Bed Mobility & Transfers

mobility

stability precedes..

attaining a position

maintaining a position precedes …

static and dynamic stability with a smaller base of support

static and dynamic stability with a large base of support precedes …

Attaining a position with a higher center of mass

attaining a position with a low center of mass precedes…

independence

autonomy

bed mobility with patients is usually taught when they have an ____ problem, and a loss of _____

rolling

scooting in supine

moving from supine to sit

sitting and scooting on the edge of bed

four types of bed mobility

if they have a lot of shearing/pain in the lower back

when should you not use the scooting up in the bed technique with a patient

good leg strength (strong hamstrings)

when can a patient use scooting in bed with bridging

Primary center of mass (greater trochanter of the shoulder)

when making a patient scoot with a draw sheet, the PT should be close to the patients ______ and make them tuck their chin to their neck if they are able to

weak legs can get stuck (ex. stroke patient)

one of the cons of bed mobility (supine to sit with log roll)

grabbing shoulder (greater trochanter) and legs if needed

how can i as the PT help facilitate a patient using the supine to sit with log roll

lumbar surgeries (no bending, lifting, or twisting needed with this)

when would you as the PT use the supine to sit with log roll with patients?

hip extensors

obliques

what muscles are used in the supine to sit with log roll?

squat pivot transfer

known as a lateral transfer

point A to point B

deconditioned

lateral transfer goals

• move from ___ to ___

• safety

• maximize independence

• use for _____ people

depends on my ability to contact the patient

close to center of mass as possible

when do we as PT’s use gait belts

stand

if the patient can ____, they can likely do a stand pivot transfer

• adaptive and assistive

• dependent vs independent

grading movements

• ____ and ____ equipment

• ___ vs ____

• Normal rankings (assistance levels)

adaptive equipment and assistive devices

equipment utilized to provide accommodation to a physical or functional impairment

no

modified independent

would a person be considered independent if they use a walker or a cane?

independent

patient doesn't require physical assistance, adaptive equipment, or verbal cues to consistently perform the activity safely and in an acceptable timeframe

modified independent

can do the activity independently, but requires either equipment, time, or setup

contact guard assistance

Therapist is in contact with the patient. Tactile cues may be needed

minimal assistance

Patient performs 75% or more of the activity safely with or without adaptive or assistive equipment.

moderate assistance

Patient performs 50% to 75% of the activity the activity safely with or without adaptive or assistive equipment.

maximal assistance

Patient performs 25% to 49% of the activity the activity safely with or without adaptive or assistive equipment.

completely dependent

Patient performs 0 to 25% of the activity the activity safely with or without adaptive or assistive equipment.

assistance (functional level of patient)

time (time ADL’s as well)

safety (safe by themselves)?

Consistency

Adaptive/assistive

Unilateral weakness

Documentation of Transfer in the Medical Record

• How much _____ the patient requires to perform the transfer and WHY (add to chart why)

• Amount of ____ to complete it

• Level of ____ demonstrated and verbalized

• _____ of performance

• Time of day

• ____ equipment utilized

• Environment (closed environment, height of table, surface)

• Direction of movement (left/right)… ( ex:______)

Bed to bed; bed to stretcher; bed to OR table transfer

indication for a supine transfer board

Assist patient to move up in bed

ALWAYS 2 PEOPLE

indication for a draw sheet or chuck

weird blood pressure changes

when is it good to use a tilt table

transfer board

can be used for spinal cord injuries, but when patients are independent with the car and bed transfers

chair to bed; bed to chair; chair to chair; wheelchair to car

indication for transfer board use

chair to bed; bed to chair; chair to chair

strength issues or larger in weight

indication for using a patient lift

dependent

a patient lift can lift a _____ person, protecting caregiver and patient from potential injury

fall prevention

anchor for PT

indications for using a gait belt with a patient

safe transfer up and down steps

patient has multiple floors in home

out of pocket with no insurance help

indication for using ramps and a stair glide

Provide assist to patient for bed mobility activities (strong upper body strength)

indication for using a overhead trapeze

Strong enough, rehab, caregiver training

Contraindications

person

assistive

verbally

Vital signs

Preparations for Transfer

1. What transfer am I asking the client to perform and why (__________)?

2. Are there _______ or precautions?

3. Based upon my assessment- do I need another _____?

4. Based upon my assessment- do I need _____ equipment?

5. ____ discuss the transfer technique with the patient

6. Personal protective equipment (PPE)

7. Clear the area and prepare ALL equipment

   1. Oxygen tubing, Foley catheter, IV tubing, bed controls, TV control, nursing call button, chest tubes, telemetry, etc.

8. _____ (pre and post transfer)

as much of the activity as he or she can

shoes or non-skid socks

squat-pivot

equal height

Basic Transfer Principles

1. Have the client perform ….

2. Always be aware of your body mechanics

3. Always have the client wear _____ prior to standing

4. Lock all wheels (bed and/or wheelchair)

5. Lower all side rails

6. Remove armrest of wheelchair for _____ transfers

7. Strive for _____ of transfer surfaces

8. Monitor equipment (catheter, IV's, CT's et al)

9. Be aware of hygiene and client modesty

parallel bars

1

walker

2

bilateral axillary crutches

3

single point cane

4

no assistance device

5