At the completion of this chapter, the reader will be able to:
Understand the importance of bed mobility to prevent secondary complications
Describe some of the precautions when positioning a patient
Discuss the biomechanical principles behind correct body mechanics
Describe some of the challenges facing a clinician while moving a patient or heavy object
Describe some of the mechanical devices that can be used during bed mobility tasks
List the 12 principles of good body mechanics
Discuss the biomechanical principles and the integral elements of the motor control progression that can be implemented during a bed mobility tasks
Demonstrate how to provide bed mobility to a dependent patient
Demonstrate how to instruct a patient in bed mobility
Describe the importance and the principles behind patient positioning
Describe the importance and the principles behind patient draping
Bed mobility activities are designed to adjust the body position of a recumbent patient to prevent the development of joint contractures or skin breakdown. In contrast, depending on the patient's medical condition, such as after total joint replacement, there may be mobility restrictions or contraindications that affect bed mobility.
A number of medical conditions can result in mobility and position restrictions or contraindications. These include:
This patient population is prescribed a positioning device, a triangular foam cushion, which is strapped between the legs to keep the hip in an abducted position. It is important to remember that these range-of-motion restrictions apply in relation to both hip and trunk motion. For example, both lifting the knee while sitting or leaning forward at the waist result in hip flexion beyond 90°. From a clinical perspective, extra care must be taken when the patient is moving from supine to sitting to prevent both excessive hip flexion and excessive hip adduction.
Hemiplegia: rolling from supine to sidelying on the hemiplegic side is relatively straightforward, but rolling to lie on the stronger side presents a greater challenge.
Spinal cord injury (SCI): the functional ability of the patient who is post SCI depends on the level and degree of injury (Table 10-1). With respect to bed mobility, an injury at the level of the sixth cervical vertebra (C6) will typically allow a patient to achieve independent performance of bed mobility.
TABLE 10-1Functional Outcomes Related to Level of Spinal Cord Injury ||Download (.pdf) TABLE 10-1 Functional Outcomes Related to Level of Spinal Cord Injury
|Level of Lesion