1. Patient Mobility and Activity
Description:
Technical Contact:
This course will describe and demonstrate safe patient mobility and activity. It will take approximately 60 minutes to complete this course.
If you have technical
questions please contact the Service Desk at
in Milwaukee or
Content Contact:
Features:
Elizabeth Malanowski, PT
Physical Therapist, AWAMC
Lila Daut, OTR
Supervisor, Rehab Services, AWAMC
Donna Harry, OTR
Coordinator, Rehab Services, ASLMC
Created: 6/2014
Reviewed:
Instructions on how to navigate this course
This course includes videos that do have sound. Please complete it at a computer with speakers and a headset or earbuds.

2. Disclaimer
This is a review of patient mobility and activity, including body mechanics practices, and basic transfer techniques. This is not intended to take the place of in-person, hands- on experience or updated information through your instructor or on-site mentors.

3. Nursing Students- Adjustment to PowerpointRR
Nursing Students- Adjustment to Powerpoint
Some links will not work- those that refer to FYWB can be accessed thru our Patient Education site
The reference to Egress Testing can be found in EPIC under Daily Cares-Mobility
Reference to Level of Assistance and Suggested Equipment Chart is found adjacent to Powerpoint

4. Learning Objectives
The audience for this course includes all caregivers that assist patients with mobility.
After completing this course you will be able to:
State good body mechanics while assisting patients with mobility
Identify equipment used for safe and effective activity and mobility
Define proper preparation required for safe patient activity
Describe general transfer and mobility techniques
Identify special considerations for common diagnostic groups

5. Importance of Taking this Course
It is important that all caregivers that assist patients with mobility and activity do so in a safe and effective manner. This will help to:
Decrease caregiver injuries
Maintain a safe patient environment
Promote patient independence
Increase patient and caregiver satisfaction

6. Safe Patient Handling
When assisting a patient with or without equipment, it is important for the caregiver to understand proper body mechanics for assisting the patient, and to follow current Aurora guidelines for safe patient handling. This course will present the best way to guide your patient’s mobility. Whether assisting a patient with or without equipment, always encourage the patient to be actively involved by using their own abilities to do as much of the movement as possible. By allowing this, it will move the patient towards independence and decrease the workload and increase safety for the caregiver.

7. Posture
The spine has four curves (two inward lordotic curves at the cervical and lumbar areas and two outward kyphotic curves at the thoracic and sacral pelvic areas)
When these curves are in good alignment, your weight is supported by the bones which decreases stress at joints, ligaments and muscles
Loss of these curves can lead to injury

8. Body Mechanics – Preparation
It is important to be prepared for safe patient handling
Wear non-slip, supportive shoes
Have a clear pathway
Maintain a wide base of support for stability
Use a gait belt
Click on the link below and review the FYWB:
Body Mechanics (x15523 r78)

9. Body Mechanics
Tighten your abdominal muscles and maintain a neutral spine by avoiding bending forward, backward or twisting at your spine
Keep the object or person you are assisting close to your body
Position yourself at the level of the object/person you are assisting by bending your hips and knees
Squeeze your buttocks and push with your legs as you assist, maintaining your neutral spine
The next slide shows two pictures of good body mechanics while assisting the patient with bed mobility and transfers

10. Good Body Mechanics

11. Use of a Gait Belt
A gait belt should be used with patients needing assistance or supervision with transfers and ambulation.
Place the belt with the buckle in front of the person’s mid- section, tooth side facing outward (in the case of abdominal incisions, lines or drains at mid-section, place belt under armpits)
Feed metal tipped end through the tooth end of the buckle and pull until snug so the teeth secure it
Feed the remainder of the metal tipped end through the hole portion of the buckle
Tighten it until snug, but maintain comfort

12. Use of a Gait Belt – Additional Tips
Hold onto belt at all times when assisting the person to transfer or when walking
Place your hand under the belt, palm side up using a firm grasp. Stand behind and to the side of the person
Check with rehab provider regarding specific instructions on walking or transferring someone
Click on the link below and review the FYWB:
Use of a Transfer/Gait Belt (PE )

13. General Mobility – Safety Check
Be familiar with any precautions relating to the admitting diagnosis
Assess movement and general strength in all 4 extremities
Know the motivation level of the patient
Know if the patient has any comprehension or direction following deficits
Allow the patient time to move on their own before assisting them
The Egress test is a great place to start when you don’t know the patient’s functional mobility status
Click here to access the First Time Up Egress Assessment from the Falls Prevention website

14. Bed Mobility and Transfers – Use of a Friction Reducing Device
When assisting patients with bed mobility and transfers it is often helpful to use a friction reducing device (ie) Patran. Common uses include:
Turning the patient – place the Patran under the sheet/chux, then utilize this to slide and weight shift the patient onto their side
Repositioning – encourage the patient to help as much as possible

