Transcript Patient Mobility and Activity Description: Technical Contact: This course will describe and demonstrate safe patient mobility and activity.

Patient Mobility and Activity
Description:
Technical Contact:
This course will describe and demonstrate
safe patient mobility and activity. It will take
approximately 60 minutes to complete this
course.
If you have technical
questions please contact
the Service Desk at
414-647-3520 in Milwaukee
or 1-800-889-9677.
Content Contact:
Features:
Elizabeth Malanowski, PT
• Instructions on how to navigate this course
• This course includes videos that do have
sound. Please complete it at a computer
with speakers and a headset or earbuds.
Physical Therapist, AWAMC
Lila Daut, OTR
Supervisor, Rehab Services, AWAMC
Donna Harry, OTR
Coordinator, Rehab Services, ASLMC
Created: 6/2014
Reviewed:
© Aurora Health Care, Inc.
Disclaimer
This is a review of patient mobility and activity, including
body mechanics practices, and basic transfer techniques.
This is not intended to take the place of in-person, handson experience or updated information through your
instructor or on-site mentors.
© Aurora Health Care, Inc.
RR
Nursing Students- Adjustment to Powerpoint
Some links will not work- those that refer to FYWB can be
accessed thru our Patient Education site
The reference to Egress Testing can be found in EPIC under
Daily Cares-Mobility
Reference to Level of Assistance and Suggested Equipment
Chart is found adjacent to Powerpoint
© Aurora Health Care, Inc.
Learning Objectives
The audience for this course includes all caregivers that
assist patients with mobility.
After completing this course you will be able to:
• State good body mechanics while assisting patients with
mobility
• Identify equipment used for safe and effective activity and
mobility
• Define proper preparation required for safe patient activity
• Describe general transfer and mobility techniques
• Identify special considerations for common diagnostic
groups
© Aurora Health Care, Inc.
Importance of Taking this
Course
It is important that all caregivers that assist patients with
mobility and activity do so in a safe and effective manner.
This will help to:
•
•
•
•
Decrease caregiver injuries
Maintain a safe patient environment
Promote patient independence
Increase patient and caregiver satisfaction
© Aurora Health Care, Inc.
Safe Patient Handling
When assisting a patient with or without equipment, it is
important for the caregiver to understand proper body
mechanics for assisting the patient, and to follow current
Aurora guidelines for safe patient handling.
This course will present the best way to guide your
patient’s mobility. Whether assisting a patient with or
without equipment, always encourage the patient to be
actively involved by using their own abilities to do as much
of the movement as possible. By allowing this, it will move
the patient towards independence and decrease the
workload and increase safety for the caregiver.
© Aurora Health Care, Inc.
Posture
The spine has four curves (two
inward lordotic curves at the
cervical and lumbar areas and
two outward kyphotic curves at
the thoracic and sacral pelvic
areas)
• When these curves are in good
alignment, your weight is
supported by the bones which
decreases stress at joints,
ligaments and muscles
• Loss of these curves can lead
to injury
© Aurora Health Care, Inc.
Body Mechanics – Preparation
It is important to be prepared for safe patient handling
• Wear non-slip, supportive shoes
• Have a clear pathway
• Maintain a wide base of support for stability
• Use a gait belt
• Click on the link below and review the FYWB:
– Body Mechanics (x15523 r78)
© Aurora Health Care, Inc.
Body Mechanics
• Tighten your abdominal muscles and maintain a neutral
spine by avoiding bending forward, backward or twisting
at your spine
• Keep the object or person you are assisting close to your
body
• Position yourself at the level of the object/person you are
assisting by bending your hips and knees
• Squeeze your buttocks and push with your legs as you
assist, maintaining your neutral spine
The next slide shows two pictures of good body mechanics
while assisting the patient with bed mobility and transfers
© Aurora Health Care, Inc.
Good Body Mechanics
© Aurora Health Care, Inc.
Use of a Gait Belt
A gait belt should be used with patients needing
assistance or supervision with transfers and ambulation.
1. Place the belt with the buckle in front of the person’s midsection, tooth side facing outward (in the case of abdominal
incisions, lines or drains at mid-section, place belt under
armpits)
2. Feed metal tipped end through the tooth end of the buckle
and pull until snug so the teeth secure it
3. Feed the remainder of the metal tipped end through the
hole portion of the buckle
4. Tighten it until snug, but maintain comfort
© Aurora Health Care, Inc.
Use of a Gait Belt –
Additional Tips
• Hold onto belt at all times when assisting the person to
transfer or when walking
• Place your hand under the belt, palm side up using a firm
grasp. Stand behind and to the side of the person
• Check with rehab provider regarding specific instructions
on walking or transferring someone
• Click on the link below and review the FYWB:
– Use of a Transfer/Gait Belt (PE-2244-88)
© Aurora Health Care, Inc.
