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

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 instructions regarding maintaining the capacity for mobility in the otherwise immobile patient (see Chapter 9), facilitating independent mobility in bed (see Chapter 10), and transferring from the bed to other surfaces (see 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 actively and purposefully lengthen and shorten, moving 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 integrity. Mobility from place to place has been dependent. Bed mobility, moving from one bed position to another, provides one of the earliest opportunities for patients to engage in functional mobility. 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 includes the positioning and repositioning activities of rolling and scooting in the bed (see Chapter 7) along with the tasks of 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 3.5 to 5.5 kg [8 to 12 lb]), and the skeletal and connective tissues must be able to withstand the stresses of movement and static support. Bed mobility can even challenge the cardiac and pulmonary systems, particularly in patients who have been immobile for long periods (see Table 7-3, Effects of Immobility on the Systems and Tissues of the Body, in Chapter 7). It is important, therefore, for the clinician to continue to apply knowledge and skills, such ...