Exam 3: Functional Mobility

what is mobility?

mvmts that results in a change of body position or location

what is bed mobility?

moving from one bed position to another

-rolling to sidelying

-supine to sit

-sit to stand

what is a transfer

mvmt from one surface to another

influencing factors for functional mobility include

-age

-stage in life cycle (infancy → adulthood)

-social and cultural variations (walking, wheelchair)

-physical environment (ramps, stairs)

-acceptable degree of independence

-individual environmental factors

-societal environmental

functional mobility outcome measures

-patient's build (body weight, height, etc.)

-pre-morbid performance patterns (if sedentary before, then won't be active now)

-habits, roles, routines

-psychological state

-pain (pre-existing, secondary impairment)

activities in supine position include

1) bridging

2) rolling (toward affected - easier; toward unaffected - hard)

3) side-lying to sit

bridging

-back and hip extensors support the body

-UE's assist in providing proximal stability

what muscles support the body when bridging

back and hip extensors

when bridging, the _____ assists in providing proximal stability

a) UEs

b) LEs

a) UEs

what are the functional purposes of bridging

-use of a bedpan

-LB dressing in supine

-reduce pressure on butt

-bed scooting

what are the causes of ineffective mvmt when bridging

-absent or decreased back and hip extensors

-decreased recruitment of abdominals

-reduced proximal stability

easier?

a) rolling toward affected side

b) rolling toward unaffected side

a) rolling toward affected side

more difficult?

a) rolling toward affected side

b) rolling toward unaffected side

b) rolling toward unaffected side

rolling toward affected side

1) preposition affected arm (shldr F 90, elbow F/E, scap pro)

2) flex unaffected knee

3) unaffected arm reaches across midline

4) unaffected leg crosses midline

*instruct pt NOT to push against surface w/ unaffected LE

*practice rolling to affected side and back to supine

*once improvement occurs, have pt lift head slightly and rotate toward direction of mvmt

rolling toward unaffected side

-frequently initiated by extensor pattern of head, neck, and back

-affected arm is "left behind"

-instruct pt to use unaffected UE to 1) flex affected knee and bring it across midline and 2) bring affected UE up and over chest

*can use bedrail as assist but discouraged bc not readily available at home

*provide manual A to hip and trunk during rolling (decrease A as ability improves)

what are the goals of rolling toward UNaffected side

1) to decrease maladaptive compensatory strategies

2) promote more effective and efficient mvmt patterns

what ineffective movement strategies are seen with rolling toward unaffected side

-extensor pattern of head, neck, and back

-affected arm is "left behind"

supine to sit

adults typically use momentum strategy in which force is generated within the trunk and transferred to the LEs

*instead use a force control strategy

what ineffective movement strategies are seen with supine to sit

momentum strategy in which force is generated within the trunk and transferred to the LEs

what is a force control strategy for supine to sit?

graduated changes in position

1) roll to side lying

2) push up with UEs

3) bring LEs over side of bed (counterweight)

*provides increased stability

-concentric and eccentric forces used in these movements

treatment strategies for supine activities

-roll toward affected side first (decreased effort and reduces maladaptive mvmt strategies)

-rise from both sides of bed early in tx (reduces associated rxns)

-start sitting upright and learn to lie down first

activities in sitting

sitting and reaching

-anteriorly

-posteriorly

-laterally

-in rotational pattern

why are activities in sitting important?

bc they help to promote controlled mvmt and bear and shift weight

reaching anteriorly

concentric contraction of low back muscles

eccentric contraction of abdominals

reaching posteriorly

concentric contraction of trunk flexors

eccentric contraction of trunk extensors

reaching laterally

concentric contraction of trunk flexors and extensors on non-WB side

eccentric contraction of ^^ on WB side

reaching in rotational pattern

primary muscles are abdominal obliques

implicit skill learning

set up the activity and environment to elicit desired movement

gradations

-modify force of manual assist

-modify amount of contact area (i.e. NDT)

-alter the reach distance (sagittal, frontal, transverse planes)

sit to stand

-knees flexed

-anterior weight shift

-elbow extension

-trunk extension

sitting treatment strategies

-begin training in "high seats" (gradually lower to standard heights)

-train to scoot toward edge to follow for hip extension and knee flexion

-promote anterior weight shifts (use verbal +/or tactile cues; manual A if needed)

-lots of forward reaching activities

-WC push-ups as HW

why are forward reaching activities important?

-increases confidence

-decreases fear of anterior weight-shifting

-important step in sit-to-stand

-increases ability of affected LE to bear weight

standing activities

1) static standing

2) dynamic standing

3) free standing balance

static standing

can use a standing table

blocking method

-pts hips against a raised mat

-OT sits on stool on pt's affected side

-OT blocks pt's knees with their own

-OT's BUE free to stabilize

dynamic standing

-gradually incorporate weight shifts (ant., post., rot.)

-introduce knee bending during weight shifts

-introduce reaching activities

free standing balance

-begin with CGA

-progressively increase distance from pt

-scanning environment while standing

-holding conversation while standing to engage cognition (make balance subconscious)