Week 2- Functional Mobility

Question 1

what is functional mobility aimed at?

Answer 1

In-bed mobility

Transfers – to and from surfaces

Performing occupations during:
* standing/sitting,
* walking (ambulation)/wheeling
* Using devices, e.g. wheelchair, powered mobility, canes

Question 2

what is community mobility?

Answer 2

Moving around in the community
* Walking, Wheeling, Bicycling
* Driving, busing, taxis, and other
transportation system

Question 3

looking at the hierarchy of mobility what is considered community mobility?

Answer 3

car transfers

functional ambulation for community mobility

community mobility and driving

Question 4

looking at the hierarchy of mobility what is considered functional mobility?

Answer 4

bed mobility
mat transfers
wheelchair transfer
bed transfer
functional ambulation for ADL
toilet and tub transfer

Question 5

what do people do in bed?

Answer 5

sleeping
intimacy
ADLS
skin inspections

Question 6

what is bed mobility?

Answer 6

rolling from Side to side

rolling from supine to prone

ability to sit up in bed

Ability to handle upper and lower
extremities during all of the above

Performance in short and long leg
sitting

Question 7

what are some devices to assist with bed mobility?

Answer 7

• Rope ladder
• Overhead trapeze bar
• Bed rail
• Mechanical Lif

Question 8

what are the different types of transfers?

Answer 8

stand-step
stand pivot
squat pivot
transfer board
total assist

Question 9

what are the different levels of assistance?

Answer 9

stand by
minimum
moderate
maximum

Question 10

what are some preparation steps for log rolling on a bed?

Answer 10

Easier to have bed flat; but may raise bed to comfortable height to
facilitate trunk from side-lying to sitting
* Ask client to assist/participate as able e.g. reach across to you to help
“roll” into side lying
* Position client in side lying
* Bend hips and knees to 90 degrees
* Place your arm under client’s thighs and bring knees out over edge of bed
to act as counterweights while simultaneously reaching under
shoulder/scapula to raise the upper trunk
* If able the client may assist by using the top arm to push up

Question 11

what do sit to stand transfers require?

Answer 11

intact balance with the integration of:
* adequate mobility at pelvis, hips, knees
* postural alignment, postural adjustments, weight shifting
* and strength in core and lower extremitie

Question 12

when may we choose to do a stand step transfer?

Answer 12

Client is able to weight bear, but may be unsteady or weak

Question 13

what are the steps to a stand step transfer?

Answer 13

1. Position chair in relation to bed: minimize “travel” during and after transfer
   completion
2. Client to lean forward and scoot to edge of chair surface (assist as required)
3. Ensure your feet and knees are prepared to support client’s feet and knees
4. Client to lean forward “Nose over toes” and push on thighs to come to
   standing (‘un-folds”)
5. Stand-by closely OR support client at waist & scapulae
6. When fully standing, client to step and turn until in line with bed
7. Ensure client feels bed behind knees
8. Client to put hands on thighs and bend knees to ease down onto bed

Question 14

as a therapist how should you body mechanics be?

Answer 14

• Wide base of support
• Bend knees
• Lift with the legs
• Fixate the trunk
• Back straight
• Tuck the chin in
• Shift weight from one
  leg to the other (turn
  with the feet)
• Keep the load close

Question 15

when may we choose a stand pivot transfer?

Answer 15

Client is able to weight bear through one leg only

Question 16

what are the steps to a stand pivot transfer?

Answer 16

1. Position chair in relation to bed: minimize “travel” during and after transfer completion
2. If one arm is paralyzed, ensure this arm is protected e.g. tucked in lap or in sling
3. Ensure your feet and knees are prepared to support client’s feet and knees; your
   knees should be ready to support by positioning on each side of affected leg’s knee
4. Client to lean forward “Nose over toes” and push on thighs to come to standing
5. Support client at waist and scapulae
6. When fully standing, pivot/slide the affected leg until client is in line with bed;
   supporting (unaffected) leg is able to step/hop, while pivoting (affected) leg
   pivots/slides
7. Ensure client feels bed behind knees
8. Client to put hands on thighs and bend knees to ease down onto bed

Question 17

when may we choose a squat pivot transfer?

Answer 17

Client is unable to completely weight bear and/or stand uprig

Question 18

what are the steps to a squat pivot transfer?