General Mobility – Safety
Check
• Be familiar with any precautions relating to the admitting
diagnosis
• Assess movement and general strength in all 4 extremities
• Know the motivation level of the patient
• Know if the patient has any comprehension or direction
following deficits
• Allow the patient time to move on their own before
assisting them
• The Egress test is a great place to start when you don’t
know the patient’s functional mobility status
– Click here to access the First Time Up Egress Assessment
from the Falls Prevention website
© Aurora Health Care, Inc.
Bed Mobility and Transfers – Use
of a Friction Reducing Device
When assisting patients with bed mobility and transfers it is
often helpful to use a friction reducing device (ie) Patran.
Common uses include:
• Turning the patient – place the
Patran under the sheet/chux,
then utilize this to slide and
weight shift the patient onto
their side
• Repositioning – encourage the
patient to help as much as
possible
© Aurora Health Care, Inc.
Bed Mobility and Transfers – Use
of a Friction Reducing Device
Other uses include:
• Boosting in bed – have the patient help by bending their
knees and pushing themselves up
• Lateral transfers – complete in small steps not one big
move
• Assisting the patient to the edge of the bed – place the
Patran under the patients buttocks and assist them in
scooting to the edge of the bed
© Aurora Health Care, Inc.
Friction Reducing Device –
Patran
Safety
• Keep a barrier (sheet, chux) between
the patient’s skin and the Patran
• Always keep the Patran one hand
length away from the edge of the
bed to prevent the patient from
sliding off of the bed
• Do not use to lift patient, but rather to
slide patient
• Do not leave under the patient in
bed, patients can slide down to the
bottom of the bed if the Patran is left
under them
• Bariatric patients – use a Hovermatt
© Aurora Health Care, Inc.
Bed Mobility
The following slides will review helpful tips for assisting
patients to move in bed
© Aurora Health Care, Inc.
Getting Ready
• Adjust the bed height to caregiver’s waist height
• Consider deflating the mattress at least part way
• Have the patient help by:
– Bending their knees so that their feet are flat on the bed
– Turning their head in the direction they are moving/rolling
– Reaching for the side rail in the direction they are
moving/rolling
© Aurora Health Care, Inc.
Boosting
• Place a friction reducing device (ie) Patran, with a draw
sheet/chux covering it, under the patient
• Position the bed on a slant where the head of the bed is
lower than the feet, if not medically contraindicated
• Cue the patient to assist with boosting
© Aurora Health Care, Inc.
Technique 1 for Safe Boosting
1. Encourage the patient to assist in boosting by bending their
knees so their feet are flat on the bed
2. Patient to push/slide themselves up to the head of the bed
(aided by the friction reducing device) by straightening their
knees. If able, encourage patient to use the bed rails
3. Caregiver can stabilize the patient by holding their ankles
© Aurora Health Care, Inc.
Technique 2 for Safe Boosting
1. One caregiver stands on each side of the bed
2. With the friction reducing device in place, grasp the sheet/
chux at the shoulders and hips of patient
3. Weight shift and take a step as you slide the patient towards
the head of the bed; do not lift
© Aurora Health Care, Inc.
Technique 3 for Safe Boosting
1. Two caregivers both stand at the head of the bed
2. With the friction reducing device in place, grasp the
sheet/chux at the head and shoulders of patient and slide
patient towards the head of bed
© Aurora Health Care, Inc.
Assisting the Patient from
Supine to Sit
Have the patient help by:
•
•
•
•
Bending their knees so their feet are flat on the bed
Reaching for the rail, rolling onto their side
Bringing their legs off the bed
Pushing up onto the elbow they are laying on into a sitting
position
Caregivers can guide the patient from the upper trunk/rib area
– never pull on their arms or neck
© Aurora Health Care, Inc.
VIDEO: Assisting the Patient from
Supine to Sit
Click the screen below to watch a short video demonstrating
how to assist the patient from supine to sit
Note: maximize the volume to hear the speaking
© Aurora Health Care, Inc.
Assisting Patient to the Edge
of the Bed in Sitting
• Place yourself in front of the patient
• Have the patient help by:
– Shifting their weight onto one hip
– Bringing the other hip forward
– Repeating until their feet are flat on the floor
• Caregivers can assist the patient at their hip and under their
thigh, utilizing a friction reducing device between the bed
sheet and draw sheet/chux, if needed
© Aurora Health Care, Inc.
