Bed Mobility & Transfer Activities PDF

Pierson and Fairchild’s Principles & Techniques of Patient Care Chapter 8 Bed Mobility & Transfer Activities ©Stanbridge University 2022 Chapter Objectives Instruct a patient how to perform bed mobility and functional activities in preparation for a transfer...

Pierson and Fairchild’s Principles & Techniques of Patient Care Chapter 8 Bed Mobility & Transfer Activities ©Stanbridge University 2022 Chapter Objectives Instruct a patient how to perform bed mobility and functional activities in preparation for a transfer Adjust the position of a patient who is recumbent with or without the assistance of another person in preparation for a transfer Instruct a person how to perform various transfer techniques with and without assistance. Instruct one or more assistants how to perform a safe lift transfer Instruct a person how to properly guard and protect a patient while performing various transfer techniques ©Stanbridge University 2022 Definition of Transfer Safe movement of a person from one surface, location, or position to another ©Stanbridge University 2022 Bed Mobility Bed Mobility is a specific type of transfer. Because there are so many components/ considerations to getting someone out of bed, clinically we tend to speak about it and document about it as if it were its own separate entity or category. ©Stanbridge University 2022 ©Stanbridge University 2022  Functional Mobility: Bed Mobility, Transfers & Gait Bed mobility: Everything (techniques, verbal cues, level of assistance, precautions, sitting balance) involved with getting someone repositioned in/on the bed/mat/plinth. i.e., supine, prone, side lying, sitting EOB Transfers: Everything involved with getting someone from one surface to another. i.e., sitting to standing, sitting EOB ↔W/C, bed to gurney, bed to Hoyer lift Gait: Everything involved with a patient walking ©Stanbridge University 2022 Position and Bed Mobility Activities Move upward, downward, or from side to side Roll Turn over Move from recumbent position to sitting Note: “Bed” refers to bed, mat, plinth, or other supporting surface. ©Stanbridge University 2022 Required Documentation Amount or type of assistance required (physical and verbal cues) Amount of time to complete bed mobility Level of safety demonstrated Level of consistency of performance Equipment or devices used Example: Pt required mod assistance for supine to side lying to right with use of railing and VCs for correct log rolling techniques. ©Stanbridge University 2022 Before Performing Bed Mobility Analyze transfer into component parts, i.e., position of equipment, operator of the equipment, position of patient’s body, and movements required (just as you would prepare for proper body mechanics. Prepare patient- Do they have non-skid socks? Is their brief clean and dry? Prepare the environment- manage IV lines, move tray table and wheelchair leg rest out of the way, have AD withing reach. Prepare yourself and other persons involved- explain to the patient what to expect and for the patient to assist as much as they can. Make sure your gait belt is within reach. ©Stanbridge University 2022 Four General Parameters for Determining Appropriate Bed Mobility Interventions Your assessment of the patient’s ability to assist Information from the medical review, the patient, or the patient’s family/caregiver- Co-morbidities such as orthostatic hypotension, HTN, confusion Physician’s order- WB status? Other precautions such as sternal precautions or hip precautions Goals of treatment ©Stanbridge University 2022 Bed Mobility Equipment and Devices Hydraulic or pneumatic lift: see Procedure 8-7 Electric bed: see Procedure 8-8 Bedrail- patients can use their UE to pull themselves to assist with rolling. Over-the-bed or trapeze bar- assist with pressure relief or assist pt to pull themselves towards HOB. ***Equipment can be useful, but it may develop dependence from the patient. The devices should only be used if the patient is unable to perform a safe transfer without them or if the therapist/caregiver is unable to safely assist the patient. ©Stanbridge University 2022  Preparing for the Transfer (Procedure 8-1) Plan transfer across shortest distance Initially, plan to move the patient toward the stronger side and assist with the weak side (not always able to do this depending on the room set