Answer 18

1. Position chair in relation to bed: minimize “travel” during and after transfer completion
2. Client to lean forward and scoot to edge of surface (assist as required).
3. Ensure your feet and knees are prepared to support client’s feet and knees; your knees should be
   ready to support by positioning on each side of the knees to prevent buckling
4. Client to place hands on armrests and then to transferring surface; if one arm is paralyzed, ensure
   this arm is protected e.g. tucked in lap or in sling
5. Supporting client at waist, scapulae or transfer belt, shift their weight forward from the buttocks
   toward and over their feet
6. At the same time, pivot the client toward the transferring surface
7. Ensure client or you feel buttocks are safely on the bed surface
8. Re-position on transferred surface as neede

Question 19

when may we choose to use a transfer board transfer?

Answer 19

client is unable to weight bear (L/E amputations, SCI)

Question 20

what are the steps to a transfer board transfer?

Answer 20

1. Transferring surfaces need to be equal level
2. Set-up w/c parallel to bed
3. Client leans away from transferring surface and places
   board under 2/3 of buttocks.
4. Client uses upper extremities to lift up and move laterally
5. Be prepared to support if balance or weakness challenges

Question 21

when may we choose to do a total assist transfer?

Answer 21

YOU are not comfortable performing the transfer alone

Question 22

what are some principles of a total assist transfer?

Answer 22

• Ask the client/caregiver
• Do not grab, pull or twist you or the client; DO NOT pull up under the
  axilla
• Set up! Communicate!
• Keep center of gravity over base of support if possible

Question 23

what determines type of transfer and level of assistance required?

Answer 23

Critical Thinking and Assessment Skills

Question 24

what do we need to know in order to determine type of transfer and level of assistance required?

Answer 24

UE/LE strength
* Mobility
* Endurance
* Cognitive status
* Stability of both surfaces

Question 25

what are some questions you may as to Assess/Evaluate a Clients ability?

Answer 25

*"Do you need any help?” * “Can you stand on your own?” * “Can you take a few steps?” * “Can you use your arms to help?” * “To which side do you prefer to transfer?”

Question 26

what is stand by assistance?

Answer 26

supervision, close guarding

Question 27

what is minimum assistance?

Answer 27

client does 75-100%

Question 28

what is moderate assistance?

Answer 28

client for 50-75%

Question 29

what is maximum assistance?

Answer 29

client does 25-50%

Question 30

what is total assistance?

Answer 30

client has minimal participation

Question 31

what are some environmental considerations before doing a transfer?

Answer 31

Wheelchair set up * Brakes on * angled ~30°, Perpendicular or Parallel, * Remove armrest on side transferring to * Remove footplates or swing away Bed set up * Height, stable Client’s set-up * Footwear on! (bare feet acceptable) * Heels angled towards the transferring surface * Client to lean forward and scoot to edge of surface (assist as required) * “Nose over toes” (center of gravity over base of support) Guard and ensure final positio

Question 32

what do crutches require?

Answer 32

upper body strength

Question 33

what are features of the under am axillary crutches?

Answer 33

*Typically short term; less $$, * Precaution: provide education to avoid leaning on axillary crutches * May incur damage to brachial plexu

Question 34

what are the features of forearm crutches?

Answer 34

Typically longer term; lighter weight; more ergonomic

Question 35

how do we measure someone for crutches?

Answer 35

* Shoes on * Measure from floor to axilla; subtract 2” (5cm) or 2-3 finger widths * Adjust hand grips to height of waist (~30 degree flex at elbow); ensure wing nuts are secure

Question 36

what side is a cane held on?

Answer 36

when compensating for a unilateral condition, the cane is held on the unaffected side

Question 37

what is the purpose of a cane?

Answer 37

Promotes even center of balance Improves balance Maintains alignment of hips and shoulders

Question 38

how do we measure someone for a cane?

Answer 38

* Measure with shoes on * Stand with arm loose at side * Measure from floor to wrist crease * Elbow should be flexed ~ 20-30 degrees

Question 39

how do we measure someone for a walker?

Answer 39

* Measure with shoes on * Stand with arm loose at side * Measure from floor to wrist crease * Elbow should be flexed ~ 20-30 degrees * Consider width of walker and width of doorways * Seat height (4WW

Question 40

how do you educate a client on how to use a walker?

Answer 40

* Stand straight * Move the walker ahead first, lifting all 4 legs; set them down at same time * Take a step with your affect leg into the frame of the walker, then step with unaffected; use arms and walker to balance during weight shift * Leave some space between you and the front of the walker * Use brakes when not actively engaged in mobility (4WW) * Do not hold on to the walker when transferring from sit-stand * To go up curbs: * Place the walker up on the curb with all 4 legs down flat on the ground * Step up with the unaffected leg first * To go down curbs: * Place the walker down to the lower level * Step down with affected leg