HomeEquipment and Assistive Devices list) # Page 68 ## Transferring a Client – Levels of Assistance - Maximum assistance: client cannot bear weight or assist; use a total mechanical lift/slings - Moderate assistance: can sit; some upper body strength but not enough lower body strength; use sit-to-stand lifts and assistive devices - Minimum assistance: can rise from seated position and stand with support; use gait belt and devices - No assistance: client can stand, march in place, and walk independently - Safety: ensure non-skid footwear and a clear pathway # Page 69 ## Ensuring Safe Patient Handling and Mobility (SPHM) - Assess client abilities and medical diagnosis - Assess ability to assist - Use appropriate number of assists - Check area for clutter - Explain plan to client - Administer pain management as needed (assessment) - Support body properly; minimize friction - Use SPHM equipment as necessary # Page 70 ## Equipment and Assistive Devices – Additional List - Gait belts - Stand-assist and repositioning aids - Lateral-assist devices - Friction-reducing sheets - Mechanical lateral-assist devices - Transfer chairs - Powered stand-assist and repositioning lifts - Powered full-body lifts # Page 71 ## Positioning Patients - Pillows, mattresses, adjustable beds, bed side rails, trapeze bar, other equipment # Page 72 ## Moving, Turning, or Transferring - Turning a patient in bed - Moving a patient up in bed - Transferring bed-to-stretcher or bed-to-chair - Assisting with range-of-motion exercises (active and passive) # Page 73 - Key anatomical landmarks: hips, heels, head, elbows, shoulder, sacrum # Page 74 - (Content labeled A/B; likely diagram-related notes; content not provided in text.) # Page 75 ## Implementation: Safety - (Content not detailed in the provided transcript.) # Page 76 - (No content provided on this page.) # Page 77 - MED MATER RETRACTABED (likely a device reference; content not detailed in transcript) # Page 78 - ccora (unclear; content not detailed in transcript) # Page 79 - (No content provided on this page.) # Page 80 ## Mechanical Aids for Walking - Walker - Cane - Braces - Crutches - Other mobility aids (drive-assisted devices, etc.) # Page 81 ## Assistive Devices for Walking – Pivot Maneuver (Step-by-step) - Step 1: Patient crosses arms over chest; position and safety check - Step 2: Gait belt placement and patient support - Step 3: Move wheelchair to bed side; patient holds shoulders; therapist uses gait belt - Step 4: Pivot maneuver to assist patient transfer # Page 82 ## Walker Instructions 1) Push up from bed using side rails 2) Place hands on walker 3) Move walker and affected leg forward 4) Move the unaffected leg forward to meet the first leg # Page 83 ## Cane Instructions 1) Use cane on the unaffected (strong) side 2) Stand 3) Place cane about 6 inches in front of the advancing foot 4) Move the affected leg to be beside the cane 5) Move the unaffected leg beyond the cane by about 6 inches 6) Move the cane forward 6 inches beyond the foot 7) Move the affected leg forward to align with the cane # Page 84 ## Crutches – Ambulation & Gaits - Gait patterns: 4-point, 3-point, 2-point, swing gait - Step-by-step setup: introduce, ensure patient stability, place crutches correctly, and advance legs accordingly - Steps include positioning crutches, weight-bearing status, and sequence of leg advancement # Page 85 ## Going Upstairs with Crutches - Instructions emphasize safety with the injured leg leading or following depending on the pattern; specifics not detailed in this excerpt # Page 86 ## Going Downstairs with Crutches - Instructions emphasize safety with the injured leg leading or following depending on the pattern; specifics not detailed in this excerpt # Page 87 - (No content provided on this page.) # Page 88 ## Variables Leading to Back Injury in Health Care Workers (Ergonomics) - Uncoordinated lifts - Manual lifting and transferring without assistive devices - Lifting when fatigued or after back injury - Repetitive movements (lifting, transferring, repositioning) - Standing for long periods - Transferring patients and repetitive tasks - Transferring/repositioning uncooperative or confused patients # Page 89 ## Proper Body Mechanics - Definition: Use of proper body movement to prevent injury and enhance coordination and endurance # Page 90 ## Safe Body Mechanics – Proper vs Improper Lifting - Good practice examples and common mistakes in lifting objects # Page 91 ## Safe Body Mechanics – Practical Plan - Plan your lift - Ask for help if needed - Widen your base of support - Bend your knees - Tighten abdominal muscles - Lift with leg muscles - Keep the load close to the body - Keep the back straight - Summary: A structured checklist to reduce risk of injury during lifting and moving tasks **Note on LaTeX usage in this document:** Where chemical/ionic notation or simple formulas appear, they are represented using LaTeX for clarity. For example, calcium storage/release is denoted as $$\mathrm{Ca^{2+}}$$ and phosphate as $$\mathrm{PO_4^{3-}}$$. Additionally, a general ROM relation can be expressed as $$\text{ROM} = \theta_{\max} - \theta_{\min}$$ where θ represents joint angle.