up. Obtain necessary equipment or assistance before performing Ensure the patient is properly dressed Wash hands (always) and don gloves (if appropriate)– great habit….you never know! Introduce yourself to the patient Explain the bed mobility procedure to the patient and demo if necessary Obtain consent after explaining activity and possible risks Have patient explain to you the steps of the task- if you just ask the pt, “do you understand my directions”, they will likely say “yes.” Best to have pt repeat directions back to you. ©Stanbridge University 2022  During the Bed Mobility Intervention Lock all wheels on the bed, wheelchair, gurney, etc Be aware of extraneous lines and tubes If using a draw sheet or sling, prep that ahead of time Remain close to the patient and guard them appropriately Use brief, concise one-step commands/instructions Encourage maximal mental and physical participation Use proper body mechanics Perform a safe and efficient transfer ***Remember that in order to be therapeutic (billable), the patient needs to be learning and they need to be participating. Anyone can just lift or move the patient on their own. ©Stanbridge University 2022 Safety Concerns: Bed Mobility Proper shoes and clothing – closed shoes or non-skid socks. Avoid sandals, regular socks, or smooth soled shoes. Be alert to the unexpected- always prepare as if the pt will go dependent at any time and you may have to assist them more than expected. Best position for the therapist (i.e. raise/lower bed)→proper body mechanics for the therapist Best position for caregiver: in front or slightly to the side Secure lap belt, bedrail, or other protective devices Environment free of unnecessary equipment ©Stanbridge University 2022 Conditions Requiring Special Precautions- total hip replacement Anterior Approach1: No hip extension past neutral Posterior Approach: (no lying in prone, no full No flexion of hip past 90 deg bridges) No hip adduction past neutral No hip external rotation past neutral No hip internal rotation past neutral No adduction past neutral No hip flexion >90 1. Do not pull on the surgical leg or lie on surgically replaced hip. No combo movement: 2. Use abduction wedge for both approaches adduction, ER and flexion >90 1. Giles, S. (2015). PTA Exam The Complete Study Guide. Scarborough, MN: Scorebuilders. P.118. ©Stanbridge University 2022 Conditions Requiring Special Precautions Low back trauma or discomfort No lumbar rotation No trunk side bending No trunk flexion 1. Use logrolling technique – shoulders and hips move at the same time 2. Flex hips and knees in supine or side laying to relieve pressure from low back *** Remember the “BLT”…no bending, lifting or twisting ©Stanbridge University 2022 Conditions Requiring Special Precautions Spinal cord injury No traction forces No rotational forces Do not move person downward by pulling lower extremities Logroll when turning in bed Osteoporosis very likely in people with chronic spinal cord injury (SCI) Patients may experience syncope when going from supine to sitting ©Stanbridge University 2022 Conditions Requiring Special Precautions Burns Avoid shearing force across burn or graft site Sliding creates a shearing force, causing friction Patients should be instructed to elevate a limb when moving to avoid friction ©Stanbridge University 2022 Conditions Requiring Special Precautions Hemiplegia Do not pull on the involved or weakened extremities (especially the shoulder) – high risk of subluxation Patients can experience pain when rolling over the involved shoulder ***If pt also has aphasia, they may not be able to communicate effectively about their pain ©Stanbridge University 2022 Mobility Activities- what is it used for? To adjust recumbent patient’s body position To prevent skin problems and contractures Encourage independent movement Reduce friction prior to moving Consider the effects of gravity Apply basic principles of physics and body mechanics Can be Independent, Assisted or Dependent in nature ©Stanbridge University 2022 Types of Bed Mobility Hooklying (aka bridging) Rolling L↔R Scooting L ↔ R or up ↔ down Supine ↔ R or L Sidelying Supine ↔ Prone Supine ↔ Sitting EOB ©Stanbridge University 2022 Note About Assistance After explaining and demonstrating the task, ask the patient to perform as much of the movement as possible Allow them to attempt to move