VIDEO: Assisting the Patient to the
Edge of the Bed in Sitting
Click the screen below to watch a short video demonstrating
how to assist the patient to the edge of the bed in sitting
Note: maximize the volume to hear the speaking
© Aurora Health Care, Inc.
Assisting a Patient in Lying Down
from Sitting at the Edge of Bed
• Make sure the patient is sitting on the upper half of the bed
close to their pillow
• Have the patient help by:
– Scooting their hips back onto the bed so they are
supported well and will not slide off the bed
– Leaning to the side down onto their elbow
– Lowering their head to the pillow
– Bringing their legs up onto the bed
• Caregivers can assist as needed
• Utilize a friction reducing device for repositioning the patient,
if needed. Do NOT leave the Patran under the patient when
alone in the bed
© Aurora Health Care, Inc.
VIDEO: Assisting the Patient to
Lie Down from Sitting at the Edge
of the Bed
Click the screen below to watch a short video demonstrating
how to assist the patient to lie down from sitting at the edge
of the bed
Note: maximize the volume to hear the speaking
© Aurora Health Care, Inc.
Transfers
The following slides will review helpful tips for transferring
patients to/from bed and chair
© Aurora Health Care, Inc.
General Transfer Instructions
• Assist or instruct patient to scoot to the edge of the chair or
bed
• Apply the gait belt for safety
• If the patient uses a walker or crutches, stand to the side of
the patient
• Assist or instruct patient to place feet flat on the floor,
tucked underneath
• If it is your first time moving the patient and depending on
the results of the Egress test:
– If minimal assist or less, position yourself to the side of the
patient and place one hand on the gait belt and the other
hand guarding at the front of the shoulder
– If more than minimal assist is needed, use lift equipment
© Aurora Health Care, Inc.
General Transfer Instructions continued
Have the patient help by:
• Pushing with their arms from chair or the bed to stand,
counting to three as needed
• Bending forward and pushing through their legs to stand,
then putting their hands on the walker/cane/crutches, if used
• Turning their feet by taking small steps until they are in front
of the chair/bed with their legs touching the bed/chair
• Reaching their hands back to arm rest/bed surface
• Bending forward and lowering their body down to a sitting
position
• Scooting their buttocks back away from the edge
© Aurora Health Care, Inc.
VIDEO: Assisting the Patient to
Transfer from Bed to Chair
Click the screen below to watch a short video demonstrating
how to assist the patient to transfer from bed to a chair
Note: maximize the volume to hear the speaking
© Aurora Health Care, Inc.
General Transfer Instructions continued
If the patient has knee
instability, you may need to
stand in front of the patient
and block their knee with
your knees.
This technique will require
you to place two hands on
the gait belt.
© Aurora Health Care, Inc.
Slide Board Transfers
The therapist may recommend that the patient use a slide
board for safe transfers.
Tips for bed to wheelchair transfer:
1. Assist the patient to scoot forward on the bed and position
their feet flat on the floor.
2. Position the wheelchair on the patient’s stronger side.
Lock brakes. Remove leg rests and the armrest closest to
the bed.
3. Position the slide board under patient’s hip with chux/
Patran on top to avoid friction of patient’s skin. The other
end of the board should be placed on the wheelchair.
© Aurora Health Care, Inc.
Slide Board Transfers continued
Tips for slide board transfers: (continued)
4. Assist patient to lean slightly forward to unweight the
buttocks. Make sure patient has hands and fingers on the
top of the slide board and eventually reaches to the arm
rest to assist with sliding along the board.
5. Continue the slide sequence until the patient has fully
transferred to the chair. Make sure the patient is stable
and secure. Remove the slide board and replace the
armrest.
6. If moving to a commode or returning to bed, utilize the
same process
© Aurora Health Care, Inc.
VIDEO: Assisting the Patient with
a Slide Board Transfer
Click the screen below to watch a short video demonstrating
how to assist the patient to transfer from bed to a chair using
a slide board
Note: maximize the volume to hear the speaking
© Aurora Health Care, Inc.
Walking
The following slides will review helpful tips for walking
patients
© Aurora Health Care, Inc.
Walking with a Patient
•
•
•
•
•
Apply gait belt
Stand on the weaker/surgical side of the patient
Always hold the gait belt when walking a patient
Walk at the patient’s speed
Monitor how the patient is feeling: looking at dizziness,
SOB, perspiration, fatigue, and weakness
• Start out with short distances to assess for safety
• Use the device/equipment/assistance recommended in the
Patient Story Tips from PT/OT in EPIC if receiving therapy
© Aurora Health Care, Inc.
Walker and Crutches
Instruction
•
•
•
•
Advance walker or crutches
Step first with the surgical/weak/painful leg
The stronger, less painful leg steps last
Remind the patient:
– Not to carry anything in their hands when using a walker or
crutches.
