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Questions and Answers
What is the center of mass (CoM) primarily defined as?
Where does the center of mass typically fall when the body is standing still?
How does the addition of an external weight, such as a cast, affect the center of mass?
What is the base of support (BoS) defined as?
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Which statement accurately reflects the relationship between center of mass and movement?
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What is the primary benefit of utilizing proper body mechanics for healthcare workers?
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Which of the following is NOT one of the 5 L's of lifting mechanics?
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What should healthcare workers do if the weight to be lifted exceeds 25 pounds?
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How can maintaining proper posture during lifting decrease injury risk?
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Why is it important to exhale while lifting?
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How does a larger base of support affect stability?
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Which statement about posture is correct?
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What role does a plumb line serve in measuring posture?
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What is the effect of a smaller base of support on stability?
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How can a therapist assist a patient during a transfer to ensure stability?
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Study Notes
Lifting Mechanics Basics
- 5 L's of Lifting: Load, Lever, Lordosis, Legs, Lungs
- Load: Plan ahead, estimate load, clear path of travel, assess patient safety, ensure no movement contraindications/precautions.
- Load (Cont): Determine if lifting is possible individually, with a team, or requires a mechanical device.
- Many hospitals have minimal lifting policies. This typically requires a device like a Hoyer lift or a team approach for weights more than 25 pounds.
- Lever: Position yourself close to the object to decrease the lever arm and minimize muscle activity.
- Lever (Cont): Have the patient scoot forward in their chair and lean forward to minimize the distance between you and the load.
- Lever (Cont): Maintain a wide base of support (feet apart, one slightly forward, toes slightly outward), for shifting center of mass and stability.
- Lordosis: Maintain normal spinal curvature (slight inward curve at the lower back).
- Lordosis (Cont): Look ahead, keep chest forward, avoid twisting trunk when it is flexed.
- Legs: Bend at the hips and knees, maintaining neutral back.
- Legs (Con): Engaging trunk muscles before lifting stabilizes your core.
- Legs (Cont): Push rather than pull objects over a distance (larger base of support, lower center of mass, stronger muscle engagement, directed force).
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Alternative Lifting
- Half-kneel or Tripod Position: One knee on the ground, the other leg in front, keep spine upright, eyes and chest forward.
Lines, Tubes and Drains
- Medical devices that can be used in hospitals, home health settings, or skilled nursing facilities
- Physical therapists need to know how to safely mobilize patients with these devices to avoid pulling or dislodging them
Why Lines, Tubes, and Drains Matter for Physical Therapists
- Essential for safe patient mobility
- Therapists need to manage these devices while moving patients, being careful not to kink, pull, stretch, or dislodge them
Vital Signs Monitoring
- Use ECG or EKG leads (3, 5, 7, or 12 leads) to monitor heart rhythm, rate, and other factors
- ECG leads are usually attached to a monitor on the wall or a mobile unit
- Physical therapists need to be aware of the number of leads a patient has to avoid pulling them off
Understanding the Importance of Safety
- Multiple challenges for patients in an intensive care unit (ICU) environment to perform mobility tasks
- These challenges include factors such as pain, neuromuscular impairments, sedation, and side effects from medications
- Maintaining safety is critical when working with patients with lines, tubes, or drains
Contraindications and Precautions
- Contraindications are patient conditions that are inappropriate or advised against for therapy or specific interventions for therapy.
- Precautions are when protective measures are taken in advance to minimize the chance of injury.
General Contraindications for Exercise and Physical Activity
- Medically unstable patients whose medical status changes quickly and over time.
- Unstable vital signs.
- Uncontrolled or unstable blood glucose levels.
Precautions for Patients with Nasogastric Tubes
- Keep the head of bed at least 30 to 45 degrees upright.
- Avoid supine or prone positions.
- Avoid supine or prone for at least 30 to 60 minutes after feeding completion.
- Discuss with the nurse the best time to perform an evaluation or intervention.
Traditional Sternal Precautions
- Limit lifting to 5 to 10 pounds.