first. Then, observe the tasks they have difficulty with and provide assistance appropriately. Do not just do the movement for the patient. That is not therapy. The patient is not learning or improving if you do what they are physically capable of. The next slide shows scooting side to side for a patient who is unable to help. This is how you assist them. If the patient can do the movement, then have them do it. ©Stanbridge University 2022 Scooting Side to Side A. Clinician’s arm placement: 1. At neck and shoulders * No pillow beneath head 2. At midback (T4-8 region) To move the patient sideward, inch the patient from the head down to the feet segment by segment. The motion should be B. Clinician’s arm placement: in a direction parallel to the 1. Lower trunk surface of the bed. 2. Just distal to pelvis C. Clinician’s arm placement: 1. Under thighs 2. Under lower legs ©Stanbridge University 2022 Source: Pierson and Fairchild, 2018 Scooting side to side https://youtu.be/VuCXqP36oAg ©Stanbridge University 2022 Scooting up toward head of bed – Dependent or Heavy Patient Should remove the When scooting up or pillow shown here down, don’t scoot more than 6-10 inches at a time. You may use a draw sheet to move the patient up and down in bed if the patient is unable to assist with the motion or if the patient is too heavy for a singular person to lift. Please note that this picture shows a pillow beneath the patient’s head, which is not recommended. Source: Pierson and Fairchild, 2018 ©Stanbridge University 2022  Scooting down, towards feet of bed. Likely will not need to do this in bed. Can use tilt of head of bed and gravity to your advantage to have pt slide downwards. Ask the patient if they can tuck their chin to lift their head. If not, then the stronger clinician will use their arm closest to the patient’s head to support under the head and only use one arm to pull the draw sheet. Source: Pierson and Fairchild, 2018 ©Stanbridge University 2022 ©Stanbridge University 2022  Scooting Up: Method 1, higher level patient Here, the therapist removes the pillow, asks the patient to bridge in order to lift their hips. If necessary, can help the patient maintain their bridge while they are scooting up or down. Alternatively, can assist at the shoulders and head if the patient needs help. Assess where the difficulty is and assist accordingly. ©Stanbridge University 2022  Scooting Up: Method 2, Lower level patient Here, the therapist removes the pillow, and places it beneath the patient’s flexed knees. The therapist assists at the shoulders and head if the patient needs help. ©Stanbridge University 2022 Scooting Up https://youtu.be/d1o802OxENo ©Stanbridge University 2022  Therapist assists at pelvis. Patient uses arms and chin tuck. Scooting Down: Method 1 ©Stanbridge University 2022  Therapist assists at distal thighs Scooting Down: Method 2 (applying traction), pt. uses back of ©Stanbridge University 2022 head and arms on mat. Scooting Down https://youtu.be/angiwcyXXT8 ©Stanbridge University 2022  Rolling: Supine to Sidelying Hand placement: Scapula Method 1: Method 2: Secure the and Pelvis Swinging Pushing patient in Stand on side pt is rolling sidelying towards. ©Stanbridge University 2022 Supine to Sidelying https://youtu.be/7-3t9GAgluw ©Stanbridge University 2022  Supine to Prone to Supine Method 1: Arm Method 2: Arm down overhead Therapist on side that the patient is rolling towards ©Stanbridge University 2022 Supine to Prone https://youtu.be/2J_rVkYSpQU ©Stanbridge University 2022  Supine to Sit – Method 1 Estimate the space Hand placement: Lower the mat so needed Scapula and feet touch the floor Pelvis ©Stanbridge University 2022 Sit to Supine – Method 1 ©Stanbridge University 2022 Supine to Sit to Supine – Method 2 ©Stanbridge University 2022 Supine to Sit https://youtu.be/TIrYfOnCApo ©Stanbridge University 2022  Functional Mobility: Bed Mobility, Transfers & Gait Bed mobility: Everything (techniques, verbal cues, level of assistance, precautions, sitting balance) involved with getting someone repositioned in/on the bed. i.e., supine, prone, side laying, sitting EOB Transfers: Everything involved with getting someone from one surface to another. i.e., sitting to standing, sitting EOB ↔W/C, bed to gurney, bed to Hoyer lift Gait: Everything involved with a patient walking ©Stanbridge University 2022 Before