– Not to hold onto the walker or crutches when they stand up – it
may tip over. Instead, push up from the surface they are sitting
on.
– To follow all weight bearing/movement precautions
© Aurora Health Care, Inc.
Walker Tips
Additional tips for using a walker:
• Cue patients to stay within the frame of the walker
• Don’t allow them to lean on the walker
• Don’t allow them to push the walker too far ahead of their
base of support
© Aurora Health Care, Inc.
Cane Tips
Additional tips for using a cane:
• Canes should be used in the hand on the opposite side of
the surgical/weaker/painful leg
• Sequence for walking with a cane:
1. Cane
2. Weak leg
3. Strong leg
© Aurora Health Care, Inc.
Lift Equipment
The following slides show some of the lift equipment you
may encounter. Your site may have different equipment.
Prior to using any lift equipment, you must be trained by
your unit’s/site’s Transfer Mobility Coach.
© Aurora Health Care, Inc.
Benefits of Lift Equipment
Benefits include:
• Decreases caregiver and patient injuries
• Decreases compensation and liability costs of injured
workers
• Increases comfort and feelings of security for patients
• Increases activity for patients getting them up and out of
bed
• Encourages patients to assist and participate in transfers
Click here and review the Level of Assistance and
Suggested Equipment chart
© Aurora Health Care, Inc.
Lift Equipment and Patient
Progression
In many cases when using lift equipment, whether with
nurses, therapists, or other caregivers, the patient can be
encouraged to be actively involved
• For example when using a sit to stand device, the patient
should rely on as much of their own strength for the transfer,
with the equipment being used as a safety net for both the
patient and the caregiver
• Lift equipment can be utilized as a patient energy saving
device by using the equipment to get the patient to the
bathroom or out into the hall for more functional tasks
• In these examples lift equipment is used as one step toward
independence, just like a walker or a cane
© Aurora Health Care, Inc.
Non-Motorized Sit to Stand –
Minimal Assist Device – Stedy,
Sprite
Used for patients who fatigue easily, are light-headed, or
experiences knee buckling
Patient must:
• Be able to follow directions
• Be able to perform 75% of the transfer
• Weigh less than 265 lbs
© Aurora Health Care, Inc.
Motorized Sit to Stand – Encore,
Sara Plus, Sabina II (name varies
by site)
The patient must:
• Be able to stand on at least one leg
• Be able to follow directions
• Be able to complete 50% of the
work of a sit to stand
• Weigh less than 420 lbs
Bariatric Encore is named the EZ stand
(800 lbs limit)
© Aurora Health Care, Inc.
Total Lift – Opera, Maximove,
Golvo (name varies by site)
Used for patients who require moderate to total assist
The patient must:
• Be able to tolerate a semi-reclined
position
• Weigh less than 440 lbs
Bariatric total lift devices are called the
EZ lift, Tenor or Viking
• Check the equipment’s weight limit prior
to use
© Aurora Health Care, Inc.
VIDEO: Assisting the Patient
using Lift Equipment
Click the screen below to watch a short video demonstrating
how to assist the patient using lift equipment
Note: maximize the volume to hear the speaking
© Aurora Health Care, Inc.
The Importance of Activity
The purpose of activity in the acute care setting is to:
•
•
•
•
•
•
•
•
•
•
Prevent functional decline
Reduce delirium
Lower anxiety
Decrease depression/improve mood
Improve blood counts with cardiovascular activity/walking
programs
Lower fatigue and pain
Decrease risk for osteopenia with weight bearing exercise
Maximize patient independence
Prevent re-admissions
Improve the patient experience
© Aurora Health Care, Inc.
Simple Activity Ideas
•
•
•
•
•
•
•
•
•
Get up in a chair to eat meals
Utilize the bathroom when patients can safely walk
Perform self cares up in a chair or at the sink
Change position every 2 hours
Allow the patient to reposition self in bed as much as
possible
Encourage walks
Encourage leg and arm exercises in the chair or the bed
Encourage patients to spend time out of the room when
they are safe to do so
If your patient is receiving therapy, refer to the Therapy Tips
section in Patient Story for additional activity ideas
© Aurora Health Care, Inc.
General Mobility Safety
•
•
•
•
•
•
•
Always use a gait belt
Lock the bed and chair
Have 2 caregivers present the first time helping a patient up
If a patient needs an assistive device to walk – always use it
Don’t rush – allow time for the patient to help
Watch for orthostatic hypotension issues
If a patient has cognitive impairments do not leave them
alone in the bathroom or on the commode
• Consider asking for a therapy consult if your patient has
mobility/safety issues
© Aurora Health Care, Inc.
