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INTRODUCTION

Troy

Troy injured his spine in a motor vehicle crash, resulting in an injury at the T11 spinal cord level. He is medically stable and is beginning the more intensive phase of his rehabilitation. His goal is to return to college and live in a dormitory that has assistance for those with physical disabilities.

What objectives relating to bed mobility need to be met for Troy to achieve his goal?

What methods or interventions can Troy focus on in his rehabilitation?

What should be considered in the early stages of his discharge planning?

Bed mobility (moving from one bed position to another) includes rolling, scooting in supine, moving between supine and sitting, and sitting and scooting on the edge of the bed (EOB). Bed mobility is valuable in and of itself because it increases mobility and functional independence. When done correctly, it also provides a sound basis for out-of-bed mobility. Note that the techniques for bed mobility can also be used on mats, plinths, or other similar surfaces.

BED MOBILITY PROGRESSION

Although each patient’s condition determines the nature of their individual progression in rehabilitation, functional mobility tends to follow a predictable progression based on the interplay of motor control and biomechanical principles. In general:

  • Stability precedes mobility.

  • Maintaining a position precedes attaining a position.

  • Static and dynamic stability with a large base of support (BoS) precedes static and dynamic stability with a smaller BoS.

  • Attaining a position with a low center of mass (CoM) precedes attaining a position with a higher CoM.

For functional purposes, these general rules work together to create a progressive order of functional positions, many of which can be developed in the process of bed mobility. A patient can progress not only from one position to the next but also within each position. For example, a patient is likely to be able to maintain a seated position at the EOB (stability) before being able to move from supine into a seated position (controlled mobility). While maintaining stability in a sitting position, the patient may engage in self-care activities, developing the dynamic stability necessary for those activities.

Therapeutic exercises often challenge the patient to work on strength and motor control in progressively more challenging positions. The progression of positions is similar to that seen in the typical motor development of an infant. A typical progressive sequence of activities includes:

  • Supine or supine on elbows

  • Prone on elbows

  • Hooklying

  • Rolling, sidelying

  • Bridging

  • Quadruped

  • Sitting

  • Kneeling

  • Half-kneeling

  • Modified plantigrade (standing with feet flat on the ground and the upper limbs leaning on a table or similar structure)

The positions highlighted in red can be readily incorporated into bed mobility activities, providing a basis for more advanced rehabilitation efforts, including standing and walking. Kneeling and half-kneeling are important components of getting up from the floor.

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