Session 15 Lab Guide PDF

Session 15 Lab Guide ==================== ### Learning Goal: Safely and effectively utilize foundational intervention strategies when working with non-complex patients #### Course Goal 8: Transfer patients effectively Teach-back Jigsaw ----------------- Puzzle pieces with solid fill**The Teach-B...

Session 15 Lab Guide ==================== ### Learning Goal: Safely and effectively utilize foundational intervention strategies when working with non-complex patients #### Course Goal 8: Transfer patients effectively Teach-back Jigsaw ----------------- Puzzle pieces with solid fill**The Teach-Back Jigsaw** **Purpose:** Utilize the Teach-Back technique to educate your patient on the upcoming intervention **Task:** In your table you will be assigned an intervention that you will **educate** your patients on. You will provide the appropriate patient education instructions and then use **Teach-Back** to ensure the patient understands what was going to happen, is clear on how they will be a part of the intervention, and answer any questions they have. **Step 1: Become An Expert.** Come together with all those in the class that have the same intervention and ensure that you have the key information that you want to transmit Puzzle with solid fill**Step 2: Become A Teacher and Listener.** Return back to your table and pair up, you will have 3 minutes to provide your education and teach back before switching roles. **Step 3: Complete the Jigsaw.** Ensure that you have reviewed all the interventions by switching partners. Remember to keep to the 3 minute timeframe per person. Special Cases Practice ---------------------- - Practice and be prepared to demonstrate a case to the class 1. **Ms. Polk is a 32y.o pt. with a SCI with paraplegia. She was recently hospitalized for severe UTI. You are transferring her from bed** to wheelchair for the first time. **Prior to this hospitalization she was I in all transfers without a transfer board; however, she reports feeling tired and is deconditioned after being in bed x5days. When you enter her room she is lying supine in the bed.** 2. **Dr. Van Buren is a 64 y.o with a R THA (posterior approach) post-op day 1. Prior to surgery, they were active and independent in all ADLs. Remind your patient of hip precautions. What else would you remind your patient NOT to do during a transfer? Why? You find your patient supine in bed with an abduction wedge and want to teach your patient to transfer from the bed to the wheelchair.** 3. **Ms. Fillmore has a complete spinal cord injury with paraplegia. She has full upper body strength and fair trunk control but recently fell out of her wheelchair hurting her right shoulder. She usually transfers from her chair to the floor using a long sitting transfer but cannot do that because of the pain in her right shoulder. Transfer her onto the mat and position her in supine.** 1. **Mr. Jackson is a 72 y.o patient who had a R CVA resulting in L hemiplegia. He has significant weakness, can bear weight but tends to buckle on his L side. Transfer your patient from wheelchair to the bed and then into supine in the middle of the mat table/bed.** 4. **Mrs. McKinley is a 39 y.o patient who had a L CVA resulting in R hemiplegia. She has significant weakness throughout her right side, but good strength on her left; her left leg is reliable in standing. This is the 3^rd^ time you are seeing her for therapy and you want to teach her bed mobility and to transfer from her bed to her wheelchair. You find her in supine on the mat table.** 5. **Mr. Tyler is a 15 y.o who fractured his ankle and is NWB on his RLE. You want to help him transfer from his wheelchair** to a desk **chair. He is an athlete and has normal strength throughout.** 6. **Mr. Adams is a 17 y.o pt. with a SCI resulting in paraplegia. She is coming to you for R shoulder pain. You are transferring her from her** wheelchair to mat table in the PT gym. 7. **Ms. Madison is a 12 y.o young woman with a spinal cord lesion resulting in paraplegia. She is small for her age but quite strong in her upper body as she was a gymnast. You want to teach her to get from the floor to her chair and this is the first time you are seeing her.** 8. **Dr. Monroe has a complete spinal cord injury with paraplegia. Dr. Monroe has full upper body strength and fair trunk control. Teach Dr. Monroe another option for transferring from the w/c to the large mat table without a slideboard.** 9. **Mr. Harrison is a 35 y.o with an spinal cord injury with paraplegia with significant weakness in all muscles below the umbilicus. He has a history of bilateral shoulder overuse injuries which have resulted in limitations of shoulder extension and abduction. You want to teach your patient to transfer from the floor to his wheelchair.** Signature with solid fillDOCUMENT THE FOLLOWING TREATMENT SESSION ================================================================= **Pt. is s/p R CVA x 2 weeks. Pt. receiving homecare PT 2x per week. Today's session included educating patient on bed mobility and educating the family on safe stand pivot transfer. Your patient was able to complete the transfer but needed reminders at least 50% of the time to move forward in the chair and to reach for the bed before sitting. During your session you work on dynamic reaching and anticipatory balance exercises.