Equipment and Assistive Devices list) # Page 68 ## Transferring a Client – Levels of Assistance - Maximum assistance: client cannot bear weight or assist; use a total mechanical lift/slings - Moderate assistance: can sit; some upper body strength but not enough lower body strength; use sit-to-stand lifts and assistive devices - Minimum assistance: can rise from seated position and stand with support; use gait belt and devices - No assistance: client can stand, march in place, and walk independently - Safety: ensure non-skid footwear and a clear pathway # Page 69 ## Ensuring Safe Patient Handling and Mobility (SPHM) - Assess client abilities and medical diagnosis - Assess ability to assist - Use appropriate number of assists - Check area for clutter - Explain plan to client - Administer pain management as needed (assessment) - Support body properly; minimize friction - Use SPHM equipment as necessary # Page 70 ## Equipment and Assistive Devices – Additional List - Gait belts - Stand-assist and repositioning aids - Lateral-assist devices - Friction-reducing sheets - Mechanical lateral-assist devices - Transfer chairs - Powered stand-assist and repositioning lifts - Powered full-body lifts # Page 71 ## Positioning Patients - Pillows, mattresses, adjustable beds, bed side rails, trapeze bar, other equipment # Page 72 ## Moving, Turning, or Transferring - Turning a patient in bed - Moving a patient up in bed - Transferring bed-to-stretcher or bed-to-chair - Assisting with range-of-motion exercises (active and passive) # Page 73 - Key anatomical landmarks: hips, heels, head, elbows, shoulder, sacrum # Page 74 - (Content labeled A/B; likely diagram-related notes; content not provided in text.) # Page 75 ## Implementation: Safety - (Content not detailed in the provided transcript.) # Page 76 - (No content provided on this page.) # Page 77 - MED MATER RETRACTABED (likely a device reference; content not detailed in transcript) # Page 78 - ccora (unclear; content not detailed in transcript) # Page 79 - (No content provided on this page.) # Page 80 ## Mechanical Aids for Walking - Walker - Cane - Braces - Crutches - Other mobility aids (drive-assisted devices, etc.) # Page 81 ## Assistive Devices for Walking – Pivot Maneuver (Step-by-step) - Step 1: Patient crosses arms over chest; position and safety check - Step 2: Gait belt placement and patient support - Step 3: Move wheelchair to bed side; patient holds shoulders; therapist uses gait belt - Step 4: Pivot maneuver to assist patient transfer # Page 82 ## Walker Instructions 1) Push up from bed using side rails 2) Place hands on walker 3) Move walker and affected leg forward 4) Move the unaffected leg forward to meet the first leg # Page 83 ## Cane Instructions 1) Use cane on the unaffected (strong) side 2) Stand 3) Place cane about 6 inches in front of the advancing foot 4) Move the affected leg to be beside the cane 5) Move the unaffected leg beyond the cane by about 6 inches 6) Move the cane forward 6 inches beyond the foot 7) Move the affected leg forward to align with the cane # Page 84 ## Crutches – Ambulation & Gaits - Gait patterns: 4-point, 3-point, 2-point, swing gait - Step-by-step setup: introduce, ensure patient stability, place crutches correctly, and advance legs accordingly - Steps include positioning crutches, weight-bearing status, and sequence of leg advancement # Page 85 ## Going Upstairs with Crutches - Instructions emphasize safety with the injured leg leading or following depending on the pattern; specifics not detailed in this excerpt # Page 86 ## Going Downstairs with Crutches - Instructions emphasize safety with the injured leg leading or following depending on the pattern; specifics not detailed in this excerpt # Page 87 - (No content provided on this page.) # Page 88 ## Variables Leading to Back Injury in Health Care Workers (Ergonomics) - Uncoordinated lifts - Manual lifting and transferring without assistive devices - Lifting when fatigued or after back injury - Repetitive movements (lifting, transferring, repositioning) - Standing for long periods - Transferring patients and repetitive tasks - Transferring/repositioning uncooperative or confused patients # Page 89 ## Proper Body Mechanics - Definition: Use of proper body movement to prevent injury and enhance coordination and endurance # Page 90 ## Safe Body Mechanics – Proper vs Improper Lifting - Good practice examples and common mistakes in lifting objects # Page 91 ## Safe Body Mechanics – Practical Plan - Plan your lift - Ask for help if needed - Widen your base of support - Bend your knees - Tighten abdominal muscles - Lift with leg muscles - Keep the load close to the body - Keep the back straight - Summary: A structured checklist to reduce risk of injury during lifting and moving tasks Note on LaTeX usage in this document: Where chemical/ionic notation or simple formulas appear, they are represented using LaTeX for clarity. For example, calcium storage/release is denoted as $$\mathrm{Ca^{2+}}$$ and phosphate as $$\mathrm{PO_4^{3-}}$$. Additionally, a general ROM relation can be expressed as $$\text{ROM} = \theta_{\max} - \theta_{\min}$$ where θ represents joint angle.

