Moving the Bar: PART 3: Engaging the Patient in Early Functional Mobility

CHAPTERS WITHIN THIS SECTION INCLUDE

• Chapter 9 Maintaining Capacity for Mobility Through Range of Motion 227

• Chapter 10 Bed Mobility 251

• Chapter 11 Horizontal Transfers 270

  • Chapter Part 1: Seated Transfers 270

  • Chapter Part 2: Pivot Transfers 280

• Chapter 12 Vertical Transfers 300

INTRODUCTION

Now that the patient is physically and physiologically capable of more mobility, patient-care activities can be used to further the patient's functional ability. This section provides instruction regarding maintaining the capacity for mobility in the otherwise immobile patient (Chapter 9), facilitating independent mobility in bed (Chapter 10), and transferring from the bed to other surfaces (Chapter 11). Applying the principles of motor learning to these tasks will augment your ability to facilitate your patient's success.

Early Function

Range of Motion

A key component of the capacity for mobility is the extent to which muscle and connective tissue are able to lengthen and shorten, to move one skeletal segment in relation to another. The technique the clinician uses to maintain this capacity is called range of motion (ROM) exercise and is described in Chapter 9. ROM may be:

• ▪ Passive, which is indicated when the patient is unable to initiate movement or when active movement is contraindicated

• ▪ Active-assisted, which is indicated when the patient is able to perform a limited amount of the available movement

• ▪ Active, which is indicated when the patient is able to complete full lengthening and shortening without any physical assistance

Bed Mobility

Thus far we have dealt with promoting active mobility primarily within the patient's body: respiration, circulation, and integumentary protection. Mobility from place to place has been dependent. Bed mobility provides one of the earliest opportunities for patients to engage in functional mobility that changes location. Although bed mobility techniques can be practiced on other surfaces such as treatment mats or plinths, the activity is called “bed mobility” because the bed is the most common location for functional application.

Bed mobility comprises essentially the same elements as positioning the patient (see Chapter 7)—turning from supine to side lying, scooting up and down in bed, etc. Now, however, the patient is taking an active role in the movement, and the movement techniques are expanded to include moving from supine to sitting and scooting sideways in the seated position on the edge of the bed.

These activities can produce challenges to multiple systems of the body. Not only must the patient have the flexibility (ROM) to attain different positions, but the muscles must be strong enough to stabilize body parts and move portions of the body against gravity (the adult head alone typically weighs 8 to 12 lbs.), and the skeletal and connective tissue must be able to ...