Dependent Mobility & Forced Use

What are the 5 settings that make up the continuum of care?

• Intensive care unit (ICU)

• Patient care unit (PCU)

• Post Acute

• Home Health

• Outpatient

What are the benefits of early mobilization?

• Reduce secondary complications

  • DVT, deconditioning, contractures

• Increase level of consciousness

• Reduce learned non-use and maladaptive patterns

• Reduced ICU/hospital stays up to 2-3 days

• Greater discharge to more intense rehab

• Greater function at 3-6 month follow up

Which patient population could benefit most from early mobilization in regards to increasing level of consciousness?

TBI patients

What are things to watch out for when treating in the ICU?

• Hemodynamic & physiologic instability

• Closed & secure EVD

• Controlled ICP

• Stable neuro exam

What is the most important thing to continue to do with patients?

Educate & talk to them

What interventions are included in dependent mobility & forced use?

• Functional mobility training

• Bed mobility

• Sitting

• Transfers

• Ambulation

• ADL training

• Splinting

• Positioning

How should patient’s UE be positioned in supine or sidelying?

Elevated & extended with pillows

How should patient’s UE be positioned in sitting?

• Supported to decrease shoulder subluxation

• Arm trough, WC tray, pillows

• Elevate hand to decrease swelling

How should patient’s UE be positioned in standing?

• Supported to minimize shoulder subluxation

• GivMohr Sling

• Ottobock Shoulder Stabilizer

What is the main goal of sitting activities?

To improve and maintain symmetry

What are typical postural impairments seen in patients?

• Posterior pelvic tilt

• Thoracic kyphosis

• Cervical flexion

• Lateral trunk flexion (towards affected side)

• Unaffected pelvic WB

What are interventions to work on in sitting?

• BUE WB

• Lateral excursions

• Reaching

• Pushing

What are the benefits of sit to stands and ambulation?

• Promote BLE WB

• Facilitate success & muscle activation

• Block unwanted/unsafe movements

What is the discrepancy b/w a retained motor capacity and the spontaneous use of this motor capacity in daily life and accompanied by compensatory motor behaviors?

Learned non-use

What is constraint induced movement therapy (CIMT)?

Forcing patients to use their affected sides by occupying or tying back the unaffected sides from helping