15. Bed Mobility and Transfers – Use of a Friction Reducing Device
Other uses include:
Boosting in bed – have the patient help by bending their knees and pushing themselves up
Lateral transfers – complete in small steps not one big move
Assisting the patient to the edge of the bed – place the Patran under the patients buttocks and assist them in scooting to the edge of the bed

16. Friction Reducing Device – Patran
Safety
Keep a barrier (sheet, chux) between the patient’s skin and the Patran
Always keep the Patran one hand length away from the edge of the bed to prevent the patient from sliding off of the bed
Do not use to lift patient, but rather to slide patient
Do not leave under the patient in bed, patients can slide down to the bottom of the bed if the Patran is left under them
Bariatric patients – use a Hovermatt

17. Bed Mobility
The following slides will review helpful tips for assisting patients to move in bed

18. Getting Ready Adjust the bed height to caregiver’s waist height
Consider deflating the mattress at least part way
Have the patient help by:
Bending their knees so that their feet are flat on the bed
Turning their head in the direction they are moving/rolling
Reaching for the side rail in the direction they are moving/rolling

19. Boosting
Place a friction reducing device (ie) Patran, with a draw sheet/chux covering it, under the patient
Position the bed on a slant where the head of the bed is lower than the feet, if not medically contraindicated
Cue the patient to assist with boosting

20. Technique 1 for Safe Boosting
Encourage the patient to assist in boosting by bending their knees so their feet are flat on the bed
Patient to push/slide themselves up to the head of the bed (aided by the friction reducing device) by straightening their knees. If able, encourage patient to use the bed rails
Caregiver can stabilize the patient by holding their ankles

21. Technique 2 for Safe Boosting
One caregiver stands on each side of the bed
With the friction reducing device in place, grasp the sheet/ chux at the shoulders and hips of patient
Weight shift and take a step as you slide the patient towards the head of the bed; do not lift

22. Technique 3 for Safe Boosting
Two caregivers both stand at the head of the bed
With the friction reducing device in place, grasp the sheet/chux at the head and shoulders of patient and slide patient towards the head of bed

23. Assisting the Patient from Supine to Sit
Have the patient help by:
Bending their knees so their feet are flat on the bed
Reaching for the rail, rolling onto their side
Bringing their legs off the bed
Pushing up onto the elbow they are laying on into a sitting position
Caregivers can guide the patient from the upper trunk/rib area – never pull on their arms or neck

24. VIDEO: Assisting the Patient from Supine to Sit
4/20/2017
VIDEO: Assisting the Patient from Supine to Sit
Click the screen below to watch a short video demonstrating how to assist the patient from supine to sit
Note: maximize the volume to hear the speaking

25. Assisting Patient to the Edge of the Bed in Sitting
Place yourself in front of the patient
Have the patient help by:
Shifting their weight onto one hip
Bringing the other hip forward
Repeating until their feet are flat on the floor
Caregivers can assist the patient at their hip and under their thigh, utilizing a friction reducing device between the bed sheet and draw sheet/chux, if needed

26. VIDEO: Assisting the Patient to the Edge of the Bed in Sitting
4/20/2017
VIDEO: Assisting the Patient to the Edge of the Bed in Sitting
Click the screen below to watch a short video demonstrating how to assist the patient to the edge of the bed in sitting
Note: maximize the volume to hear the speaking

27. Assisting a Patient in Lying Down from Sitting at the Edge of Bed
Make sure the patient is sitting on the upper half of the bed close to their pillow
Have the patient help by:
Scooting their hips back onto the bed so they are supported well and will not slide off the bed
Leaning to the side down onto their elbow
Lowering their head to the pillow
Bringing their legs up onto the bed
Caregivers can assist as needed
Utilize a friction reducing device for repositioning the patient, if needed. Do NOT leave the Patran under the patient when alone in the bed

28. 4/20/2017
VIDEO: Assisting the Patient to Lie Down from Sitting at the Edge of the Bed
Click the screen below to watch a short video demonstrating how to assist the patient to lie down from sitting at the edge of the bed
Note: maximize the volume to hear the speaking

29. Transfers
The following slides will review helpful tips for transferring patients to/from bed and chair

30. General Transfer Instructions
Assist or instruct patient to scoot to the edge of the chair or bed
Apply the gait belt for safety
If the patient uses a walker or crutches, stand to the side of the patient
Assist or instruct patient to place feet flat on the floor, tucked underneath
If it is your first time moving the patient and depending on the results of the Egress test:
If minimal assist or less, position yourself to the side of the patient and place one hand on the gait belt and the other hand guarding at the front of the shoulder
If more than minimal assist is needed, use lift equipment

