Troy injured his spine in a motor vehicle accident, resulting in an injury at the T11 spinal cord level. He is medically stable and is beginning the more intensive phase of his rehabilitation. His goal is to return to college and live in a dormitory that has assistance for those with physical disabilities. One aspect of Troy's meeting his goal is that he has to be able to maneuver on his bed. What objectives relating to bed mobility need to be met for Troy to achieve his goal? What methods and/or interventions can Troy focus on in his rehabilitation? What may be considered in the early stages of his discharge planning?
Bed mobility (although it can take place on mats, plinths, or other similar surfaces) includes rolling, scooting in supine, moving between supine and sitting, and sitting and scooting on the edge of the bed. Bed mobility is valuable in and of itself in that it increases mobility and functional independence. It is also valuable because, when done correctly, it provides a sound basis for out-of-bed mobility.
Although each patient's condition determines the nature of his or her individual progression in rehabilitation, functional mobility tends to follow a predictable progression based on the interplay of motor control and biomechanical principles. In general:
▪ Stability precedes mobility.
▪ Maintaining a position precedes attaining a position.
▪ Static and dynamic stability with a large base of support BoS precedes static and dynamic stability with a smaller BoS.
▪ Attaining a position with a low center of mass (CoM) precedes attaining a position with a higher CoM.
For functional purposes, these general rules work together to create a progressive order of functional positions, many of which can be developed in the process of bed mobility. A patient can progress not only from one position to the next but also within each position as well. For example, a patient is likely to be able to maintain a seated position at the edge of the bed prior to being able to move from supine into a seated position. Similarly, a patient may be able to maintain stability in a sitting position before he or she is able to manage the challenges of dynamic stability inherent in seated self-care activities.
Bed mobility activities fit well within the framework of a physical therapy program focused on strengthening and motor control. Therapeutic exercises often challenge the patient to work on motor control and strengthening by achieving controlled mobility in one position, then moving to the next, more challenging position. The progression of positions is similar to that seen in the typical motor development of an infant. A typical progressive sequence of activities includes: