Bed Mobility

Question 1

General Functional Mobility Progressions

Answer 1

• Stability precedes mobility
• Maintaining preceds attaining
• Large BoS precedes Small BoS
• Low CoG preceds High CoG

Rolling, Sitting up/laying down, Scooting, Pulling, Shifting

Question 2

Static Positions

Answer 2

• Supine / supine on elbows
• Prone / prone on elbows
• Hook lying
• Side lying

Question 3

Dynamic Activities

Answer 3

• Rolling (supine to/from side lying first)
• Bridging
• Scooting
• Supine to/from sitting on edge of bed

Question 4

Preparation for Bed Mobility

Answer 4

• Ensure bed is locked in place
• Adjust bed height to minimize stress on clinician’s back
• Consider bed rails for assistance or as a hindrance
• Establish location of lines, leads, and tubes
• When transitioning activity from lying in the bed to sitting on edge of bed, ensure that the bed is lowered so the patient’s feet will be on the floor once seated

Question 5

What position is this

Answer 5

Supine: Hooklying

Hips and knees flexed
A component of bridging, scooting, and rolling
Clinician may need to help position legs initially

Question 6

What position is this? What is the cue?

Answer 6

• Patient is instructed to “lift hips and low back”
• Patient assists w/upper extremities (UEs), not pushing head into bed
• Clinician may stabilize at patient’s feet or provide assist at hips
• A component of scooting and some activities of daily living (ADLs)
• Important for pressure relief!!

Question 7

Supine: Scooting Up in Bed Lift, Shift and Lower

Answer 7

• Head of bed (HoB) flat if tolerated
• Begin in hooklying
• Elbows out and back
• Patient is instructed to “push through elbows and feet, lift and shift hips up towards head of bed”
• Clinician(s) may assist using bed pad

Trendelenburg position can be very useful for this!

Question 8

In Supine: Scooting SidewaysLift, Shift, and Lower

Answer 8

• Begin as if scooting up
• Patient is instructed to “push through elbows and feet, lift and shift hips to the side”
• Patient then instructed to “push through elbows to shift trunk in same direction”
• Repeat as needed
• Clinicians may assist using bed pad and/or manually

Question 9

Using equipment in supine

Answer 9

• Bed Rails
• Trapeze (Overhead handle)

Need to think about if the patient have these things at home. Not likely, can use this initially but need to move away from them if they don’t have access when they leave.

Question 10

Rolling: Supine to Side Lying

Answer 10

• Important in prevention of pressure injuries
• Used for bathing and placement of drawsheets,lift slings, incontinence products, and bed pans
• Potential component of supine-to-sitting
• Typically initiated with trunk rotation

Question 11

Rolling: Supine to Right Side lying - Coaching

Answer 11

• Scoot to the left in the supine / hook lying position.
• Turn your head and look to the right.
• Abduct the right arm ~45°.
• Bend the left hip and knee (or cross left leg over right).
• Reach left arm over and push down with left foot.
• Bring trunk into full side lying.
• Pop up railings if the patient needs more assistance to move.
• Can support centrally with hand on shoulder and hip only helping slightly still want them to do most of the work.

“Reach left arm and left leg across the body, look toward me”

Question 12

Rolling: Supine to Prone

Answer 12

• Proceed as in rolling into side lying but without abducting the lower arm.
• Continue from side lying into prone.
• Turn head to clear airway.
  – May need to remove pillow.

Amputee and SCI patients

Question 13

Supine to Short Sitting

Answer 13

• Typically, simultaneous upper- and lower-body movement, powered primarily by core musculature
• When mobility is impaired, motion is usually done segmentally through side lying.

Question 14

Supine to Sitting through side lying on the left

Answer 14

• Roll from supine to left side lying.
• Lift or slide both lower extremities (LEs) off the edge of the bed.
• Push right hand down into the bed, extending the right elbow.
• Abduct the left arm and extend the left elbow, using it to push upright.
• Moving the legs off the bed first creates a force couple, making it easier for the patient to lift the upper body.

Question 15

Assisting from supine to sitting: Positioning

Answer 15

• Get very close to patients to be able to help

Question 16

Short sitting to supine

Answer 16

• Lower upper body to the bed, controlling with UEs
• Lift both LEs onto the bed (can also be done one at a time)
• Roll to supine
• When having a patient sit on the edge of the bed before lying down, planning ahead and having the patient sit about 1/3 of the way down from the head of the bed will reduce the amount of reposition necessary in supine. If the patient sits at the middle of the bed, once in supine, he or she will need to move up toward the head of the bed, a move that tends to create shearing forces on the patient’s skin and can be taxing for the patient / clinician.
• Patients often require assistance lifting the LEs onto the bed even when they are able to complete the remainder of the task. This patient is using her stronger leg to assist the weaker leg onto the bed.

Question 17

Sitting: Scooting Sideways: Lift, Shift, and Lower

Answer 17

• Used for repositioning before lying down
• A component of lateral seated transfers
• A component of preparing to come to standing position

Question 18

Sitting: Scooting Sideways Toward the Right

Answer 18

• Abduct the right arm and place hand on bed.
• Push down with both hands, lifting hips up and to the right.
• Repeat as needed.
• Preferable to complete with feet on the floor as not all patients have the mechanical advantage to complete without distal support

Question 19

Sitting: Scooting Up and Back: Lift, Shift, and Lower

Answer 19

• Used for repositioning in chair or on edge of bed
• A component of sit-to-stand and pivot transfers
• Encourage the patient to place their feet underneath them (as able), lean their trunk slightly forward, place their hands by their hips to help push up, and push through their feet as they rise and shift
• “nose over toes”
• If patient is unable to lift and shift in one movement, they may shift one hip back at a time
• As a therapist using a mat or putting our hands on their hips to assist.

