newspaper in the hand Attempt propping to sidelying to adjust pillows Practice rolling in a darkened room Ask the patient to roll quickly 17 TS-2_by SHAMIMA_2017 3/4/2018

18. Sitting in bed Long-leg sitting is the [posture in which the legs are extended straight out in front of the person on a flat surface and the hips are flexed to at least 90⁰. Long-leg sitting can permit other activities in bed such as watching TV, reading, donning a shirt, or taking medication. Short-leg sitting is the posture in which a person sits with the hips flexed at least to 90⁰ and knees are flexed over the edge of the surface. Short leg-sitting allows for activities to be performed while sitting on the edge of the bed such as donning a shirt, putting on shoes, or preparing to stand or to transfer to a wheelchair. 18 TS-2_by SHAMIMA_2017 3/4/2018

19. BED MOBILITY IN PREPARATION FOR TRANSFER Step1: Rolling the client who has hemiplegia Step 2: Side-lying to sit up at the edge of the bed Step 3: Scooting 19 TS-2_by SHAMIMA_2017 3/4/2018

20. Step1: Rolling the client who has hemiplegia Before rolling the client, you may need to put your hand under the client’s scapula on the weaker side and gently mobilize it forward (into protraction) to prevent the client from rolling onto the shoulder, potentially causing pain and injury. Assist the client in clasping the strong hand around the wrist of the weak arm, and lift the upper extremities upward toward the ceiling. 20 TS-2_by SHAMIMA_2017 3/4/2018

21. Continue… Assist the client in flexing his or her knees Assist the client to roll onto his or her side by moving first arms toward the side, then the legs, and finally by placing one of the therapist’s hands at the scapular area and the other therapist’s hand at hip, guiding the roll 21 TS-2_by SHAMIMA_2017 3/4/2018

22. Step 2: Side-lying to sit up at the edge of the bed Bring the client’s feet off the edge of the bed Stabilize the client’s lower extremities with your knees Shift the client’s body to an upright sitting position Place the client’s hands on the bed at the sides of his or her body to help maintain balance 22 TS-2_by SHAMIMA_2017 3/4/2018

23. Step 3: Scooting Scooting is an important skill for moving to the edge of a bed or seat and can be a useful movement pattern in activity of daily living tasks such as donning pants in a seated position. The patient should begin in symmetrical sitting The therapist can encourage scooting by first cueing a lateral weight shift and Then advancing the non-weight-bearing buttock to move anteriorly . 23 TS-2_by SHAMIMA_2017 3/4/2018

24. TECNIQUES FOR TRANSFERRING MOBILITY 24 TS-2_by SHAMIMA_2017 3/4/2018

25. SIT TO STAND ( Radomoski and Latham 2013) Scoot forward on the seated surface and establish a position of “readiness to stand” (hip, knee, and ankle <90º, pelvis neutral in all planes, trunk extended and symmetrical). Bring centre of mass (COM) over base of support (BOS) by anteriorly tilting pelvis and flexing hips, while keeping the trunk and neck extended and symmetrical. This also establishes momentum that will assist with step 3. Mnemonic for patients: “Nose over toes.” 25 TS-2_by SHAMIMA_2017 3/4/2018

26. Continue… Transfer momentum from the upper body and raise buttocks off the seated surface onto both legs. Rise to the upright position by extending (but not locking) the hips and knees. Adjust standing postrure to meet environmental/ task demands. 26 TS-2_by SHAMIMA_2017 3/4/2018

27. STAND TO SIT ( Radomoski and Latham 2013) Position body directly in front of the seating surface (“feel” the seat behind both legs). “Fold” body onto the chair (anterior pelvic tilt, hip and knee flexion, ankle dorsiflexion, while keeping trunk and neck extended and symmetrical). Eccentrically contract leg extensors to control the downward pull of gravity. After upper thighs are resting on the seating surface, “scoot” to assume a position of “readiness for function” in seated activities. 27 TS-2_by SHAMIMA_2017 3/4/2018

28. Possible Environmental Modification ( Radomoski and Latham 2013) Raise seat to decrease lower limb force requirements (while still providing a stable surface of the feet). Grade seat to lower heights as strength in leg extensors improves. Use chair without arms if patient shows too much reliance on using hands for push-off. Select chair that allows for placing the feet back (knee and ankle 90  ) 28 TS-2_by SHAMIMA_2017 3/4/2018