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Source: Wolters Kluwer. Theme: Mobility and Activity. This page introduces the overarching topic of movement and the role of the musculoskeletal system in supporting mobility.

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Concept emphasis: Movement with the skeleton versus without the skeleton. The presence of the skeleton provides a framework for movement; without it, mobility concepts would be undefined.

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Role of Skeletal System in Movement

Calcium storage and release: \mathrm{Ca^{2+}} ions are stored in bone and released as needed for physiological processes.
Phosphate storage/release: In bone mineral storage, phosphate groups (PO_4^{3-}) are involved in mineral homeostasis.
Protection of internal organs.
Stores and releases fat (yellow bone marrow stores lipids).
Produces blood cells (bone marrow).
Stores and releases minerals.
Facilitates movement.
Provides structural support for the body.
Significance: The skeletal system is not only a rigid framework but an active regulator of minerals (e.g., Ca^{2+}) and blood cell production, directly impacting movement and metabolic balance.

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Types of Bones

Long bone (e.g., humerus)
Flat bone (e.g., sternum)
Irregular bone (e.g., vertebra)
Short bone (e.g., talus)
Notes: Each bone type has characteristic shapes and functions aligned with mechanical needs and protective roles.

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Important Functions of Muscles

Motion (movement execution)
Maintenance of posture
Support of body structures
Heat production during muscle activity

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Ligaments and Tendons (examples related to the knee)

Quadriceps tendon
Patella
Lateral collateral ligament (LCL)
Patellar tendon
Femur
Posterior cruciate ligament (PCL)
Anterior cruciate ligament (ACL)
Medial collateral ligament (MCL)
Fibula
Tibia
Notes: Ligaments connect bones and stabilize joints; tendons connect muscles to bones and transmit force for movement.

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Joints

Fibrous joints: Connected by dense connective tissue (mostly collagen). They are fixed and immovable.
Cartilaginous joints: Connected by cartilage; provide cushioning between bones.
Synovial joints: Bones joined by a joint capsule; contain synovial fluid for lubrication during movement.

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Front of Head – Fibrous Joints

Posterior fontanelle
Anterior fontanelle
Suture line (sutures between skull bones)
Dense fibrous connective tissue
Notes: Fibrous joints in the skull allow for growth and protection of the brain in infancy; sutures gradually ossify with age.

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A firm yet flexible connective tissue is found in many areas (ears, nose, larynx, ribs, intervertebral discs, knees, ankles).
Cartilaginous Joints: Cartilage-based joints providing flexibility and cushioning.

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Synovial Joints – Key Components

Ligament
Bone
Periosteum (outer bone covering)
Articulating bone
Synovial joint cavity (contains)
Articular capsule: Fibrous capsule and Synovial membrane
Synovial fluid
Articular cartilage
Notes: The synovial joint is a highly mobile joint with a lubricating fluid system and a protective cartilage surface.

