Special Cases Lab Guide(students) PDF

Session 7: Positioning, Draping, and Bed Mobility Lab for Special Cases ======================================================================= ### Learning Goal: Think Like A PT #### Course Goal \#3: Document effectively using appropriate medical terminology ### Learning Goal: Safely and Effecti...

Session 7: Positioning, Draping, and Bed Mobility Lab for Special Cases ======================================================================= ### Learning Goal: Think Like A PT #### Course Goal \#3: Document effectively using appropriate medical terminology ### Learning Goal: Safely and Effectively Utilize Foundational Intervention Strategies When Working with Non-Complex Patients #### Course Goal \#5: Use principles of biomechanics to inform decision making in movement and injury prevention #### Course Goal \#6: Position and drape patients appropriately #### Course Goal \#7: Demonstrate proper bed mobility techniques #### Course Goal \#13: Implement effective ROM and stretching interventions for non-complex patients REMINDERS: ---------- +-----------------------------------+-----------------------------------+ | **[Short-Term | **[Long-Term | | Positioning]** | Positioning]** | +===================================+===================================+ | **Key Points to Remember:** | **Key Points to Remember:** | | | | | **Short-term consider: Safety, | **Long-term consider: Safety, | | Comfort, and Access,** | Comfort, Prevention** | | | | | | **Don't forget to check | | | S.P.A.C.E** | +-----------------------------------+-----------------------------------+ | **[Short Term Positioning | **[Long Term Positioning | | Checklist]** | Checklist]** | | | | | - Patient **safety** | - Clear airway | | | | | - Good spinal alignment | - Good spinal alignment | | | | | - **Accessibility** of | - Minimized pressure over bony | | necessary areas of the body | prominences | | | | | - Trunk and extremities | - Minimized gravity creating | | supported for **comfort** | shearing forces | | | | | - Positioned well within | - Cushioned support surfaces | | **environment** (line of | | | sight, communication, etc.) | - Immobile extremities elevated | | | | | - **Special needs** | - Joint and soft-tissue | | accommodated | contractures prevented | | | | | - Has a **means to | - Trunk and extremities | | communicate** or call for | supported and stabilized | | help | | | | - Long-term functional | | | positions | | | | | | - Positioned to optimize | | | interaction with the | | | environment (line of sight, | | | communication, etc.) | | | | | | - Special needs accommodated | | | | | | - Safety | | | | | | - Normal spinal alignment | | | | | | - Prevent pressure ulcers | | | | | | - Prevent edema and | | | contractures | +-----------------------------------+-----------------------------------+ Quantifying the Amount of Assistance ------------------------------------ [SPECIAL CASES LAB ] ================================ 1. **Ernie** is s/p R THA (posterior approach). He is eager to get back to golfing and he lives in a senior living community. Currently his pain is getting better and he rates it at 3/10 when he moves. Ernie is in bed when you arrive. Your goals for therapy today are to 1) teach Ernie his hip precautions; 2) work on bed mobility activities from supine in the middle of the bed toward the edge of the table and 3) perform ankle and knee range of motion exercises in supine in bed so you want to drape him appropriately. Bed Mobility ----------------- -- Positioning Draping Range of Motion 2. **Oscar** is s/p L CVA resulting with R hemiplegia. He has trouble moving around in the bed and getting out of bed but once in sitting he has fair sitting balance. His goal is to get back to playing poker with his friends. He is supine in bed and your goal is to work on some R UE range of motion to help him with ADLs. Before you leave the session, you want to reposition him in side-lying toward supine so he can rest. Be sure to explain to Oscar's spouse why you are positioning him the way you are (what are you trying to accomplish?) Bed Mobility ------------------- -- Positioning Draping Patient Education Range of Motion 3. **Gonzo** was crowd surfing, fell and sustained a SCI with paraplegia. He is eager to go home and rejoin his band. He is working hard in rehab to learn how to get in and out of bed on his own but he still needs approximately 50% assistance. He has a tight R pec major muscle so you plan to stretch and then do some massage with lotion. He reports his buttocks is sore from being in bed and you want to work on his ability to lay prone for a prolonged hip and knee stretch and pressure relief. Bed Mobility ------------------- -- Positioning Draping Patient Education Stretching 4. **Miss Piggy** is s/p MVA and subsequent traumatic L transtibial amputation. You are working on strength and mobility in preparation for her to receive her prosthesis. She reports no pain and she did all the exercises you prescribed yesterday with the help of her spouse. When you arrive she is supine in bed, you perform hamstring stretches with appropriate draping. You also want to provide her with patient education about common contractures for patients with transtibial amputations. She asks you what would be the best position to help prevent those contractures so you work with her on positioning to decrease contractures for periods of the day. Bed Mobility ------------------- -- Positioning Draping Patient Education Stretching [ ] 5. **Kermit** is s/p prolonged ICU stay with intubation, he has recently been transferred to the medical floor but is very deconditioned and weak. You are working on strength and mobility in preparation for him to go home, he is able to initiate movement but is unable to complete movement fully against gravity. You want to work on helping him with his L hip flexion range of motion as he is working toward walking in the parallel bars. He is in a hospital gown. After your range of motion you want to position him in sidelying toward prone so he can rest. His partner is interested in helping with positioning at home and wants to know what to watch for when helping position him as well as how often to move him. Bed Mobility ------------------- -- Positioning Draping Patient Education Range of Motion Summary Questions ================= 1. What are the most common contractures experienced by patients with Transtibial amputations (TTA)? 