Chapter 34: Functional Activity Intervention in Horizontal (Bed Mobility to Quadruped Skills)

Chapter Objectives

Upon completion of this chapter, the learner should be able to:

1. Discern which functions in horizontal are important and of most benefit to a particular patient.

2. Discuss normal movement components in horizontal functions.

3. Identify abnormal movements and function in horizontal by comparing them with normal function.

4. Identify appropriate examination strategies for function in horizontal.

5. Determine impairments contributing to abnormal function in horizontal.

6. Incorporate important safety considerations during patient management in horizontal.

7. Outline expected outcomes and prognostic indicators for function in horizontal.

8. Design appropriate interventions for an individual with abnormal function in horizontal.

9. Appropriately progress or modify a patient’s treatment in horizontal.

10. Design an appropriate plan for nontherapy time motor practices or a home exercise program for a patient with abnormal function in horizontal.

11. Discuss evidence to support patient management in horizontal.

Introduction

Although functional skills in horizontal positions are an essential component of the developmental process in children (e.g., crawling and creeping for exploration and play), mobility in horizontal postures is also important for adults (e.g., for bed mobility/scooting, crawling to play with a grandchild, or creeping to the sofa to rise from the floor). This chapter shows how the therapist can deliver therapeutic activities and interventions for underlying impairments when dysfunction is detected in activities or skills in horizontal.

Typical Characteristics/Patterns of Movement in Horizontal

In horizontal, the head, trunk, and extremities move according to the demands of the task. Given the position or activity (e.g., supine rolling vs. bridging vs. quadruped), the therapist must consider all aspects of normal movement, as explained in Chapters 10 and 13, along with biomechanical elements such as base of support, center of gravity, number of segments involved in movement or weight-bearing, and length of the lever arm. In addition to being able to isolate and control movements of the trunk and extremities, patients must be able to do so under changing environmental contexts (e.g., the firmness or softness of the surface; type of bed sheets used; type of bedclothes worn; type of flooring, such as carpeting or linoleum).

Normal adults move using many different strategies depending on the demands or constraints of the task. As the task changes, they have the flexibility to vary their movement patterns and combinations. For example, in one analysis of rolling, 36 normal adult participants demonstrated 32 different combinations of movements (Richter, 1989). The most common combinations of trunk, upper, and lower extremity movements observed during rolling in this analysis are described in Table 34-1. Components and combinations of typical trunk and extremity movements for bridging, crawling, quadruped, and creeping are also included in the table (Richter, 1989; Ryerson, 1997).