Bed Exercise

Skills and Exercises in Physical Therapy

Overview of Skills 12 and 13

• Focus on two primary exercise categories: bed exercises and kitchen sink exercises.

• Purpose: To familiarize students with common exercises found in various therapeutic settings.

Teaching Exercises

• Principles of Teaching:

  • Appropriateness of the exercise is key; consider the individual needs of the trainee.

  • Use comprehensive language and demonstrate exercises, not assuming prior knowledge.

  • Tailor instructions to different learning styles (verbal, visual, kinesthetic).

• Examples of Teaching Techniques:

  • Verbal cues alongside physical demonstrations.

  • Utilize audio descriptions for auditory learners.

  • Provide visual aids (e.g., papers, apps) to reinforce learning.

• Feedback and Correction:

  • Use positive reinforcement and constructive correction on movements.

  • Example: "You're doing great! Let's adjust your knee placement."

• Key Principles:

  • Safety is paramount in all exercise instruction.

  • Education: Explain why the exercises are being performed to enhance adherence.

  • Clients are more likely to adhere to the exercise if they understand its purpose (e.g., strengthening muscles for functional tasks like sitting and standing).

Importance of Exercise Adherence

• Research shows that understanding the purpose of exercises increases patient adherence.

• Patient-centered care is critical in exercise prescriptions to ensure recovery and rehabilitation is effective.

Bed Exercises

• Designed for patients who are primarily in bed, typically those recovering from surgery or with limited mobility.

• Examples:

  • Deep Breathing and Coughing: Important to prevent complications like atelectasis post-surgery.

  • Encourage deep breaths to inflate distal alveoli in the lungs.

  • Mechanics of breathing:

    • Pump handle and lateral breathing explained through rib movements.

    • Emphasis on diaphragm usage and maintaining optimal lung function.

• Types of Exercises:

  • Ankle Pumps: Move the ankle back and forth to promote circulation and reduce the risk of deep vein thrombosis.

  • Recommendation: 5-10 repetitions every hour when awake.

  • Heel Slides: Strengthen hip, knee, and improve range of motion.

  • Bridges: Strengthens glutes and core.

  • Clamshells: Targets hip abductors.

Functional Exercise Goals

• Goals of exercises include:

  • Mobility improvement.

  • Flexibility enhancement.

  • Muscle strengthening for functional movements (getting in/out of bed, standing, walking).

• Static Quads Exercise: Focus on isometric strengthening for quadriceps and gluteal muscles.

Posture and Balance Assessment

• Assessment Techniques: Observation during assessments to determine structural abnormalities correlated to patient complaints.

  • Requires patients to be in appropriate clothing (shorts, t-shirt) for visibility.

• Posture Assessment Planes:

  • Frontal Plane: Assess alignment of the head, shoulders, elbows, knees, and ankles.

  • Sagittal Plane: Assess lordosis and kyphosis in spinal alignment.

  • Posterior View: Compare symmetric features like iliac crests and scapula alignment.

• Common Posture Issues:

  • Hypertonicity: Increased muscle tone leading to stiffness and affecting movement.

  • Hypotonicity: Decreased muscle tone impacting stability and strength.

  • Kyphosis vs. Lordosis: Normal versus excessive curvatures in designated spinal regions.

  • Variance in shoulders and hips indicative of potential issues (e.g. scoliosis).

Balance Control Systems

• Balance is derived from three main systems:

  1. Visual System: Ability of the eyes to track and fixate.

  2. Vestibular System: Inner ear function critical to balance and equilibrium.

  3. Somatosensory System: Muscle and joint receptors provide awareness of body position and movement.

• Components for Balance Control:

  • Center of Gravity: The point where body weight is concentrated.

  • Base of Support: The area beneath an individual that can be used to maintain stability.

  • Limit of Stability: The boundaries within which a body can maintain balance without changing its base of support.

Strategies for Managing Balance

• Motor strategies to maintain balance include:

  • Ankle Strategy: Used for maintaining stability through ankle movements in response to perturbations.

  • Hip Strategy: Engaged when larger disturbances occur requiring a more significant shift in body alignment.

  • Stepping Strategy: A last resort for larger disturbances requiring a physical step to regain balance.

Falls and Prevention

• Statistics show falls lead to significant healthcare costs and risks for severe injury.

  • Preventative strategies involve:

  • Strengthening exercises to enhance muscle tone and stability.

  • Environmental modifications to reduce risks of falling (good lighting, clear pathways).

Key Takeaways for Practice

• Enhancing patient understanding of their therapeutic exercises correlates positively with adherence.

• Always prioritize safety and function during exercise teachings.

• Assessing posture and balance supports tailoring individual therapy plans that cater specifically to patient needs.