Chapter 4: Interventions to Improve Bed Mobility and Early Trunk Control

INTRODUCTION

Bed mobility is a functional skill that promotes independence and allows for positional changes and self-care activities. Whether there is neurological, orthopedic, or cardiopulmonary involvement, impaired bed mobility can be a challenge for the patient, as well as family members and health-care providers. Interventions focus on facilitating the most efficient and pain-free motor skills for moving in bed. This allows the patient to accomplish activities such as rolling, coming to sitting in preparation for dressing, personal hygiene, transfers, and transitioning to standing. This chapter addresses examination and evaluation of the key motor task requirements for bed mobility, as well as activities, techniques, and exercises that can promote improved efficiency and independence.

Bed mobility skills involve:

• Rolling from supine to sidelying and from sidelying to supine or prone

• Moving in bed (bridging and scooting)

• Moving from supine or sidelying to sitting.

Individuals with efficient neurological and musculoskeletal systems use a variety of strategies and patterns to roll, all characterized by smooth transitions between postures. Patients with neurological involvement (e.g., stroke, spinal cord injury [SCI]), musculoskeletal impairments (e.g., severe acute disc pathology, trauma, recent surgery), or extensive weakness (e.g., chronic obstructive pulmonary disease, renal disease, chronic pain) often demonstrate difficulty with movement transitions and antigravity control.

TASK ANALYSIS

Task analysis is a crucial aspect of the patient management model: examination, evaluation, and development of the therapy plan of care (POC). It requires the therapist to address questions related to three key elements: (1) the task, (2) characteristics of the individual patient, and (3) the impact of the environment on motor control strategies. Inherent to each of these task analysis components are questions to be considered and answered by the therapist. See the discussion on task analysis in Chapter 2: Interventions to Improve Motor Function.

Task analysis also allows the therapist to identify the link between the patient’s inability to effectively use an appropriate movement strategy and underlying impairments (range of motion [ROM], tone, motor control, and so forth). This information helps identify the need for additional examination procedures while directing and guiding the selection of intervention strategies. Critical to performing a task analysis is knowledge of efficient posture and movement in addition to the ability to deconstruct a task into its component skills.

In observing human movement, it is important to note that normal movement, such as normal gait, is simply a guide to understanding what one should expect. In all functional mobility ...