Therapy Roles – Physical
Therapy
Physical Therapists and Physical Therapist Assistants
(PT, PTA) work with people to improve:
•
•
•
•
•
Strength
Endurance
Balance
Mobility: walking, stairs, in and out of bed and chairs
Pain management
Specializations Include:
• Arranging for prosthesis or orthotic device, such as a leg
brace
• Vestibular assessments (possible cause of dizziness)
© Aurora Health Care, Inc.
Therapy Roles – Occupational
Therapy
Occupational Therapists and Occupational Therapy
Assistants (OT, OTA) work with people to improve
independence with meaningful daily tasks, such as:
•
•
•
•
Bathing and dressing
Toileting
Household mobility (tub, toilet, car transfers)
Home management (meal preparation, laundry)
Specializations include:
• Vision (low vision, visual perceptual issues)
• Splinting and hand/upper extremity therapy (strengthening,
coordination)
• Cognition (addressing cognitive issues during function)
© Aurora Health Care, Inc.
Therapy Roles – Speech Therapy
Speech Therapists, also called Speech Language
Pathologists (ST or SLP) work with people to improve:
•
•
•
•
Communication
Thinking skills
Memory
Swallowing
Specializations include:
• Facial neuromuscular re-education
• Voice quality and clarity
• Accent reduction
© Aurora Health Care, Inc.
Therapy Roles – Therapeutic
Recreation and Therapy Aides
In some settings you may encounter:
Therapeutic Recreation Specialists (TR) who work with
people to improve:
• Independence through adaptive leisure activities, including
aquatics
• Re-integration into the community
Rehab Therapy Aides, whose role involves:
• Preparing patients for therapy, including transporting
patients and setting up devices
• Assisting with therapy treatments
© Aurora Health Care, Inc.
Skilled Therapy
Skilled therapy is appropriate when the patient and/or
family is ready to learn and will benefit from what is
needed to take him/her to a new level of function or
independence. The patient needs to show progress in
each therapy session. Examples include:
• Patient needs to learn use of ambulation device for the
first time
• Patient has new onset of weakness, balance, ADL
decline or cognitive or swallowing deficit
• New onset of stroke or other neurological event
• New surgery requiring therapy intervention to recover
(TKR, THR)
© Aurora Health Care, Inc.
When Skilled Therapy is Not
Needed
Examples of when skilled therapy is not needed:
• Requires repetitive cues or help and no real change is
anticipated for completion of ADLs or mobility
• Has long-standing cognitive impairment
• Passive ROM
• Repetitive tasks to maintain a level of function
When the person’s functional ability and skill level requires
only guidance to maintain their current level of function,
skilled therapy is no longer needed. Family or nursing
carry-over is important to maintain the patient’s current
level of function.
© Aurora Health Care, Inc.
Specific Diagnoses Tips
Click on the appropriate diagnoses below to learn more
specific mobility/activity tips. When you are done with that
diagnosis, you will be directed back to this slide to chose
another diagnosis.
•
•
•
•
•
Lumbar/cervical spine surgery
Hip/knee surgery
Abdominal surgery
Lower extremity amputation
Stroke
• Parkinson disease
• Spinal cord injury
• General weakness/frail
elderly
• Bariatric
• Oncology
© Aurora Health Care, Inc.
Lumbar Spine Surgical
Precautions and Tips
1.
2.
3.
4.
5.
Do not cross legs
Do not twist trunk
Do not bend forward at waist past 90 degree angle
Use log roll technique
Avoid having patients sit in low chairs to avoid extreme
bending when sitting or standing
6. Patients may have a lumbar brace ordered for back
support after surgery. Follow surgeon’s orders.
7. Use ADL equipment for dressing and item retrieval to
avoid bending forward. Therapy will help to assess and
order this.
© Aurora Health Care, Inc.
Lumbar Spine – Log Roll
Technique
1. Bend knees so feet are flat on bed
2. Roll onto side with shoulders, hips, and knees rotating at
same time
3. Drop feet off bed once in side lying and push to sit up
4. Reverse process to return to supine position
© Aurora Health Care, Inc.
VIDEO: Assisting the Patient to
Log Roll
Click the screen below to watch a short video demonstrating
how to assist the patient to log roll
Note: maximize the volume to hear the speaking
© Aurora Health Care, Inc.
Cervical Spine Surgical
Precautions
• Avoid any neck twisting, tilting, nodding or extension
• Perform log roll for bed mobility to avoid straining at neck
• Patients may have hard or soft cervical collars ordered for
neck support. Follow surgeon’s orders.
• Remind patients to use squat technique to pick up objects
to avoid bending forward
• Use straws for drinking to avoid neck extension
Click here when done
© Aurora Health Care, Inc.