Question 20

Special Circumstances: THA (Posterior Approach)

Answer 20

• Posterolateral approach post-operative restrictions:
  – No > 90° hip flexion
  – 0° hip adduction
  – 0° hip internal rotation
• Supine into sitting NOT through (DO NOT WANT THEM IN ADDUCTION)
• May initially require assistance of more than one person

Question 21

THA: Supine to Sitting (Posterior Approach)

Answer 21

• Remove abduction wedge (maintain slight hip abduction)
• Have the patient prop up on their elbows
• Scoot / pivot on bed, alternately moving UEs and LEs using ½ hooklying
  – May need assist with involved LE or use leg lifter
• Sit on edge of bed (EOB) with the trunk leaned back.

Moving from supine into sitting toward the involved side is often preferred to minimize dislocation risk (due to hip adduction)

Using a leg lift strap can help if they are very nervous to have assistance

Question 22

Special Circumstances: Hemiplegia

Answer 22

• Avoid pulling on the patient’s weaker arm (high risk for subluxation at shoulder)
• Be alert to location of weaker extremities because some patients experience one-sided neglect
• Be alert to static sitting balance deficits; position yourself in front of the patient and toward their affected side
• Regardless of impairments, never assume that the patient cannot actively participate in the session

Position yourseld toward their hemiperetic side (May sway when sat up); coach them throughout and stay positive

Initially, it may be easier for the patient to come to sitting from sidelying on the weaker side (and using the stronger UE to push the torso up), so that activity may be practiced earlier in bed mobility training. However, for maximum functional mobility, the patient should be instructed to get up on either side of the bed.

One sided neglect: Don’t even think or are not aware of the limb affected

Question 23

Hemiplegia: Supine to Side lying on the Weaker Side

Answer 23

• Flex stronger hip and knee.
• Reach stronger arm across the body.
• Lay the stronger leg over the weaker leg, turning the torso.

Question 24

Hemiplegia:Side lying to Sitting on the Weaker Side

Answer 24

• Use the stronger leg to help the weaker leg off the EOB
• Press down into bed with stronger hand, pushing the torso upright
• Making a fist on the stronger hand will give slightly more height

Can use strong leg to move weaker leg down and off for force coupling.

Question 25

Hemiplegia: Supine to Side lying on the Stronger Side

Answer 25

* Flex stronger hip and knee; may slip foot under weaker leg. * Use stronger hand to grasp weaker hand or forearm. * Lower flexed leg to the side while bringing UEs across the body. * Push into bed with foot to complete the roll.

Question 26

Hemiplegia:Sidelying to Sitting on the Stronger Side

Answer 26

- Slide stronger foot under weaker ankle. - Bring both legs off EOB. - Abduct stronger UE and push torso upright in quick bursts. - If use of the bedrail is desired, the patient places the hemiplegic arm across the body and then grasps the bedrail with the stronger arm to pull / push the torso up

Question 27

Hemiplegia: Sitting to Side Lying

Answer 27

- Slide stronger foot under weaker ankle. - Lower upper body into side lying, controlling with UE. - Lift both legs onto bed.

Question 28

Special Circumstances:Acute Back Surgery

Answer 28

No “BLT” No **bending** (spinal flexion) No **lifting** (more than 5-10 pounds) No **twisting** (segmental rotation of the thoracolumbar spine)

Question 29

Acute Back Surgery: Log Roll

Answer 29

* **Avoid segmental rotation** of thoracolumbar spine. * Flex hip and knee of far leg (or both legs if patient has good LE control) * Cross the arms across the chest. (Doesn't allow them to rotate) * Roll into side lying, moving the trunk as one unit to facilitate a neutral spine position ## Footnote May have a spine stabilizing brace

Question 30

Acute Back Surgery: Sidelying to Sitting

Answer 30

* Don't want legs to hang off because that creates a rotational component. * Have hand close to avoid rotation. Keep things tight and toward the core. ## Footnote Fluid motion, not fast.

Question 31

Acute Back Surgery: Sitting to Side lying

Answer 31

1. Lean down onto one elbow, abducting the shoulder and keeping the upper body facing forward. (Do not reach across with opposite arm.) 2. Lift legs onto the bed into side lying. 3. Avoid segmental rotation of the thoracolumbar spine

Question 32

Tilt Table

Answer 32

- Allows for controlled progression from supine to standing -- Acclimation of cardiopulmonary system to upright positions (Allows for slow acclimation for people who were in critical care) -- Facilitates weight bearing -- Increase arousal / awareness of patients with decreased level of consciousness - Generally, a patient who tolerates 20 min at 70° can tolerate standing upright. - Rate of incline progression will depend on patient condition and tolerance. (Requires weightbearing on at least one extremity) - Requires security straps - **Never leave patient unattended**

Question 33

Tilt Table Procedure

Answer 33

* Explain procedure. * Transfer patient to horizontal tilt table. * Position feet on foot plate. * Secure patient with straps. * Measure vital signs. * Elevate table per plan of care (typically increasing tilt ~15° to 20° at a time). * Monitor responses. * When done, lower table, remove straps, transfer patient.

Question 34

Tilt Table and Orthostatic Hypotension

Answer 34

* Orthostatic Hypotension = drop of 20mmHg in systolic BP or drop of 10mmHg in diastolic BP within 2-5 minutes of standing  -- Syptoms may include dizziness, nausea, lightheadedness, and faintness -- If experienced during Tilt Table session, does not necessitate stopping session, but may require decreasing tilt and monitoring BP and symptom changes - Drop back down to 20 degrees then slowly increase again