** Write a treatment note for this patient. Use acceptable and appropriate medical terminology and abbreviations be sure to document medical necessity and skilled Summary ------- - When WB through the LEs is not advised, patients can perform lateral/horizontal transfers in a seated position. - When WB through the LEs is possible, patients can perform squat- or standing-pivot transfers. - Blocking of the knees may be needed in pivot transfers. - Modifications to transfer techniques may be required for patients with unilateral WB limitations, with hemiplegia, or following THA or SCI. - Vertical transfers include the additional challenge of gravity and require good upper extremity range of motion and strength. - As patients' skill levels increase, their transfers may be able to be accomplished in one smooth movement rather than broken down into components. - There are multiple vertical transfer methods, and patients sometimes develop their own to accommodate their own particular needs. Summary Questions Special Cases Transfers ----------------------------------------- 1. If you were to position a patient with a SCI in his chair at the end of his PT session, what would you tell him? 2. When working with a patient with a R CVA, which side is it easier to come from sidelying to sitting EOB? 3. If both legs are partially reliable and one is stronger than the other, which leg would you block? 4. How would you ideally get a patient with a R THA from supine to sitting EOB? 5. If a patient has R CVA, which direction would you ideally like to transfer her when going from bed to wc? 6. If a patient can take weight on BLEs but has generalized weakness throughout what type of transfer would you recommend from wc to bed? 7. What is the difference between squat pivot and stand pivot? 8. If a patient with SCI has limited ROM in BLEs, what would be the best transfer from wc to floor and reverse? 9. If a patient with SCI has pain and limited ROM in RUE and wants to transfer from wc to floor what transfer would you recommend? 10. If a patient with SCI has pain and limited ROM in RUE and wants to transfer from wc to bed which direction would be best to transfer? Here's a breakdown of answers to each question related to patient transfers and positioning: 1\. \*\*Positioning a Patient with SCI in a Wheelchair\*\*: \- Advise the patient to ensure they are seated upright with proper lumbar support and to adjust their position as needed to avoid pressure sores. Remind them to perform regular pressure relief techniques, such as leaning side-to-side or lifting their body slightly every 15--30 minutes. 2\. \*\*Easier Side for a Patient with Right CVA to Transition from Sidelying to Sitting\*\*: \- It is typically easier for a patient with a right CVA to transition from sidelying to sitting on the \*\*left side\*\* (strong side), as they can use their unaffected side to help push up. 3\. \*\*Which Leg to Block if Both Legs are Partially Reliable, with One Stronger than the Other\*\*: \- Block the \*\*weaker leg\*\* to provide stability and support while allowing the stronger leg to assist in the transfer. 4\. \*\*Getting a Patient with a Right Total Hip Arthroplasty (THA) from Supine to Sitting EOB\*\*: \- To avoid hip flexion beyond 90 degrees and rotation, have the patient log-roll onto their left (non-surgical) side, then use their arms to push up to sitting while keeping their right leg extended. 5\. \*\*Ideal Transfer Direction for a Patient with Right CVA from Bed to Wheelchair\*\*: \- Transfer toward the \*\*left side\*\* (stronger side), so the patient can assist more with their unaffected side. 6\. \*\*Transfer Type for a Patient with Generalized Weakness but Able to Bear Weight on Both Legs\*\*: \- A \*\*squat pivot transfer\*\* is recommended. This allows the patient to support some of their weight with the legs while minimizing the need for a full stand. 7\. \*\*Difference Between Squat Pivot and Stand Pivot\*\*: \- \*\*Squat Pivot\*\*: Patient remains in a partial squat, not fully standing. It's used for patients with limited strength or stability. \- \*\*Stand Pivot\*\*: Patient fully stands before pivoting to the destination surface, providing more independence but requiring more strength. 8\. \*\*Best Transfer from Wheelchair to Floor and Reverse for SCI with Limited ROM in BLEs\*\*: \- An \*\*anterior-posterior (A-P) transfer\*\* is best, allowing the patient to maintain control and avoid extensive leg movement that might exceed their range of motion. 9\. \*\*Best Transfer from Wheelchair to Floor for SCI with Pain and Limited ROM in Right Upper Extremity (RUE)\*\*: \- A \*\*side transfer toward the left\*\* would reduce strain on the right arm and shoulder, which may be uncomfortable or limited in range. 10\. \*\*Best Transfer Direction for a Patient with SCI and Pain/Limited ROM in RUE from Wheelchair to Bed\*\*: \- Transfer toward the \*\*left side\*\* to minimize the use of the right arm and reduce strain on the painful side. EXTRA PRACTICE: SELECT THE MOST APPROPRIATE TRANSFER ---------------------------------------------------- After reviewing each case, use the clinical reasoning flow chart to determine the safest and most appropriate transfer for your patient. Be prepared to provide your rationale. 1. Your patient is 37 y.o 101lb female who is semi-comatose and unable to participate in the transfer from bed to gurney. You and 2 other assistants need to move the patient back into the bed. 2. Mr. Z is a 75 y.o with dx of CA, which has left him very weak and unable to sit up, roll over or move in bed. He can lift his head and follow directions. He needs to be transferred to a gurney to be transported for additional tests. You have two assistants. 3. Ms. L an 85 y.o pt. is in the hospital following a recent L CVA. He has significant weakness throughout his R side including his RUE and RLE. The patient has to be moved from the bed to a gurney and you have two assistants. The patient is obese. The patient is unable to move in bed because of weakness and paralysis. The patient understands what you are saying but is unable to respond verbally. 4. **You are working with a 39 y.o patient who weights 320 lbs and is 5'9" (BMI=47.3). He is deconditioned and has significant weakness in BLEs and BUEs. You have the assistance of 2 CNAs if you need.** 5. **Mr. G is a 73 y.o 1 day s/p R TKA. You are getting him OOB** to chair for the first time. You need to get him to the w.c. for transport to the physical therapy gym. While he is cleared medically for WBAT, he is extremely fearful and refuses to put any weight on his RLE.