PT Fundamentals Week 7 - Transcripts

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).
• 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)

• Basic ADLs: Manage basic physical needs.
  • Feeding, ambulating, transferring, toileting, bathing, continence management, dressing
• 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.