Exam Bed Mobility PDF

Lateral Scooting in Sitting •Used for repositioning toward head of bed (HOB) before lying down •Good strengthening exercise in sitting, or trunk weight-shifting training •Good “pre-transfer” training – a component of lateral seated transfers 1. Position ipsilateral leg/foot laterally to prepare to...

Lateral Scooting in Sitting •Used for repositioning toward head of bed (HOB) before lying down •Good strengthening exercise in sitting, or trunk weight-shifting training •Good “pre-transfer” training – a component of lateral seated transfers 1. Position ipsilateral leg/foot laterally to prepare to receive weight 2. Abduct the arm with the hand (or fist) on bed (+space to shift hips). 3. Push down with both hands (or fist), lean head and trunk forward, lift hips up and shift laterally. Fig. 10-21 Clinical Pearl: Level of Assistance Application of Mobility Strategies: ▪Min Assist (75-25%) o the patient is able to initiate most of the movement o focus to guard the involved, weakened, and/or painful limb or site. ▪Mod Assist (50-50%) o Therapist will require to provide multi-point assistance or guarding to ensure patient safety and prevent falls or unsteadiness or worsening of pain ▪Max Assist (25-75%) o break down to assist one body part at a time ▪Always try to incorporate verbal, tactile, and visual cues to promote patient learning and subsequent independence Spine Precautions & Protection No “BLT” ◦ No bending (spinal flexion) ◦ No lifting (more than 5 lbs) ◦ No twisting (segmental rotation of the thoracolumbar spine) Clinical Applications: ◦ Spine Precautions - After Spine Surgery ◦ Spine Protection – Acute back injury or back pain ◦ Abdominal precautions & protection after abdominal surgeries, e.g., exploratory laparoscopy, and hernia repair. https://commons.wikimedia.org/wiki/Fil e:Exploratory_Laparotomy_Scar_(03).jpg 1st: Supine to Sidelying using “Logrolling” • Flex hip and knee of both or one LE. • Cross the contralateral arm across the chest. • Roll into sidelying, moving the trunk as one unit. • No Twisting = Shoulder – Hip – Knee all face the same direction. nd 2 : Sidelying to Sitting Abduct the underside arm; place the other hand on the bed near the waist. Move legs off the bed, initially pressing down with the underside hand. Continue to push the torso upright by pushing with the underside arm. Keep shoulders facing straight ahead. (Placing the hand near the waist limits flexion and abduction of the uppermost arm which would create trunk rotation.) https://demo.staywellhealthlibrary.com/Content/healthsheets -v1/step-by-step-using-log-roll-to-get-out-of-bed-hip-care/ Total Hip Arthroplasty (THA) https://www.medscape.com/viewarticle/546103 (Top): https://www.sahortho.com/hip/approaches (Bottom:) Hip replacement. (2022, September 17). In Wikipedia. https://en.wikipedia.org/wiki/Hip_replacement Implant Components https://youtu.be/FIzxN2p0nEo (Left) A standard non-cemented femoral component. (Center) A close-up of this component showing the porous surface for bone ingrowth. (Right) The femoral component and the acetabular component working together. (Left) The acetabular component shows the plastic (polyethylene) liner inside the metal shell. (Right) The porous surface of this acetabular component allows for bone ingrowth. The holes around the cup are used if screws are needed to hold the cup in place. https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/ Risk of Hip Dislocation POTENTIAL COMPLICATIONS: ▪Nerve injury – e.g., sciatic nerve injury ▪Osteonecrosis TREATMENT OPTIONS: ▪Closed Reduction ▪Surgery ▪Arthritis due to cartilage damage https://epos.myesr.org/poster/esr/ecr2020/C08100/findings%20and%20procedure%20details https://healthliteracyhub.com/pathology-101-blog/dislocation-of-hip-joint/ Posterior or Posterolateral Approach THA, Anterior Approach THA & Total Hip Revisions, Hip Hemi-arthroplasty No hip FLEXion beyond 90° No hip EXTension beyond 0° (neutral) • Limit forward bending of the trunk. • Do not bring the leg back past the neutral position. • Do not lift or position the knees higher than the hips. • If backing up, lead with non-surgical leg • Seat the patient with the foot of the affected leg forward and knee extended or on a raised seat to decrease sitting angle. No hip INternal rotation past 0° (neutral) No hip EXternal rotation past 0° (neutral) • Do not roll the leg (thigh and knee) in toward the non• Do not roll the leg (knee and foot) out; keep the surgical leg; keep the toes of the affected leg pointed up toes of the affected leg pointed up or in, not out. or out, not in. • Gait: When turning toward surgical side, turn leg outward first No hip adduction beyond 0° (neutral) • Do not cross legs (at knees or ankles) pass umbilical line. • Keep pillows between the knees (in supine/sitting). • Avoid sidelying (If needed: on unaffected side and with 3-4 pillows between knees). Minimally Invasive Hip Arthroplasty (Mini-Posterior) NO COMBINATION of hip flexion > 90 deg, with hip IR and hip ADDuction • Strictly follow surgeon’s guidelines • Aka “Hip protection,” “Pose avoidance,” etc. No hip adduction beyond 0° (neutral) • Do not cross legs (at the knees or the ankles) pass umbilical line. • Keep pillows between the knees (in supine/sitting). • Avoid sidelying. (If needed: on unaffected side and with 3-4 pillows between knees). THA (Posterior Approach) Same precautions also apply to Hip Hemi-Arthroplasty ◦ E.g., s/p hip fracture Restrict movement of post-op hip: ▪No hip FLEXion beyond 90° ▪No hip INternal rotation past 0° (neutral) ▪No hip adduction beyond 0° (neutral) Supine → sitting NOT through sidelying THA (Anterior Approach) https://youtu.be/MTJK9tdSsQY Restrict movement of post-op hip: ▪No hip EXTension beyond 0° (neutral) ▪No hip EXternal rotation past 0° (neutral) ▪No hip adduction beyond 0° (neutral) Clinical Pearl: Initially train patient to get out on Stronger side. In preparation for discharge – when patient demonstrates improved motor control in surgical leg, train patient to get out of bed on either side to maximize function. E.g., Left THA – posterior approach 1. Provide patient education on pertinent hip precautions to prevent hip dislocation. Flatten the bed completely. Then remove hip abduction pillow. 2. To get OOB on the stronger (R) side i. Bend strong (R) leg to a hook-lying position. ii.UEs: Use overhead trapeze if available; or use elbows to scoot laterally in bed iii.Assist pt to scoot or bridge close to (R) EOB using RLE and BUE (surgical leg can relax) iv.Patient fully scoots upper torso to L, and R leg toward EOB till R heel comes off the edge of bed. Therapist guards L leg to prevent hip adduction pass neutral. Left THA – posterior approach 3. To Long Sitting: i. Instruct pt to use elbows to prop upper torso up to sit up toward LEs till pt achieves modified long-sitting position. ii. Pt must keep UEs prop behind torso to avoid excessive hip flexion pass 90 deg. iii. Therapist: one hand support pt’s R scapula through axilla; another hand block patient’s L medial thigh from hip adduction or internal rotation pass neutral https://www.physio-pedia.com/Total_Hip_Replacement Left THA – posterior approach 4. Pt turns and pivots on gluts till sitting upright with BLE positioned in hip ER. • Pt keeps BUE behind torso while scooting to avoid excessive hip flexion. • Therapist: one hand support pt’s scapula through axilla; another hand block and gently scoot patient’s R medial thigh and assist to position in R external rotation. https://www.physio-pedia.com/Total_Hip_Replacement