Performing the Transfer Analyze transfer into component parts, i.e., position of equipment, operator of the equipment, position of patient’s body, and movements required (see Procedure 8-1) When performing a sit to stand transfer to and from a wheelchair, remove or swing away both leg rests. Prepare patient Prepare the environment Prepare yourself and other persons involved ©Stanbridge University 2022 Transfer Essentials Lock all wheels (ex: bed, wheelchair) Be alert to devices or external factors that may interfere (lines, tubes, monitors) Remain close to and guard patient properly Use proper body mechanics Use concise statements while guiding the patient and others through the transfer intervention Instruct the patient (and assist as necessary) to scoot forward to edge of sitting surface, position feet slightly behind the knees, lean trunk forward (“nose over toes”), and push off with at least one upper extremity (if able) ©Stanbridge University 2022 During the Transfer Use brief, concise one-step commands/instructions Encourage maximal mental and physical participation Use proper body mechanics Perform a safe and efficient transfer ©Stanbridge University 2022 Safety Concerns in Transfers Proper shoes (with non-skid soles) Safety belt/gait belt Be alert to the unexpected Best position for caregiver: in front or slightly to the involved side Secure lap belt, bedrail, or other protective devices Environment free of unnecessary equipment ©Stanbridge University 2022  Types of Knee Blocks with Transfers Anterior Tibial Block – Single Leg Anterior Lateral Single Leg Block - Squeeze Double Leg Anterior Tibial Block ©Stanbridge University 2022 Anterior Tibial Block – Single Leg Best block for single leg blocking Provides support to prevent buckling due to placement of the lower extremity across anterior tibia Therapist’s foot placed inside patient’s involved limb Therapist’s knee placed outside patient’s involved limb Cannot be crossed the other direction due to involved leg abducting Allows therapist to be out of the way of the patient’s body during the transfer, giving them space to lean forward Do not contact any anterior knee structures when blocking ©Stanbridge University 2022 Alternate Anterior Tibial Block - Lateral Best block for single leg blocking Provides support to prevent buckling due to placement of the lower extremity across anterior tibia Therapist’s front medial femur placed across patient’s anterior tibia Therapist’s front knee is flexed and foot outside patient’s foot Therapist’s back leg placed behind patient’s involved leg to prevent hyperextension Allows therapist to be out of the way of the patient’s body during the transfer, giving them space to lean forward and grab assistive device Do not contact any anterior knee structures when blocking ©Stanbridge University 2022 Single Leg Block - Squeeze Therapist’s thighs around patient’s medial and lateral femoral epicondyles Less commonly used Does not prevent buckling in sagittal plane Okay for higher level patients who need medial/lateral stability or stabilization in the frontal plane ©Stanbridge University 2022  Used for patients with B LE weakness/involvement Double Anterior Therapist’s feet medial to patient’s feet Therapist’s medial epicondyles lateral to patient’s knees Bilateral anterior tibial block Tibial Knee Block If knee structures are at risk of pain or skin breakdown, may place a small towel in between patient’s knees during the transfer ©Stanbridge University 2021 Sit to Stand Transfer – Dependent (Double Anterior Tibial Knee Block) ©Stanbridge University 2022 Sit to Stand Transfer – Assisted (Anterior Tibial Block – Front) Preferable for assistive devices that are unilateral or can be placed on one side during the transfer: Crutches, Canes, Lofstrand Crutches ©Stanbridge University 2022 Stand to Sit Transfer – Assisted (Anterior Tibial Block – Front) ©Stanbridge University 2022 Sit to Stand Transfer – Assisted (Anterior Tibial Block – Lateral) Preferable for devices that are bilateral, requiring both UE support: FWW, Platform Walker ©Stanbridge University 2022 Stand to Sit Transfer – Assisted (Anterior Tibial Block - Lateral) ©Stanbridge University 2022 Sit to Stand Transfer – Double Anterior Tibial Knee Block ©Stanbridge University 2022 Stand to Sit Transfer – Double Anterior Tibial Knee Block ©Stanbridge University 2022