Mobility Flashcards

Question

How would you cue a person to move up on the bed with a SV/SB level of assistance?

Answer 1

1. Cue them to bend their knees so their feet are flat on the bed. 2. Cue them to tuck their chin 3. Cue them to push with their feet and wiggle/walk their bottom and shoulder blades up the bed (“scoot or shuffle”).

Answer 2

Rarely Needed! 1. Cue them to bend their knees so their feet are flat on the bed. 2. Cue them to “shuffle down the bed”.

Answer 3

Cue: "Ready, Steady, Push" 1. Cue them the same way you would for supervision but block their feet so they don’t slide. 2. Can consider tipping the head of the bed down but need to screen for precautions/ contraindications 3. If they need more assistance then this, recommend using 2 person assist with the slide sheet.

Answer 4

Cue: “Ready, steady, slide” 1. Use your rolling 2PA technique to roll the patient one way and place the slide sheet under them. 2. Roll them back to supine and slightly towards the other direction so you can get the slide sheet out 3. Have them cross their arms across their chest 4. If you think the patient will be able to assist pushing through their feet, cue and assist them to bend up their knees and place feet flat on the bed. 5. Using a lunge position with one foot towards direction of travel and arms close to the body, hold the slide sheet and shift weight from back to front foot, sliding the patient up the bed.

Answer 5

Use the overhead lift

Answer 6

This functional activity starts from side-lying, use your bed mobility cues to facilitate the patient to move over in bed and roll so they are starting in side lying at the edge of the bed. 1. From side lying, cue the patient to drop their legs over the ledge of the bed, while at the same time, push through their hand and elbow on the bed and sit up. 2. Ideally, they should use momentum from their legs dropping over the edge to assist with coming into sitting.

Answer 7

Cue: “Ready, steady, sit” 1. Assist the patient to drop their legs over the bed if needed. 2. Then place one hand under their THORAX/ SHOULDER that’s on the bed, and the other on the ASIS. 3. As they push down with their hand and elbow, push on their ASIS to tilt the pelvis and assist into sitting as your other hand helps lift their trunk into sitting. 4. If they’re able to drop their own legs over the bed, you can already have your hand on their thorax and pelvis, and use momentum form the legs to come to sitting 5. Once in sitting, steady them with your hands on their shoulders or pelvis unless they can maintain their own static sitting balance.

Answer 8

Cue: “Ready, steady, sit” 1. One person should be in front of the patient and this person is responsible for the LEGS 2. The other person is behind and is responsible for the TRUNK and UPPER BODY 3. From side lying, the person in front assists to bring the legs off the bed, and then facilitates the pelvis into an upright posture (like you do in 1PA). 4. At the same time (using momentum from the legs dropping) the person behind has their hands on either side of the TRUNK and assists the patient into upright sitting. 5. Once in sitting the person in front steadies the pelvis and the person behind the head (if needed) and trunk.

Answer 9

Ability to maintain an upright posture without moving.

Answer 10

1. HEAD CONTROL - can the patient keep their head upright over their shoulders? 2. TRUNK CONTROL - can they keep their trunk upright and in midline or are they learning to a side or forward/ backward? 3. BASE OF SUPPORT - are their feet flat on the floor?

Answer 11

Ability to maintain balance while moving in sitting.

Answer 12

Can the patient maintain balance while creating movement. 1. Observe the patient reaching side to side and forward, with close guarding. 2. Look for whether they can weight shift moving their COG outside their BOS and return to initial position.

Answer 13

1. Re-assess strength in an against gravity position for main muscles required for standing. - Seated marching +/-resistance (hip flexion) - Knee extension +/- resistance 2. Assess sitting balance (Static/Dynamic) 3. Willingness to transfer weight forward and bring “nose over toes” is key to being able to stand.

Answer 14

1. Moving bottom towards the edge of the bed. (feet fully flat on floor, bottom walking with chest forward, NOT sliding and leaning back) 2. Moving feet behind knees. 3. Moving weight forward “nose over toes”. (repeat x3) 4. Pushing up into through hands and feet stand up.

Answer 15

1. Weight shift and “walk” or “shuffle” bottom forwards to edge of bed 2. Place feet so toes are behind knees. 3. Lean forwards (“nose over toes”) 4. Push through your legs to stand, hands can also be used to push off the bed or chair to stand 5. If using a gait aid, it is acceptable to have 1 hand on the gait aid, but the other should push from the surface they are sitting on.