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Bone, Synovium, Synovial fluid, Ligament, Cartilage.
Notes: Functional integration of bone, soft tissue, and synovial structures enables smooth articulation.

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Cartilaginous and Synovial Joints

Facet joints
Joint capsule
Joint cavity
Body of vertebra
Intervertebral disc
Spinous process
Notes: The spinal joints include cartilaginous (intervertebral discs) and synovial elements in facet joints, contributing to mobility and load distribution.

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Spinal Discs and Nerve Interaction

Spinal cord, disc annulus fibrosus, nucleus pulposus
Normal disc vs. herniated disc: disc material can compress a nerve root when degenerative or traumatic processes occur
Vertebral body
Notes: Herniation can cause radicular pain and neurologic symptoms; proper disc integrity is essential for stable nerve function.

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NORMAL VERTEBRA, NERVE, DISC; SUBLUXATION
Notes: Subluxation implies partial joint dislocation or misalignment; stability in the spine relies on vertebral integrity and disc health.

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Types of Movements

Flexion: bend; reduces the angle between bones
Extension: straighten the limb
Hyperextension: continue past normal extension
Abduction: move away from the baseline
Adduction: move toward the baseline
Pronation: turning palm/posterior-facing
Supination: turning palm/anterior-facing
Circumduction: circular motion
Rotation: side-to-side movement
Inversion: turning inward
Eversion: turning outward
Dorsiflexion: toes toward the body
Plantarflexion: toes pointed downward

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Abduction & Adduction

Abduction: moving away from the midline
Adduction: moving toward the midline

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Supination, Flexion, Extension, Pronation, Abduction, Adduction
Medial Rotation (internal) and Lateral Rotation (external)
Dorsiflexion and Plantarflexion

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Hyperextension (extending beyond normal range)
Example ROM: Hip flexion/extension/hyperextension

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Joint Movements – Rotation and Related Motions

Internal rotation
External rotation
Supination
Pronation
Inversion
Eversion

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A: Pronation
B: Supination
C: Eversion
D: Inversion
E: Dorsiflexion
F: Plantarflexion
G: Abduction
H: Adduction
Notes: These terms describe the orientation and movement of the limbs and feet.

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Contractures

Inactivity, injury, or arthritis can lead to contractures
A contracture tightens or shortens muscles, tendons, or ligaments, causing deformity
Flexion contracture: a flexed joint that cannot straighten actively or passively
Chronic loss of joint motion due to structural changes
Common in hips, knees, elbows
Symptoms: pain and loss of movement in the joint

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ACTIVE ROM vs PASSIVE ROM

Active ROM: performed by the patient
Passive ROM: performed by a physiotherapist or helper
Clarifications on use:
- Active ROM is for patients who can move themselves
- Passive ROM is often used for patients who cannot move independently (e.g., after injury or in paralysis cases)
Note: The page contains a contradictory line about passive ROM; standard clinical practice uses passive ROM to assist patients who cannot move voluntarily

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ROM Exercises (Examples)

Perform hourly while awake
Client education:
- Ankle pumps: toes toward the head and away
- Foot circles: rotate feet at the ankles
- Knee flexion: bend and straighten the knees

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Types of Exercises

Isotonic: muscle shortening and active movement (e.g., ROM exercises, swimming, jogging, bicycling)
Isometric: muscle contraction without shortening (e.g., holding a pose like a plank)
Isokinetic: muscle contraction with resistance at a constant speed (e.g., stationary bike with adjustable resistance)

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Isotonic Exercises

Focus: muscle shortening with movement; improves strength and function through full range of motion

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Isometric Exercise

Focus: muscle contraction without movement
Benefits: maintain strength without joint movement; useful when joint movement is painful or restricted

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Isokinetic Exercises

Resistance-based training with constant speed
Can be progressed by increasing resistance while maintaining speed
Example: Resistance chair (as shown in the image)

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Benefits of Exercise to Cardiovascular System

Increased efficiency of the heart
Decreased resting heart rate and blood pressure
Improved blood flow to all body parts
Improved venous return
Increased circulating fibrinolysin (breaks up clots)

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Benefits to the Respiratory System

