Clinical Rationale for Patient Positioning - Rolling Direction: Patients are typically rolled onto their strong side to facilitate the next step, which involves pushing up into a seated position using the strength of that side. - Risks of Rolling onto the Effective (Affected) Side: - Sensory Deficits: Patients often lack sensation on their weak side, meaning they might not feel if their limb is in an awkward or harmful position. - Joint Integrity: In cases of very weak upper limbs, the pressure applied during a roll can cause the shoulder to sublux or dislocate. - Stability: A lack of sensation can prevent the patient from remaining stable on that side, potentially leading to instability or a "wobbly" posture. - Sensation Recovery: Rolling onto the effective side is discouraged to ensure that sensation returns without accidental harm being caused to the limb. # Ergonomics and Environmental Setup - Therapist Height and Bed Adjustment: - The bed height should be adjusted to accommodate the shortest therapist (e.g., Gabby). - While the tallest therapists can adjust by bending their knees throughout the day, shorter therapists cannot "grow any taller" and should not work on their "tippy toes," as this reduces stability. - Lateral Space Assessment: Before beginning a transfer, ensure there is sufficient space on the bed. If the patient (e.g., Kadita) is too close to the edge, a lateral shift must be performed first. # The Lateral Shift Procedure - Preparation: - 1. Ask the patient to bend their strong leg so the foot is flat on the bed. - 2. Assist the patient in bending the impaired leg. - 3. Support: If the patient is heavily impaired, the therapist must hold the knee to prevent the leg from sliding down or flopping out. - Coordination: In a two-person team, one therapist manages the legs while the other manages the shoulders. - Execution: - The patient is instructed to lift their hips and slide them across the bed. - The command used is "Ready, steady, lift" or "Ready, steady, action." - The speaker prefers "Ready, steady, action" compared to "1, 2, 3" because it provides a clear cue for the exact moment of movement. - Body Realignment: Once the hips are shifted, the patient is straightened out, assisting with the upper body if necessary. # Two-Person Supine to Side-Lying Transfer - Arm Placement: The therapist must lift the patient's arm and place it on their tummy (chest) before rolling to ensure it is not "left behind" or pinned under the body. - Patient Preparation: Instruct the patient to turn their head in the direction of the roll before the movement begins. - Roles and Commands: - One therapist supports the shoulder/scapula. - The second therapist (assistant) supports the knees. - The command is "Ready, steady, roll." - Safety Positioning: Therapists must always stay in front of the patient during the roll. A patient should never be rolled away from the therapist to avoid the risk of them falling off the bed. # Two-Person Side-Lying to Sitting Technique - Procedural Steps: - 1. Shoulder Support: The lead therapist places a hand over the patient's shoulder and scapula as soon as a gap is created. - 2. Leg Leverage: The assistant (Gabby) guides the patient's feet and legs forward and off the edge of the bed. This utilize gravity and momentum; the weight of the legs going down helps the torso come up. - 3. Patient Push: The patient is instructed to give a "big push" with their underside elbow. - 4. Post-Transfer Support: Once the patient is sitting, the therapist must maintain a hold on them (at the shoulder or trunk) to prevent them from falling forward or sideways. - Handling Details: The assistant at the knees may loop around the bottom leg and hold the top leg with their wrist. Placing a hand on the hip allows the therapist to push down on the pelvis to lever the shoulders upward. # One-Person Transfer Techniques - Adaptation: If a patient is familiar or the therapist is confident, a one-person transfer is possible by the therapist positioning themselves more centrally to the patient's body. - Single-Person Execution: - One hand is placed behind the scapula and the other on the hips/legs. - The therapist uses the patient's legs to help pull the body weight over. - In the transition from side-lying to sitting, the therapist shifts their hand to the hip to push the pelvis down as the shoulders move up. # Supine to Sitting in a Single Fluid Motion - The Momentum Method: This technique bypasses the pause in side-lying, moving from the back to sitting in one continuous motion. - Timing: The therapist prepares the arm and timing so that the roll and lift happen simultaneously. - Procedure: The patient pushes with the elbow while the therapist rolls the legs off and lifts the torso using momentum. - Command: "Ready, steady, sit up." # Questions and Discussion - Leg Movement Timing: - Question: Should the legs stay off the bed before the lift? - Answer: It is more effective to do it in one movement because the momentum helps the therapist get their hand under the patient's shoulder, which is otherwise difficult to access until the movement has started. - Bed Height Concerns: When the bed is at an ideal ergonomic height for the therapist, the patient's feet may not touch the floor once they are upright. - Clinical Solution: The therapist should keep the "hand button" (bed remote) nearby to immediately lower the bed once the patient is sitting. - Safety with Unstable Patients: - Question: Is there a worry about pushing a patient over? - Answer: Yes, especially with "bally" (unstable) patients or when there is a significant size difference between therapist and user. In such cases, a second therapist is recommended for safety. - Practice Duration: The group is instructed to practice these movements for approximately 20minutes.