Foundations of mobility

What are the steps in the stability-mobility continuum?

Capacity for mobility → Stability → controlled mobility → Skill

Large BoS (base of support) means ____ CoG (center of gravity)?

Low

What are the 3 lifting techniques?

Squat lift

Half-kneel lift

Single stance leg lift

What are HAI?

Any infection acquired within a healthcare setting

What is an example of a multi-drug resistant organism?

MRSA

Describe the 2 types of contact infections

Direct: person to person

Indirect: person to object to person

Describe airborne transmission

Small particles that stay suspended in the air for longer periods of time

Inhaled by or deposited on host

Describe droplet transmission

Large particles in air contact with host mucous membranes

Often by coughing or talking

What type of hygiene must be conducted with enteric precautions like Cdiff?

Antimicrobial soap and water for 15-60 seconds

What PPE is needed with contact precautions? When do you don and doff them?

Gloves and gown

Don before entering room, doff before exiting

What PPE do you use for airborne precautions? When do you don and doff them?

Face mask or respirator → gloves not explicitly needed

Don before entering room, doff after leaving

Patient must be placed in negative airflow room

What PPE do you use for droplet precautions? When do you don and doff them?

Facemask, gown, gloves

Before entering room, before leaving room

What is the definition of a sign?

Something objective and observable

Quantifiable and measurable

What is the definition of a symptom?

Subjective

How a person experiences a condition

What is tachycardia

HR > 100 bpm in adults

What is bradycardia?

HR < 60bpm in adults

What does measuring heart rhythm assess for?

Regularity or irregularity

What does measuring heart amplitude assess for?

Strong, bounding, weak

Formula for maximum heart rate?

220 - age

Formula for target HR during aerobic exercise

Maximum HR x % desired intensity

Where do you manual palpate brachial artery?

In infants and before checking BP in adults

What does systolic BP tell us?

Pressure at ventricular contraction

What does diastolic BP measure?

Pressure at ventricular relaxation

What is normal SBP in a neonate? (1 to 28 days old)

greater than 60

What is normal SBP in infant? (age 1 mo to 12 mo)

70-95

What is normal SBP in children? (age 1yo to 8yo)

80-110

What are the BP criteria to stop activity?

SBP>250

DBP>115

SBP drop greater than 10 from baseline

What do you assess when measuring respirations?

Rate, rhythm, depth, ease, breath sounds

Short term positioning: Supine

Pillow under head

Bend hips and knees

Elevate feet

Pillows under upper arms for comfort

Short term positioning: Prone

Always place pillow under shins

Bad pillow placement = exaggerated spinal curves

What is the best pillow placement for short term side lying?

One under head

One between legs to cushion medial knees and ankles touching

One at chest to rest arms on

What is the most common short term side lying position?

One leg straight, other leg knee and hip flexed

What is the best short term sitting position for pregnant women?

Alternative sitting → pt leans forward onto supportive surface

Never put on a rolling stool!

What 3 things are you trying to prevent with long term positioning?

Contractures, pressure injuries, edema

In fowlers position, what are 2 negative impacts?

Increase shearing forces

Promote contractures of hips

What are some medical conditions that trendelenberg position assists with?

Hypotension and pulmonary interventions

In long term supine, you need _____ knee bend than short term supine?

Less

Trendelenberg position helps with movement of what?

Fluid in the lungs

What do you do with pt’s arms in long term supine?

Support them near the heart (prop on a pillow)

What is modified long term sidelying?

¾ supine or ¾ prone

What should you consider during long term sitting?

90-90-90 rule

May require small lumbar roll

Increased repositioning frequency

Support arms

What kind of contractures are most common?

Flexion

What is the time limit for 1 position in bed?

No more than 2 hours

What is the time limit for 1 position in sitting?

No more than 15 mins

What areas are most susceptible to pressure injuries in sidelying?

Sacrum and heels

What areas are most susceptible to pressure injuries in sidelying?

Medial aspects of knees and ankles

What is the “redness rule”?

Do not position a pt with pressure on a compromise area

The use of restraints on a pt requires what?

A medical order

What PROM can you use on a pt with THA?

Supine abduction

External rotation

When positioning a pt with hemiparesis, what do you keep in mind with supine and sidelying?

Supine: elevate limbs of hemiparetic side

Sidelying: don’t position on top of hemiparetic side

Flexion and extension happens in what plane of movement?

Sagittal

Adduction and abduction happens in what plane of movement

Frontal

Internal and external rotation happen in what plane of movement?

Transverse

What are the benefits of PROM?

Decrease local edema

Stimulate tissue healing

Prevent adhesions

What are the benefits of AROM?

PROM +:

Increases sensory input

Promotes tissue alignment

Skeletal muscle pump enhances circulation

What are the contraindications of PROM?

Without consent

When motion will prevent tissue healing

Extreme muscle gaurding

What is the dose for PROM in neurological conditions?

Slower reps with 20-60 sec hold at end range

What are the contraindications for AROM?

PROM +

Pain throughout motion/after completion

Cardiac stress

Adverse exercise responses

What is the objective for using a straight plane of motion?

Allows isolation of movement

Good for examination and treatment

What is the objective for using a diagonal plane of motion?

Closer to daily functional movement

Not appropriate for exams

What kind of hand position should you use when performing ROM?

Lumbrical (lego hand)

What is an example of a soft end feel through a joint?

Elbow flexion - forearm tissue meets biceps

What is an example of firm end feel through a joint?

Ankle dorsiflexion - hits almost end range

What is an example of hard end feel through joint movement?

Elbow extension - bone limitations

What is an “empty” end feel?

Range stopped because of pain - always abnormal

In the cognitive phase of learning, what is the learner relying on?

Visual input and minimized distractions

In the associative phase of learning, what is the learner focused on?

Proprioceptive input, focused feedback on repeated errors

In the autonomous phase of learning, what is the learner focused on?

Practicing speed, accuracy, and variety

True or false: the tilt table requires weight bearing capabilities on both extremeties

False - only 1 LE is necessary for support

On a tilt table, the greater the incline the ______ WB through LEs

Greater

How many degrees at a time should you increase the tilt table?

15-20 degrees

What are the precautions for acute back surgery?

No BLT

Bending

Lifting more than 5-10 lbs

Twisting

How should a patient move with an acute back injury?

Log rolling

People with spinal cord injuries typically perform activities in what position?

Long sitting

What grip should you hold the gait belt with?

Supinated

When fitting a wheelchair, what is the most important measurement?

Seat depth

What are the negative effects of a w/c being too wide?

Hard to propel yourself and fit through small spaces

What is the problem with a w/c being too narrow?

Puts pressure on hips

What is the problem with a w/c seat being too shallow or deep?

Shallow: lack of good support

Deep: pressure on knees and sacral sitting

What is the problem with a w/c having a seat too high or low?

Low: hard to rise from chair, knees stay elevated

High: difficulty fitting under desks