Improved alveolar ventilation
Decreased work of breathing
Improved diaphragmatic excursion

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Benefits to the Musculoskeletal System

Increased muscle efficiency and flexibility
Increased coordination
Reduced bone loss
Improved nerve impulse transmission efficiency

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Benefits to Metabolic Processes and GI System

Increased triglyceride breakdown
Increased gastric motility
Increased production of body heat
Increased appetite
Improved intestinal tone, digestion, and elimination
Weight control

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Sleeping Positions

Correct: Side-lying with a small head pillow and a pillow between the knees; spine straight; hips and legs aligned
Incorrect: Head elevated with a large pillow; spine curved; legs crossed causing hip misalignment

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Hip Surgeries – Anatomy

Acetabulum (socket)
Femoral Head (ball)
Femur (thigh bone)

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Do not bend forward past 90 degrees.
Do not cross legs.
Do not turn toes inward or twist.
Do not turn knees inward or together.
The information is for general educational purposes; consult a health care provider for personalized advice.
Reference: X17 106/2020 AAC Tow Hip Replacement

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Use an Overhead Trapeze to Move in Bed

Purpose: assist mobility and positioning without excessive strain

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Compression Stockings

Purpose: improve venous return, reduce edema, and lower DVT risk

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Sequential Compression Devices (SCDs)

Purpose: enhance venous return and reduce DVT risk through intermittent compression

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DVTS – Deep Vein Thrombosis

Risk awareness in immobile or post-surgical patients

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Nursing Actions for DVT Risk

Notify provider if concern
Order ultrasound as needed
Elevate the leg and minimize pressure at the site of inflammation
Anticipate anticoagulant therapy as ordered
Consider D-dimer testing

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Client Education – DVT Prevention

Avoid crossing legs and prolonged sitting
Avoid wearing restrictive lower-extremity clothing
Do not place pillows behind the knees
Avoid massaging legs or dependent positioning

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Osteoarthritis (OA)

Most common type of arthritis and a degenerative joint disease
Affects middle-aged and older adults
Cartilage breakdown leads to pain, stiffness, reduced function
No cure; management includes lifestyle changes, medications, and sometimes surgery

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Causes/Risk Factors for OA

Cartilage breakdown with age and wear
Genetics/family history
Age
Obesity increases joint stress
Prior injuries accelerating cartilage wear
Occupation, repetitive movements, and other conditions can contribute

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OA Symptoms

Joint pain worsened by movement, eased by rest
Stiffness
Swelling and tenderness
Crepitus (grating sensation)
Bone spurs
Loss of flexibility

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Articular cartilage, Meniscus, and Joint space changes with OA
Normal joint features vs. OA: bone spurs and cartilage loss with joint space narrowing

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Osteoporosis

Affects bone strength; bones break easily; often called a “silent disease” until a fracture occurs (hip, spine, or wrist common)

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Normal vs. Osteoporotic bone appearance (illustrative)

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Risk Factors for Osteoporosis

About 1 in 5 women over 50; ~1 in 20 men
Family history of fractures or osteoporosis
Prior fracture after age 50
Early menopause or ovariectomy
Poor diet (calcium, vitamin D, protein)
Smoking
Heavy alcohol use
Hormonal imbalances (e.g., too much thyroid hormone or low estrogen in women, low testosterone in men)
Low body mass index (underweight)

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Maintaining Bone Health with Aging

Nutrition: adequate calcium, vitamin D, and protein; sources include low-fat dairy, leafy greens, fish, fortified foods
Activity: weight-bearing and resistance exercises (e.g., walking, strength training, stairs, dancing)
Avoid smoking
Limit alcohol consumption

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Factors Influencing Mobility

Developmental considerations
Physical health (muscular, skeletal, nervous system problems; other organ system issues)
Mental health
Lifestyle, attitude, values
Fatigue and stress
External factors

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Balance, Posture, Alignment – Spine Disorders

Normal spine vs. lordosis, kyphosis, scoliosis

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Posture Visuals

Poor posture: Forward head, flat back, rounded shoulders
Good posture: Upright alignment with balanced spinal curves

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Equipment and Assistive Devices (examples)

Standard patient mover, sit-to-stand board, bariatric equipment, overhead devices, etc. (Labelled content appears garbled in the source; interpret as