- No pushing or pulling with the arms.
- No reaching behind the back.
- No driving.
- No overhead reaching.
Functional Movement
- Essential for daily life like walking, bending, squatting, reaching, and rotating.
- Helps prevent injuries by reducing stress on joints, muscles, and ligaments.
- Rehab professionals aim to restore functional movement to help patients recover.
- Optimizes athletic performance by enhancing strength, speed, agility, and endurance.
- Closely tied to independence and quality of life by enabling individuals to engage in social and occupational activities.
Functional Movement Assessment
- Used to establish a baseline, set goals, and assess intervention effectiveness.
- Provides indicators of a patient's initial abilities and progression.
- Helps determine if a patient needs extended care or can return home.
- Manifests an individual's safety level for performing tasks.
- Provides evidence of intervention effectiveness.
- Used for documentation purposes to support payer requirements of change in patient functional status.
Activities of Daily Living (ADLs)
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Basic ADLs: Manage basic physical needs.
- Feeding, ambulating, transferring, toileting, bathing, continence management, dressing
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Instrumental ADLs: More complex activities for independent living.
- Companionship/mental support, transportation, shopping, meal prep/clean-up, housekeeping, medication management, finances, communication
Functional Levels
- Used for documentation and communication between healthcare professionals.
- Seven common levels (often six):
- Independent (I)
- Modified Independent (Mod I)
- Supervision (S)
- Minimal Assistance (Min A, CGA)
- Moderate Assistance (Mod A)
- Max Assistance (Max A)
- Total Assistance (Dependent)
Levels Requiring No Tactile Assistance
- Independent: Functions safely and efficiently alone, no cueing needed, autonomous stage of learning.
- Modified Independent (Mod I): Independent but requires assistive device or takes longer, no cueing needed, autonomous stage.
- Supervision: No tactile help, but a person must be present for monitoring, may need cues, associative stage of learning.
Levels Requiring Tactile Assistance
-
Minimal Assistance (Min A, CGA): Needs help with a small part of the task, unsafe without assistance, associative stage.
- Contact Guard Assist (CGA): brief points of contact throughout activity.
- Moderate Assistance (Mod A): Needs help with half the task, unsafe without assistance, cognitive stage of learning.
- Max Assistance (Max A): Can only perform a quarter of the task, heavy assistance needed, high fall risk, cognitive stage.
- Total Assistance (Dependent): Requires full assistance for task completion, higher lifting force needed.
Functional Levels of Assistance
- Functional Level: Clinician/caregiver performs all lifting and assistance for patients with limited movement.
- Safety: Body mechanics for clinicians are crucial, and additional helpers are often needed for this level.
- External Lifting Devices: Suitable for patients at this level, especially when motor learning is not the goal but just moving the patient.
- Maximal Assistance: External lifting devices are also applicable to this level with similar circumstances.
- Terminology: Documentation often uses "min assist," "mod assist," or "max assist" followed by a number (e.g., "x2") indicating the required number of extra helpers.
- Distinguishing Factor: The "min," "mod," or "max" component describes the level of assistance each caregiver/clinician is providing.
Basic and Instrumental Activities of Daily Living (ADLs)
- Basic ADLs: Everyday activities.
- Instrumental ADLs: Activities necessary for community participation.
Levels of Assistance
- Clinical Levels: Approximately six or seven levels are utilized in clinical practice.
- Characterizing Levels: The text visualizes these practical levels of assistance.
- Level Description: You should be able to explain the characteristics of each level.
- Assigning Levels: You should be able to apply the appropriate functional level based on the assistance required by the therapist.
- Additional Helpers: The notation "+1" or "+2" may indicate the number of extra helpers required for a task, activity, or transfer.
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Description
Explore the essential principles of lifting mechanics, focusing on the 5 L's: Load, Lever, Lordosis, Legs, and Lungs. This quiz will guide you through safe lifting techniques that prioritize patient safety and minimize injury risk. Perfect for healthcare professionals and caregivers looking to enhance their lifting skills.
