Activity Based Assessment Notes

Activity Based Assessment

Aims of Lecture

• Practical skills assessment: bed mobility, transfers, sitting balance, and standing balance.
• Key points of manual handling.
• Consideration for documentation.

Functional/Activity Assessment Elements

• Bed mobility
• Transfers: lie to sit to lie, bed to chair to bed, and sit to stand to sit.
• Sitting balance
• Standing balance.

Assessment of Bed Mobility

• Movements up and down the bed.
• Bridging: Lifting the bottom up with knees bent, assessing hip extensor strength.
• Side to side assessment: shifting hips and pelvis to the left or right.
• Rolling: Assessing rolling to both left and right sides.
• Equipment: slide sheets, bedsticks, cot studs.
• Always check patient capabilities first, before assisting.

Transfer of Lie to Sit

• Two methods: rolling to one side and tipping up, or the swivel method.
• Rolling to affected side may risk shoulder injury.
• Swivel method requires abdominal strength and is unsuitable for spinal or abdominal surgeries.
• Assess patient's spontaneous method before assisting.

Bed to Chair Transfers

• Hierarchy of assistance (most to least):
  • Mechanical gantries/sling lifters
  • Mechanical stand lifters
  • Manual stand lifters
  • Slide board transfers
  • Pivot transfers (low or high)
  • Stand transfers (pivot in standing or stepping)
• Gantry/ceiling hoist and sling lifters used for dependent patients without independent sitting balance.
• Always consider the 24-hour picture and patient's cognition and behavior.
• Sling hygiene is important.

Stand Lifters

*Mechanical vs non-mechanical.
*ArjoCeraSteady is common non-mechanical stand lifter.

Slide Board Transfers

• For patients with some sitting balance who can't stand.
• Assess lateral shift ability first.
• Position wheelchair at a slight angle towards the stronger side.
• Patients must keep fingers safe.

Pivot Transfers

• For patients with good sitting balance who are managing slide board transfers well.
• Low pivot: Using a slide board to cover the gap.
• High pivot: Semi-stand position without a slide board.
• Complete towards the stronger side.

Sit to Stand to Sit

• Assess sitting balance and leg strength.
• Patient setup: bottom forward in the chair, feet back.
• Assess trunk movement, hip and knee flexion to extension, and weight bearing.
• Assess from a higher seat or with hands on a rail if needed.
• Assess ability to complete without arms.

Stand and Transfer

• Stand type transfer: completed by a patient that can stand, has some level of trunk control standing plus or minus support.
• Assess balance and trunk control and lower limb strength to determine which transfer is best.
• Consider cognition and behavior.

Manual Handling

• Occurs when a person is lifted, lowered, pushed, pulled, carried, moved, held, or restrained.
• Principles:
  • Risk assessment and planning.
  • Assessing safety of the task.
  • Considering required equipment.
  • Maintaining a neutral spine.
  • Keeping the load close to the body.
  • Encouraging patients to do as much as possible.

Documentation

• Document capabilities in the objective assessment.
• Ward recommendations may differ.
• Structure: bed mobility, transfers, sitting balance, and standing balance.
• Comment on level of ability (independent, standby, assist).
• Document equipment, direction, cues, and tips.