© Aurora Health Care, Inc. Patient Mobility and Activity Description: Technical Contact: Content...

© Aurora Health Care, Inc.© Aurora Health Care, Inc.

Patient Mobility and Activity

Description: Technical Contact:

Content 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 contactthe Service Desk at414-647-3520 in Milwaukee or 1-800-889-9677.

Elizabeth Malanowski, PTPhysical Therapist, AWAMCLila Daut, OTRSupervisor, Rehab Services, AWAMCDonna Harry, OTRCoordinator, Rehab Services, ASLMCCreated: 6/2014Reviewed:

• 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.

Features:

https://lmsproxy.aurora.org/courses/courses_aurora/navigation/course_navigation.htm

© Aurora Health Care, Inc.

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, hands-on experience or updated information through your instructor or on-site mentors.

Disclaimer


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


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


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


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.


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


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)

http://www.aurorahealthcare.org/fywb_pdfs/x15523r078.pdf




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


Good Body Mechanics


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 mid-

section, 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


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)

http://www.aurorahealthcare.org/fywb_pdfs/PE-2244-88.pdf

http://www.aurorahealthcare.org/fywb_pdfs/PE-2244-88.pdf


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

https://iconnect.aurora.org/DotNetNuke/LinkClick.aspx?fileticket=3Nf-eEg2XcY=&tabid=1680


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


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


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


The following slides will review helpful tips for assisting patients to move in bed

Bed Mobility


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


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


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



1. One caregiver stands on each side of the bed2. With the friction reducing device in place, grasp the sheet/

chux at the shoulders and hips of patient3. Weight shift and take a step as you slide the patient towards

the head of the bed; do not lift



1. Two caregivers both stand at the head of the bed2. 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


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

positionCaregivers can guide the patient from the upper trunk/rib area – never pull on their arms or neck


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 sitNote: maximize the volume to hear the speaking

mms://media1.aurora.org/lms/1001355PTMOBACT/Supine_to_sit.wmv


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


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 sittingNote: maximize the volume to hear the speaking

mms://media1.aurora.org/lms/1001355PTMOBACT/Edge_of_the_Bed_in_Sitting.wmv


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


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 bedNote: maximize the volume to hear the speaking

mms://media1.aurora.org/lms/1001355PTMOBACT/Lie_Down_Sitting_at_the_EdgeBed.wmv


The following slides will review helpful tips for transferring patients to/from bed and chair

Transfers


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


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


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 chairNote: maximize the volume to hear the speaking

mms://media1.aurora.org/lms/1001355PTMOBACT/Bed_to_Chair.wmv


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.


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.


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


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 boardNote: maximize the volume to hear the speaking

mms://media1.aurora.org/lms/1001355PTMOBACT/Slide_Board_Transfer.wmv


The following slides will review helpful tips for walking patients

Walking


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


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


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


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. Cane2. Weak leg3. Strong leg


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.

Lift Equipment


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

https://iconnect.aurora.org/DotNetNuke/LinkClick.aspx?fileticket=RpcQk66UTiQ=&tabid=1680


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


Non-Motorized Sit to Stand – Minimal Assist Device – Stedy, Sprite

Patient must:• Be able to follow directions• Be able to perform 75% of the transfer• Weigh less than 265 lbs

Used for patients who fatigue easily, are light-headed, or experiences knee buckling


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)


Total Lift – Opera, Maximove, Golvo (name varies by site)

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

Used for patients who require moderate to total assist


VIDEO: Assisting the Patient using Lift Equipment

Click the screen below to watch a short video demonstrating how to assist the patient using lift equipmentNote: maximize the volume to hear the speaking

mms://media1.aurora.org/lms/1001355PTMOBACT/Using_Lift_Equipment.wmv


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


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


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


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)


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)


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


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


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)


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.


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


Lumbar Spine Surgical Precautions and Tips

1. Do not cross legs2. Do not twist trunk3. Do not bend forward at waist past 90 degree angle4. Use log roll technique5. Avoid having patients sit in low chairs to avoid extreme

bending when sitting or standing6. 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.


Lumbar Spine – Log Roll Technique

1. Bend knees so feet are flat on bed2. Roll onto side with shoulders, hips, and knees rotating at

same time3. Drop feet off bed once in side lying and push to sit up4. Reverse process to return to supine position


VIDEO: Assisting the Patient to Log Roll

Click the screen below to watch a short video demonstrating how to assist the patient to log rollNote: maximize the volume to hear the speaking

mms://media1.aurora.org/lms/1001355PTMOBACT/Log_Roll.wmv


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


Posterior Total Hip Replacement (THR) Precautions

To prevent the hip from dislocating, instruct the patient to avoid:1. Crossing legs or feet2. Sleeping without a pillow between legs3. Hip flexion > 90 (bringing knee above hip level)4. Hip internal rotation/turning leg inward toward body


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


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

Reacher

Long handled equipment

Leg lifter


Anteriolateral Total Hip Replacement (THR) Precautions

To prevent the hip from dislocating, instruct the patient to avoid:1. Crossing legs2. Side stepping or turning away from the

surgical leg3. Taking large steps with the surgical leg4. Active abduction/moving leg out to side

(use leg lifter or perform passive abduction only)

5. Hip extension/moving leg behind body6. Hip external rotation/turning leg outward7. Hip flexion >90 (bringing knee above

hip level)


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


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


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.


SuperCap/SuperPATH Hip Replacement

These patients follow the same safe zone precautions and exercise program that Direct Anterior patients follow



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.


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



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



The patient should sit in a chair with residual limb supported

Do NOT have the patient sit with their residual limb flexed



The patient should lie on their stomach; this will prevent hip flexion contractures


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



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



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



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


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


CVA: Positioning for Eating

The patient needs to be positioned correctly while eating/ drinking to increase oral intake, promote comfort/safety and prevent aspirationClick on the link below and review the FYWB:

• Positioning During Eating

http://www.aurorahealthcare.org/fywb_pdfs/x35303.pdf


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


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


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 chairNote: maximize the volume to hear the speaking

mms://media1.aurora.org/lms/1001355PTMOBACT/CVA_Transfer_Tips.wmv


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



Considerations for Parkinson Disease Patients – Freezing

Freezing – An unpredictable loss of motionPatients 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


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 movementHypokinesia – 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


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


Considerations for Parkinson Disease Patients – Rigidity

Rigidity – Severe stiffness of the muscles, mainly in the trunk and extremitiesTips/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


Considerations for Parkinson Disease Patients – Retropulsion/Propulsion

Retropulsion – An involuntary backward walking or loss of balanceTips/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/shufflingTips/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


Considerations for Parkinson Disease Patients – Retropulsion/Propulsion

Patients do not have the ability to stop retropulsion and propulsion easilyAdditional 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



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

Considerations for Spinal Cord Injury (SCI)



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


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



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


https://iconnect.aurora.org/iconnectLite/launch/iconnect?appId=INTCOM0053&seqNo=0


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)

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

•Bone metastases/fragile bones

•Change in weight•Memory and thinking problems•Hearing loss


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