Answer 16

1. "Side on" STS - most common technique, generally start here. 2. Front on” STS - bilateral support, some people prefer this, can be helpful if working with someone with UNILATERAL weakness. 3. Stand aid/Sara Steady 4. Mechanical standing lift

Answer 17

Cue: “Ready, steady, stand” 1. Sit/stand in front of the patient and facilitate “shuffling” their bottom forwards by weight shifting to one side, while bringing forward the other side - hands best placed on PELVIS 2. Assist them to place their feet behind their knees. 3. Move to standing beside them. 4. Assist or cue them to lean forwards to bring their “nose over toes” so they can start to lift their bottom off the plinth 5. Assist to stand by having one hand on their PELVIS or TRANSFER BELT and the other guarding in front of their SHOULDER 5. Place your FOOT in front of theirs to prevent SLIPPING. Your knee can be used to BLOCK the patient’s KNEE to offer more stability.

Answer 18

1. One PT sits in front, the other behind. 2. To assist patient in shuffling forward, the PT BEHIND weight shifts the TRUNK, while the PT in FRONT facilitates the PELVIS to move forward. 4. Assist the patient to place their feet under their knees 5. PTs move to each side of the patient. 6. Similarly to 1PA, facilitate patient leaning forward to move “nose over toes” and then help the patient stand with support at the PEVLIS and ANTERIOR SHOULDER. Have your feet in front of theirs and a knee block can be used on each side if needed. 7. If the person is unable to stand with 2PA, consider other assistive equipment such as the Sara Steady/Stand aid or a standing mechanical lift.

Answer 19

Cue: “Ready, steady, stand” 1. Sit/squat in front of them, facilitate “shuffling” their bottom forwards by weight shift to one side, while bringing forward the other side - hands best placed on PELVIS 2. Assist them to place their feet behind their knees. 3. Two options to assist with the stand - Sit in a chair and place both your knees AROUND their WEAK KNEE to offer support, place your hands on their pelvis or transfer belt. - In a SEMI SQUAT place each of your knees to the side of their knees or against their knees to offer support, place your hands on their pelvis or transfer belt. 4. Assist or cue them to lean forwards to bring their “nose over toes” so they can start to lift their bottom off the plinth. 5. Assist to stand by BLOCKING their knee/knees and assisting to stand at their pelvis/transfer belt.

Answer 20

1.Use previous techniques to assist patient to shuffle forwards to the edge of the bed or chair 2. Move the Sara Steady into place, assisting the patient to lift their feet onto the platform if needed. 3. Have them lean forwards and grip the bar. 4. Cue the patient to push through their legs and pull through their arms to stand while using 1 or 2 person assist at the pelvis and shoulder 4. If using the Stand Aid just for standing practice, can return to sitting and not put the paddles in place. 5. If you are using it to transfer, place the paddles behind the patient and have them sit down on the paddles.

Answer 21

1. Use previous techniques to assist patient to shuffle forwards to the edge of the bed or chair 2. Move the standing mechanical lift into place, assisting the patient to lift their feet onto the platform if needed. 3. Place sling around waist and do it up 4. Have them lean forwards placing their elbows on the platform and gripping the handles, secure sling into lift. 5. Cue the patient to push through their legs and pull through their arms to stand while using the lift to raise them. 6. Additional assistance from 1-2 people can be used (therapy session only) 7. Slowly lower again to sitting

Answer 22

- Ability to maintain upright standing without movement keeping your COG over BOS - Examples: standing feet together, single leg stand

Answer 23

- Looks at the person’s posture 1. Are they able to hold their alignment in midline 2. Can the person stabilize their pelvis over hips, knees and ankles (while maintaining head/trunk control) - May see movement at hips and/or ankles as the person works to keep their COG over their BOS.

Answer 24

- Ability to maintain upright balance while the body and/or BOS is moving - Examples: Reaching, walking, bending to pick something up.

Answer 25

1. Can the patient shift their weight and move their COG outside their BOS and return to initial position? 2. Observe the patient reaching sideways/forward, with close guarding and return to initial position.

Answer 26

1. Static/Dynamic Standing Balance 2. Progress to weight shifting from one leg to the other, starting with small movements and weight and then increasing to more weight on the limb as able. - Weight shifting is a good precursor to stepping as it involves bringing all the weight onto one limb and unload the other limb in preparation to step. 3. Once the patient can accept all weight onto one limb practice stepping on the spot and progressing speed and frequency to “marching’ on the spot”. 4. Once they can march on the spot they are likely able to do a step transfer and you can consider progressing to ambulation (walking)

Answer 27

1. Step transfer 2. Pivot transfer 3. Slide-board transfer

Answer 28

- Patient will need to have relatively good strength/ balance as they need to be able weight shift adequately to lift their foot and step. - Generally if someone was previously standing/ transferring/ ambulating and you believe they will get back to this you would aim for this e.g. post op, medical unit etc. - If they can stand but not step, consider using a Stand Aid or Mechanical Standing Lift (depending on how much assistance they need to stand)

Answer 29

- Often used when a patient is unable to stand or if they can stand but not step (and this will likely be a longer term issue), and/or they have significant weakness through one side - Generally able to facilitate a pivot transfer if a patient has at least 1 strong/weight bearing arm and leg. - Commonly used with patients with stroke, SCI, and unilateral LE limb.