2. What are the movement restrictions for patients with THA with posterolateral approach? 3. Why do patients with a THA anterior approach often have no restrictions while those with a posterior approach have significant restrictions? 4. If you are having a patient with a THA posterior approach moving to sitting EOB, if they had a choice which direction would you most like them to move to maintain hip precautions? 5. Besides moving the operated leg into adduction, how else might a patient with a THA posterior approach break precautions when moving in bed? 6. Common contractures in patients post CVA? 7. One thing you should NEVER do when working with a patient post CVA? 8. Is it easier for a patient post CVA to come to sitting EOB from weaker or stronger side? 9. How would you teach a patient post CVA to get his leg up onto the bed when moving from sitting EOB to sidelying? 10. What can a patient post CVA do to get better leverage when using her strong arm to lower herself to the bed on the weaker side? 11. How would you teach a patient with a SCI to roll in bed? 12. What movements would you tell a patient with PSF to avoid? Here are detailed responses to your questions regarding various patient conditions and rehabilitation considerations: 1\. \*\*Common Contractures in Patients with Transtibial Amputations (TTA)\*\*: \- \*\*Knee Flexion Contracture\*\*: The most common contracture due to prolonged sitting and improper positioning. \- \*\*Hip Flexion Contracture\*\*: Often occurs if the patient does not maintain hip extension while seated or lying down. \- \*\*Abduction Contracture\*\*: Can develop due to poor positioning, especially if the residual limb is not properly supported. \- \*\*External Rotation of the Hip\*\*: May also be observed if the limb is not properly aligned during sitting or lying. 2\. \*\*Movement Restrictions for Patients with Total Hip Arthroplasty (THA) Using the Posterolateral Approach\*\*: \- \*\*Hip Flexion\*\*: Restricted to less than 90 degrees. \- \*\*Hip Internal Rotation\*\*: Should be avoided. \- \*\*Hip Adduction\*\*: Avoid crossing the legs. \- These precautions help prevent dislocation of the hip joint after surgery. 3\. \*\*Differences in Restrictions Between THA Anterior and Posterior Approaches\*\*: \- \*\*Posterior Approach\*\*: Involves cutting through muscles and ligaments that stabilize the hip joint, making it more prone to dislocation. This requires more stringent precautions. \- \*\*Anterior Approach\*\*: Preserves more of the surrounding soft tissue and muscles, leading to a lower risk of dislocation, allowing for fewer restrictions. 4\. \*\*Preferred Direction for THA Posterior Approach When Moving to Sit EOB\*\*: \- \*\*Move the Operated Leg Out to the Side\*\*: Moving the leg to the non-operated side (abducting the leg) is preferred to maintain hip precautions and avoid risk of dislocation. 5\. \*\*Other Ways Patients with THA Posterior Approach Might Break Precautions When Moving in Bed\*\*: \- \*\*Rolling Towards the Operated Side\*\*: This can cause hip flexion and internal rotation, violating precautions. \- \*\*Sitting Up with the Operated Leg Crossed Over the Non-Operated Leg\*\*: This compromises the adduction and flexion precautions. 6\. \*\*Common Contractures in Patients Post-CVA\*\*: \- \*\*Shoulder Flexion and Adduction\*\*: Due to spasticity and weakness. \- \*\*Elbow Flexion Contracture\*\*: Often occurs from muscle imbalances. \- \*\*Wrist Flexion Contracture\*\*: Can develop due to poor positioning and muscle tone. \- \*\*Hip Flexion and Adduction\*\*: Can occur from prolonged positioning or spasticity. \- \*\*Knee Flexion Contracture\*\*: Commonly observed in affected legs. 7\. \*\*One Thing to NEVER Do When Working with a Patient Post-CVA\*\*: \- \*\*Never Use the Affected Limb as a Stabilizer\*\*: This can lead to further injury or poor motor patterns. Always encourage the use of the strong side for stabilization. 8\. \*\*Easier Side for a Patient Post-CVA to Come to Sitting EOB\*\*: \- \*\*Stronger Side\*\*: It is generally easier for a patient to come to sitting EOB from the stronger side due to better control and strength, which aids in the transfer. 9\. \*\*Teaching a Patient Post-CVA to Get the Leg onto the Bed When Moving from Sitting EOB to Sidelying\*\*: \- Instruct the patient to lean back slightly and use their strong leg to help push the weaker leg up onto the bed. \- They can also use their arms for leverage, pushing off the bed with their strong arm while guiding the weaker leg up. 10\. \*\*Improving Leverage for a Patient Post-CVA Using a Strong Arm to Lower Themselves to the Bed on the Weaker Side\*\*: \- \*\*Shift Weight\*\*: Encourage the patient to shift their weight towards the stronger side before lowering. \- \*\*Use a Pivot Technique\*\*: They can pivot around their stronger arm for better leverage. \- \*\*Incorporate Upper Body Strength\*\*: Use the strong arm to help control the descent while stabilizing with the stronger side. 11\. \*\*Teaching a Patient with SCI to Roll in Bed\*\*: \- Instruct the patient to bring their knees up toward their chest. \- They should then use their arms to reach across their body while pushing through their elbows to initiate the roll. \- Utilize a head-hips relationship, turning their head in the direction they want to roll while simultaneously bringing their hips in the same direction. 12\. \*\*Movements to Avoid for a Patient with Postural Stability Dysfunction (PSF)\*\*: \- \*\*Avoid Rapid Movements\*\*: Sudden or jerky movements can compromise stability. \- \*\*Avoid Excessive Forward Bending\*\*: This can lead to loss of balance and falls. \- \*\*Avoid Standing on Uneven Surfaces\*\*: Increases the risk of instability and falls. These considerations are crucial for effective rehabilitation and safety for patients recovering from these conditions.