Posterior Total Hip Replacement
(THR) Precautions
To prevent the hip from dislocating, instruct the patient to
avoid:
1.
2.
3.
4.
Crossing legs or feet
Sleeping without a pillow between legs
Hip flexion > 90 (bringing knee above hip level)
Hip internal rotation/turning leg inward toward body
© Aurora Health Care, Inc.
Posterior Total Hip Replacement
(THR) Precautions – Tips
• Avoid sitting in low chairs in order to limit hip flexion when
transferring from chairs
• Place surgical foot forward when standing up or sitting
down to avoid breaking the 90 degree hip precaution
• Using crutches or a wheeled walker will improve pain
control when bearing weight through the surgical leg
• Always check orders for any weight bearing restrictions
© Aurora Health Care, Inc.
Posterior Total Hip Replacement
(THR) Precautions - continued
• Assistive devices such as reachers, sock aids, long
shoehorn or leg lifters may be needed; OT helps to
assess and recommend this equipment
• Some of the equipment you may see include:
Sock aide
Long handled
equipment
Leg lifter
Reacher
© Aurora Health Care, Inc.
Anteriolateral Total Hip
Replacement (THR) Precautions
To prevent the hip from dislocating,
instruct the patient to avoid:
1. Crossing legs
2. Side stepping or turning away from the
surgical leg
3. Taking large steps with the surgical leg
4. Active abduction/moving leg out to side
(use leg lifter or perform passive
abduction only)
5. Hip extension/moving leg behind body
6. Hip external rotation/turning leg outward
7. Hip flexion >90 (bringing knee above
hip level)
© Aurora Health Care, Inc.
Anteriolateral Total Hip
Replacement (THR) – Tips
• Avoid sitting in low chairs in order to limit hip flexion when
transferring from chairs
• Place surgical foot forward when standing up or sitting
down to avoid breaking the 90 degree hip precaution
• Using crutches or a wheeled walker will improve pain
control when bearing weight through the surgical leg
• Always check orders for any weight bearing restrictions
• Assistive devices such as reachers, sock aids, long
shoehorn or leg lifters may be needed; OT helps to assess
and recommend this equipment
© Aurora Health Care, Inc.
Direct Anterior Hip
Replacement
This surgery decreases the amount of trauma to the
muscles and soft tissues; precautions include:
• Avoid externally rotating and extending the hip at the same
time (turning leg outward while moving the leg backward)
• Do not stand and twist
• Do not bend forward past the point of pain
• Perform activities “in the Safe Zone” (the pain in the new
hip should be minimal and not increase while doing the
activity)
• Using crutches or a wheeled walker will improve pain
control when bearing weight through the surgical leg
• Assistive devices such as reachers, sock aids, long
shoehorn or leg lifters may be needed; OT helps to assess
and recommend this equipment
© Aurora Health Care, Inc.
Direct Anterior Total Hip
Replacement (THR) Precautions
The patient may do the
activities as shown as
long as pain in the new
hip is minimal and does
not increase while doing
the activity (Safe Zone).
Special equipment may
be needed.
© Aurora Health Care, Inc.
SuperCap/SuperPATH Hip
Replacement
These patients follow the same safe zone precautions and
exercise program that Direct Anterior patients follow
Click here when done
© Aurora Health Care, Inc.
Abdominal Surgery Precautions
• Educate your patients on the logroll technique for bed
mobility, bending the knees and rolling onto the side to push
up to a sitting position
– This technique will decrease the strain and pain at the
abdominal muscles and incisional area
– The logroll should be reversed when returning to a laying
down position
– To see a video on the Log Roll technique, click on the
Cervical/Lumbar spine diagnosis when done with this
section, if you haven’t reviewed this already
• When applying a gait belt prior to transfers and gait,
consider your patient’s abdominal incision, drains or lines.
– The gait belt may need to be placed under the armpit for
comfort.
© Aurora Health Care, Inc.
Abdominal Surgery Precautions
• Encourage your patients to walk with nursing and therapy for
improved lung function after surgery
• Patients should hold a pillow to their incision for splinting
when doing their deep breathing and coughing techniques to
decrease pain as well
Click here when done
© Aurora Health Care, Inc.
Lower Extremity Amputation –
Positioning
The patient should:
• Lie on their back with legs straight
Do NOT put a pillow between their thighs or put a pillow
under their residual limb
© Aurora Health Care, Inc.
Lower Extremity Amputation –
Positioning
The patient should sit in
a chair with residual limb
supported
Do NOT have the patient
sit with their residual limb
flexed
© Aurora Health Care, Inc.