Answer 30

- Similarly to the pivot transfer, this can be used when a patient is unable to stand or step, often patients start with a slide board before progressing to a pivot transfer - Can be used if a patient is unable to weight bear through lower limbs. For this to be independent, the patient needs strong upper limbs and good sitting balance - Commonly used with patients with SCI limb loss or trauma with limited weight bearing

Answer 31

- Commonly used when a patient is unable to weight-bear through lower extremities, has inadequate sitting or standing balance or has a low neurological status and cannot engage in a more active transfer - In general, we try to avoid using an overhead lift unless necessary.

Answer 32

1. Once standing, cue them to step around towards the chair and back up until they can FELL the chair behind their KNEES 2. Reach back for the arms of the chair and slowly sit down and lower themselves into the chair.

Answer 33

1. Once in standing offer your hand or a gait aid for stability. 2. Cue them in the same way as for supervision while providing some support.

Answer 34

1. For this you are often providing more assistance either on a transfer belt or at their pelvis. You may be helping with weight shift or blocking a knee 2. If they need more than moderate assist, best to get a second person.

Answer 35

This functional activity starts from sitting at the edge of the bed. 1. Cue them to set their wheelchair on their strong side facing 45 degrees to the edge of the bed with FOOTPLATES off, ARMREST lifted and BRAKES on. 2. Cue them to place their feet flat on the floor with their HEEL facing towards the wheelchair. 3. Cue them to reach with the hand CLOSEST to the wheelchair to the OUTER arm of the wheelchair 4. Cue them to lean forwards moving their head as far away from the wheelchair as possible to facilitate their bottom being lifted 5. Cue using their arms to push from the plinth/bed and pull on the wheelchair arm rest to pivot their bottom into the wheelchair. 6. Cue them to position themselves centred in the chair and replace footplates so their feet are supported.

Answer 36

1. Assist them with wheelchair setup as per supervision 2. Assist them to place their feet flat on the floor with their HEELS facing towards the wheelchair 3. Assist them to reach with the HAND CLOSEST to the wheelchair to the OUTER arm of the wheelchair 4. Assist them to lean forwards with their head over YOUR SHOULDER as far as possible to facilitate their bottom being lifted, your hands go on their PELVIS to assist with this movement 5. Cue them to come lean forwards and pull on the wheelchair arm rest as you assist to pivot their bottom into the wheelchair. 6. Assist them to position themselves centred in the chair and replace footplates so their feet are supported.

Answer 37

Same as 1PA with addition of second person behind, to assist with bottom/pelvis moving into chair.

Answer 38

This functional activity starts from sitting at the edge of the bed. 1. Cue them to set their wheelchair on their strong side facing 45 degrees to the edge of the bed with footplates off, armrest lifted and brakes on 2. Cue them to weight shift away from the wheelchair and place the slide board under them and BRIDGING between the bed and wheelchair. Have them return to midline, sitting on the slide-board. 3. Have them place their feet flat on the floor with their heels facing towards the wheelchair and arm towards the wheelchair outstretched onto the slide board making sure their FINGERS aren’t under it. 4. Cue them to lean forwards moving their head as far away from the wheelchair as possible to facilitate their bottom being lifted and move along the slide board. 5. Continue this pattern to move along the slide board until in the wheelchair 6. Cue them to position themselves centred in the chair and replace footplates so their feet are supported.

Answer 39

1. Assist them with wheelchair setup as per supervision. 2. Assist them to weight shift away from the wheelchair and place the slide board under them so it bridges between the bed and chair. and return to midline 3. Assist them place their feet flat on the floor with their heels facing towards the wheelchair and arm towards the wheelchair outstretched onto the slide board making sure their fingers aren’t under it. 4. Cue them to lean forwards moving their head over your shoulder as far away from the bed as possible to facilitate their bottom being lifted and then moved along the slide board. Your hands go on their PELVIS to assist with this movement 5. Continue this pattern to move along the slide board until in the wheelchair 6. Assist them to position themselves centred in the chair and replace footplates so their feet are supported.

Answer 40

Same as 1PA with addition of second person behind, to assist with bottom/pelvis moving into chair.

Mobility Flashcards

(65 cards)