Week 7 Mobility with Spine Precautions (Station 1) PDF

PT 704 Lab Week 7 Mobility with Spine Precautions (Station 1) Activity 1: Supine to Sit following Back Surgery (Spine / abdominal precautions) Review: Spine Precautions: No BLT i. No bending forward and backward ii. No lifting > 5 pounds iii. No twisting/rotation of the spine Orthosis Donning and...

PT 704 Lab Week 7 Mobility with Spine Precautions (Station 1) Activity 1: Supine to Sit following Back Surgery (Spine / abdominal precautions) Review: Spine Precautions: No BLT i. No bending forward and backward ii. No lifting > 5 pounds iii. No twisting/rotation of the spine Orthosis Donning and Fitting if MD order is present: • • • Some patients do not need orthosis after surgery. If the Orthosis is in place when receiving the patient supine, the Therapist must check positioning and proper fitting of the orthosis in place prior to any movement, ROM, or repositioning. If the MD Order states, “Orthotics/Orthosis at all times.” • Orthosis must be donned and properly fitted in supine, flatbed, in an anatomical position prior to any movement, ROM, or repositioning. Review: Supine to Sitting (referenced from Week 6 Lab handout) Logrolling only = shoulders, hips, and knees face the same direction throughout E.g., To get OOB on R side at initial training 1. Lower HOB. Position pt in hook-lying to “shorten” the person. 2. Instruct patient to initiate logrolling to R by gently pushing L foot off the mattress while L arm reaches across for the bedrail or EOB. • Therapist: assists at L shoulder/scapula and L pelvis to maintain a neutral spine. 3. (Preparation:) Position R elbow forward and scoot b/l ankles forward toward EOB 4. Instruct pt to push off from R elbow (keep head tucked gently) while dropping both ankles off the bed to sit up. • Therapist: one hand assists at R scapula through R axilla; another hand provides leverage at the top pelvis and scoots the femur-knee forward off EOB. 5. Upon sitting, instruct pt to support oneself with hand, feet flat on the floor to avoid excessive lordosis and truncal loading. • Therapist’s hands remain on trunk/scapula and pelvis to assist in repositioning and ensure neutral spine and proper alignment (no BLT) K Sam 1 Activity 2: Upon sitting: Positioning in Static Sitting: 1. Check to make sure the patient’s pelvis is level. 2. Patient scoots forward till feet are flat and even, the pelvis is flat and even to achieve proper spine alignment. a. typically, if the patient is in a hospital bed, it’s helpful to have the edge of the bed slightly elevated to reduce the need and workload the patient needs to exert to go from sitting to standing. b. Assistance and cues will be provided to ensure the patient's spine is straight and compliant with no BLT precautions. Orthosis Donning and Fitting if MD order is present: • • • Again, some patients do not need orthosis after surgery. If the Orthosis is in place when receiving the patient supine, the Therapist must check again to ensure proper fitting of the orthosis prior to any movement, ROM, or repositioning. If the MD order states, “Orthosis when Out-of-Bed.” o That means an orthosis is ordered for OOB activity, therapist will put on the orthosis for the patient in a static sitting at the first visit (and work toward patient's self-management). o Orthosis must be donned and properly fitted in upright sitting, feet flat on the floor, knees hip-width apart, upright posture, and chin tuck throughout the fitting procedure. Regardless, reinforce precautions in sitting through demonstration. Examples Resources: Cervical Aspen Collar in Supine and Sitting: https://youtu.be/94E3ZIH3wSE?si=IcJjf2RC6ird-WNB Spine brace in supine: https://youtu.be/uHSl2y1dIms?si=3J-x1jjuWATJKM1o K Sam 2 Gait Cycle, Stride length, Step length  Step Length – the linear distance between the occurrence of one point in the gait cycle of one foot and the same point in the gait cycle accomplished by the opposite extremity (e.g., L heel strike to R heel strike).  Stride Length –the linear distance between the occurrence of one point in the gait cycle of one foot and the recurrence of that point by the same extremity (e.g., L heel strike to L heel strike).  Gait Cycle – the time period that begins with the initial contact of an extremity and lasts until that extremity strikes the ground again (contains a stance + swing phased of each LE) stance FIGURE 14-1 Gait cycle, stride length, and step length and width Gait Pattern – Phases https://youtu.be/DP5-um6SvQI?si=sZNMRI-a9pycRw4Z Other Gait-Related Terminology:  Stance Time -the period that an extremity is in contact with the ground  Single-limb support time - the period when only one extremity is in contact with the ground  Double-limb support time  Swing time - period that an extremity is off the ground during the swing phase of that extremity  Cadence  Speed - period when both feet are in contact with the ground the number of steps taken in a given unit of time (ex: steps/sec, or steps/min) - the rate at which an individual’s locomotion covers a specific distance (ex: m/s) Common Weight-Bearing Status for Lower & Upper Extremities:  “FWB RLE” = Full Weight Bearing    No restriction to weight bearing. “WBAT RLE” = Weight-Bearing As Tolerated  As tolerated, up to full body weight  Limited by weakness, pain, balance, apprehension, etc. “50% PWB RLE” = Partial Weight-Bearing  Commonly ranged from 30% to 50%. For example, “30% PWB RLE,” “40% PWB RLE.”  Need to have a defined percentage (%) in the Physician’s order  Need MD order to clarify % if not clearly stated in the order.  Depending on the facility and surgeons, PT may default to NWB if mobility needs to be initiated. Common Weight-Bearing Status for Lower & Upper Extremities (cont.)   “TTWB RLE” = Toe-Touch Weight-Bearing; or TDWB RLE = Touch-Down Weight-Bearing  Light enough to avoid crushing a potato chip (or a raw egg) underfoot.  Primarily for balance  Can promote normal gait pattern, especially if the patient will be on restricted weight bearing for weeks or longer. “NWB RLE” = Non-Weight-Bearing  Cannot put any weight through the affected limb.  This includes not resting the foot on the ground during standing or ambulation.,