Bed mobility is a basic skill that promotes independence and allows for self-care activities. Whether treating a patient with neurologic involvement, a patient who is elderly or debilitated, or a person with acute low back pain, impaired bed mobility can be a challenge for the patient, as well as family and health-care providers. Interventions focus on facilitating the most efficient and pain-free skills for moving in bed to accomplish activities such as rolling, personal hygiene, dressing, and coming to sitting in preparation for transfers or transition to standing. This chapter presents methods for examining and evaluating the key components required for bed mobility, as well as activities, techniques, and exercises that can promote improved efficiency and independence.
Interventions to Improve Control in Bed Mobility Skills
Bed mobility skills involve rolling from supine to sidelying and from sidelying to supine or prone, moving in bed (bridging and scooting), and moving from supine or sidelying to sitting. People who have efficient neurological and musculoskeletal systems utilize 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 informs development of the physical therapy plan of care (POC) and requires the therapist to address questions related to understanding 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 components of task analysis are questions to be considered and answered by the therapist. See the discussion on task analysis in Chapter 2: Interventions to Improve Motor Function (summarized in Box 2.2).
Task analysis also allows the therapist to identify the link between the patient's inability to effectively use an appropriate movement strategy (abnormal movement) and underlying impairments. This information helps identify the need for additional examination procedures and directs and guides selection of intervention strategies. Critical to performing a task analysis is knowledge of efficient posture and movement and 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 characteristics is simply a guide to understanding what one should expect. In all functional mobility skills, one can observe great variations across the lifespan regarding what may be considered "normal" (e.g., the considerable variation in gait characteristics exhibited within a population of "normal" people). This has been referred to as the challenge of normal with the suggestion that, as movement specialists, physical therapists should be observing and aiming for efficiency of movement. Efficient movement is defined as having adequate mechanical capacity (mobility ...