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At the completion of this chapter, the reader will be able to:

  1. Understand the importance of bed mobility to prevent secondary complications

  2. Describe some of the precautions when positioning a patient

  3. Discuss the biomechanical principles behind correct body mechanics

  4. Describe some of the challenges facing a clinician while moving a patient or heavy object

  5. Describe some of the mechanical devices that can be used during bed mobility tasks

  6. List the 12 principles of good body mechanics

  7. Demonstrate how to provide bed mobility to a dependent patient

  8. Demonstrate how to instruct a patient in bed mobility

  9. Describe the importance and the principles behind patient positioning

  10. Describe the importance and the principles behind patient draping


Bed mobility activities are designed to increase functional independence or increase patient safety. For example, the patient must frequently adjust their position to prevent the development of joint contractures or skin breakdown. Bed mobility may be assisted by equipment, with help from another individual or individuals, or performed as independently as possible by the patient. There are many occasions when a patient needs to be positioned by the clinician. Examples include when a patient has decreased sensation to pressure or when the patient cannot alter their position independently. In those cases, the recumbent patient’s body needs to be frequently moved, so the methods may have to be taught to nursing staff, family members, or caregivers. In contrast, depending on the patient’s medical condition, such as after total joint replacement, the patient may need to learn to restrict certain movements that are contraindicated (see Clinical Pearl).


Several medical conditions can result in mobility and position restrictions or contraindications. These include:

  • Total hip arthroplasty (THA): the restrictions and contraindications following this surgical technique depend on the approach the surgeon used:

    • The posterolateral approach involves avoiding hip flexion of the hip beyond 60°–90°, 0° hip adduction, and 0° of hip internal rotation.

    • The lateral or anterolateral approach involves avoiding hip extension, external rotation, and adduction across the midline.

It is important to remember that these range-of-motion restrictions apply to both hip and trunk motion. For example, lifting the knee while sitting is biomechanically the same as leaning forward at the waist—both result in hip flexion beyond 90°.

  • Hemiplegia: rolling from supine to side lying on the hemiplegic side is relatively straightforward, but rolling to lie on the stronger side presents a greater challenge.

  • Spinal cord injury (SCI): the patient’s functional ability post-SCI depends on the level and degree of injury (Table 7-1). For example, an SCI at the sixth cervical vertebra (C6) level will typically allow a patient to achieve the performance of bed mobility independently.

TABLE 7-1Functional Outcome Related to Level of Spinal Cord Injury

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