Lower Extremity Amputation –
Positioning
The patient should lie on their stomach; this will prevent
hip flexion contractures
© Aurora Health Care, Inc.
Lower Extremity Amputation –
Mobility
Mobility:
• Mobility devices may include a walker, slide board, and
wheelchair with residual limb support
– Refer to PT Tips section in the Patient Story
• Protection of the residual limb is critical, especially during
early mobility
– Knee immobilizer or therapist fabricated rigid/semi-rigid
removable dressing can help protect limb during mobility
Click here when done
© Aurora Health Care, Inc.
CVA: Positioning in Bed
• Assist with turning weaker patients every two hours to
prevent skin breakdown
• Elevate the involved upper extremity (UE) on pillows so that
the patient’s hand is above heart level to assist with
decreasing edema
• Consider a heal pressure relief boot to prevent heel
breakdown and foot drop when in bed
• Roll to the stronger side when sitting up at the edge of the
bed to increase patient participation
© Aurora Health Care, Inc.
CVA: Positioning in Bed
When lying on back:
• Position pillow to support
upper arm, elbow and hand
• Use foot splint as needed to
prevent heel cord tightness or
skin breakdown
When lying on unaffected
side:
• Support affected arm and leg
on pillow
• Position pillow behind back to
prevent backward rolling
© Aurora Health Care, Inc.
CVA: Positioning in Bed
When lying on affected side:
• Support unaffected leg on
pillow
• Position affected arm with
shoulder blade/shoulder
slightly forward
• Position pillow behind back to
prevent backward rolling
© Aurora Health Care, Inc.
CVA: Positioning in the Chair
Have the patient:
• Position hips and buttocks back in
the chair as far as possible with hips
and knees at a 90 degree angle
• Place feet on the footrest or flat on
the floor
• Use pillows to support the patient’s
trunk on weaker side as needed
• Support involved arm on pillows or a
table
• Alternate sitting up in chair and lying
down for short periods to prevent
fatigue
© Aurora Health Care, Inc.
CVA: Positioning for Eating
The patient needs to be positioned correctly while eating/
drinking to increase oral intake, promote comfort/safety and
prevent aspiration
Click on the link below and review the FYWB:
• Positioning During Eating
© Aurora Health Care, Inc.
CVA: Transfer Tips – Set-up
Prior to the transfer:
• Have knowledge of how the patient transfers
• Have all equipment ready: apply gait belt, prepare transfer
surface, choose assistive device
– Wheelchairs provide support and ease of transfer due to
removable armrests and height surface vs room chairs
• Position the transfer surface on the patient’s stronger side
– Exception: If the patient pushes heavily to one direction,
transfer to that direction
• Angle the patient’s heels toward the surface you are
transferring to for ankle safety
© Aurora Health Care, Inc.
CVA: Transfer Tips
During the transfer:
• Stand in front of the patient with hands around rib cage
using a gait belt; consider a second person to stand by
• Be mindful of the patient’s:
– Involved upper extremity as it may need support due to
weakness, decreased sensation or neglect
– Involved lower extremity as it may need blocking at the knee
to prevent buckling
• You may need to use lift equipment if needing more than
minimal assist
© Aurora Health Care, Inc.
VIDEO: CVA Transfer Tips
Click the screen below to watch a short video demonstrating
how to assist the stroke patient to transfer from bed to a
chair
Note: maximize the volume to hear the speaking
© Aurora Health Care, Inc.
CVA: Vision Problems After
Stroke Affecting Mobility
Visual neglect results in some patients ignoring objects to
the right or left of midline. If hemiparesis is on the right
side, visual neglect will be to the right of midline.
• Neglect affects safe positioning of extremities, walking and
self-cares
• Cue patients to use their hands and eyes to find the entire
object/surface in front of them
Click here when done
© Aurora Health Care, Inc.
Considerations for Parkinson
Disease Patients – Freezing
Freezing – An unpredictable loss of motion
Patients are most likely to freeze when:
• Starting to walk
• Nearing a target (ex: chair)
• Performing two mobility tasks at same time (ex: turning
when walking)
• Approaching narrow spaces, doorways or thresholds
• Changing tasks or motions
Tips/cues to give to patients to overcome freezing:
• Count their steps out loud
• Visualize stepping through long grass while walking
• Visualize beyond the obstacle
© Aurora Health Care, Inc.
Considerations for Parkinson
Disease Patients – Tremors
and Bradykinesia/Hypokinesia
Tremors – Medication timing and optimization of dosing
can help to reduce tremors making self-cares and
mobility easier
Bradykinesia – Slow movement
Hypokinesia – Small movement
Tips/cues to give to patients with tremors and/or
bradykinesia:
• Allow extra time to transfer and complete ADL tasks
• Cue the patient to move bigger
• Do NOT cue the patient to move faster as this has shown
to decrease speed and efficiency of movement and
causes anxiety
© Aurora Health Care, Inc.
Considerations for Parkinson Disease
Patients – Medication
Parkinson patients experience medication cycles of ‘on’
and ‘off’ times which affect their mobility
• During ‘on’ times, patients may experience:
– A burst in ability to move which could put them at risk for falls
– Extra muscular movements called dyskinesia or chorea, a
side effect of Parkinson medication, can cause them to be
unsafe
• During ‘off’ times, patients may experience:
– An increase in freezing episodes and/or muscle rigidity
© Aurora Health Care, Inc.
Considerations for Parkinson Disease
Patients – Rigidity
Rigidity – Severe stiffness of the muscles, mainly in the
trunk and extremities
Tips/cues to give to patients with rigidity:
• Encourage the patient to move their muscles/joints before
mobility
• Wait until the medication has kicked in as movement will
become less rigid
• Fixed/stiff facial muscles or flat affect may give the
impression that the patient is not experiencing emotion/pain,
therefore be sure to carefully address their needs
© Aurora Health Care, Inc.
Considerations for Parkinson Disease
Patients – Retropulsion/Propulsion
Retropulsion – An involuntary backward walking or loss of
balance
Tips/cues to give to patients with retropulsion:
• Have the patient lean forward as they sit to help with control
of the descent to avoid plopping into position
Propulsion – Fast uncontrolled forward walking/shuffling
Tips/cues to give to patients with propulsion:
• Have the patient stop their movement, take a deep breath,
and restart walking with cues for big steps
• Don't rush the patient as this will cause further uncoordinated
movement
© Aurora Health Care, Inc.
Considerations for Parkinson Disease
Patients – Retropulsion/Propulsion
Patients do not have the ability to stop retropulsion and
propulsion easily
Additional cues/tips to give to patients with retropulsion and
propulsion:
• Keep hand on gait belt at all times to avoid falls
• Cue patient to stop, take a deep breath and start over
• If using a device, cue the patient to not let the device get too
far ahead of them
Click here when done
© Aurora Health Care, Inc.
Considerations for Spinal
Cord Injury (SCI)
Due to paralysis, SCI patients may need to use a variation
of squat pivot and sliding boards transfers
• Caregiver should block one or both of the patient’s knees for
stability, safety, and ease of transfer
• Lift equipment may be needed
• Consult with the therapists treating the patient for tips for
your specific patient needs
Click here when done
© Aurora Health Care, Inc.
Considerations for General
Weakness and Frail Elderly
• When changing positions, allow a few minutes for the
patient to stabilize as some older patients are more prone
to a decrease in BP upon rising, causing light-headedness
• Time up in the chair or walking may be best broken into
shorter spans of time to avoid fatigue
• Moving from a low surface (chair) to a higher surface (bed),
in addition to being fatigued from sitting up for a period of
time, may mean the patient will require more assist or lift
equipment to return to bed
© Aurora Health Care, Inc.
Considerations for General Weakness
& Frail Elderly
• Skin can be more fragile so ensure the patient does not
bump into hard objects during mobility (ie) wheelchair leg
rests, commode legs, bedside tables
• Eye sight, hearing or dementia can effect mobility safety, so
know ahead of time if these are concerns. Accommodate for
these by having a clear path and simplifying your
instructions as needed
Click here when done
© Aurora Health Care, Inc.
Considerations for Bariatric
Patients
• Have appropriate bariatric equipment available in the room
at all times to avoid the potential of unsafe mobility (gait
belt, ambulation device/lift equipment, commode, Patran,
chairs).
• Patients may be reluctant to discuss their difficulty with
mobility/ADLS. Create an accepting atmosphere leading to
more openness with the ultimate goal of keeping both you
and the patient safe.
• Click here to be taken to the Aurora Safe Lifting Website. In
the Bariatrics section, review the following:
– Bariatric Rental Equipment List
– Bariatrics Toolkit Option from VA Website
Click here when done
© Aurora Health Care, Inc.
Considerations for Oncology
Patients
Common long term side effects of cancer or cancer
treatment that can affect the patient’s mobility include:
•
•
•
•
Pain
Fatigue
Swelling (lymphedema)
Bone loss (osteopenia)
•
•
•
•
Bone metastases/fragile bones
Change in weight
Memory and thinking problems
Hearing loss
Mobility tips:
• Allow patient time to move on their own before assisting
• Avoid excessive pushing/pulling when assisting with mobility
to decrease the risk of fractures
• Allow frequent rest breaks
Click here when done
© Aurora Health Care, Inc.