31. General Transfer Instructions - continued
Have the patient help by:
Pushing with their arms from chair or the bed to stand, counting to three as needed
Bending forward and pushing through their legs to stand, then putting their hands on the walker/cane/crutches, if used
Turning their feet by taking small steps until they are in front of the chair/bed with their legs touching the bed/chair
Reaching their hands back to arm rest/bed surface
Bending forward and lowering their body down to a sitting position
Scooting their buttocks back away from the edge

32. VIDEO: Assisting the Patient to Transfer from Bed to Chair
4/20/2017
VIDEO: Assisting the Patient to Transfer from Bed to Chair
Click the screen below to watch a short video demonstrating how to assist the patient to transfer from bed to a chair
Note: maximize the volume to hear the speaking

33. General Transfer Instructions - continued
If the patient has knee instability, you may need to stand in front of the patient and block their knee with your knees. This technique will require you to place two hands on the gait belt.

34. Slide Board Transfers
The therapist may recommend that the patient use a slide board for safe transfers.
Tips for bed to wheelchair transfer:
Assist the patient to scoot forward on the bed and position their feet flat on the floor.
Position the wheelchair on the patient’s stronger side. Lock brakes. Remove leg rests and the armrest closest to the bed.
Position the slide board under patient’s hip with chux/ Patran on top to avoid friction of patient’s skin. The other end of the board should be placed on the wheelchair.

35. Slide Board Transfers - continued
Tips for slide board transfers: (continued)
Assist patient to lean slightly forward to unweight the buttocks. Make sure patient has hands and fingers on the top of the slide board and eventually reaches to the arm rest to assist with sliding along the board.
Continue the slide sequence until the patient has fully transferred to the chair. Make sure the patient is stable and secure. Remove the slide board and replace the armrest.
If moving to a commode or returning to bed, utilize the same process

36. VIDEO: Assisting the Patient with a Slide Board Transfer
4/20/2017
VIDEO: Assisting the Patient with a Slide Board Transfer
Click the screen below to watch a short video demonstrating how to assist the patient to transfer from bed to a chair using a slide board
Note: maximize the volume to hear the speaking

37. The following slides will review helpful tips for walking patients

38. Walking with a Patient Apply gait belt
Stand on the weaker/surgical side of the patient
Always hold the gait belt when walking a patient
Walk at the patient’s speed
Monitor how the patient is feeling: looking at dizziness, SOB, perspiration, fatigue, and weakness
Start out with short distances to assess for safety
Use the device/equipment/assistance recommended in the Patient Story Tips from PT/OT in EPIC if receiving therapy

39. Walker and Crutches Instruction
Advance walker or crutches
Step first with the surgical/weak/painful leg
The stronger, less painful leg steps last
Remind the patient:
Not to carry anything in their hands when using a walker or crutches.
Not to hold onto the walker or crutches when they stand up – it may tip over. Instead, push up from the surface they are sitting on.
To follow all weight bearing/movement precautions

40. Walker Tips Additional tips for using a walker:
Cue patients to stay within the frame of the walker
Don’t allow them to lean on the walker
Don’t allow them to push the walker too far ahead of their base of support

41. Cane Tips Additional tips for using a cane:
Canes should be used in the hand on the opposite side of the surgical/weaker/painful leg
Sequence for walking with a cane:
Cane
Weak leg
Strong leg

42. Lift Equipment
The following slides show some of the lift equipment you may encounter. Your site may have different equipment. Prior to using any lift equipment, you must be trained by your unit’s/site’s Transfer Mobility Coach.

43. Benefits of Lift Equipment
Benefits include:
Decreases caregiver and patient injuries
Decreases compensation and liability costs of injured workers
Increases comfort and feelings of security for patients
Increases activity for patients getting them up and out of bed
Encourages patients to assist and participate in transfers
Click here and review the Level of Assistance and Suggested Equipment chart

44. Lift Equipment and Patient Progression
In many cases when using lift equipment, whether with nurses, therapists, or other caregivers, the patient can be encouraged to be actively involved
For example when using a sit to stand device, the patient should rely on as much of their own strength for the transfer, with the equipment being used as a safety net for both the patient and the caregiver
Lift equipment can be utilized as a patient energy saving device by using the equipment to get the patient to the bathroom or out into the hall for more functional tasks
In these examples lift equipment is used as one step toward independence, just like a walker or a cane

45. Non-Motorized Sit to Stand – Minimal Assist Device – Stedy, Sprite
Used for patients who fatigue easily, are light-headed, or experiences knee buckling
Patient must:
Be able to follow directions
Be able to perform 75% of the transfer
Weigh less than 265 lbs

46. Motorized Sit to Stand – Encore, Sara Plus, Sabina II (name varies by site)
The patient must:
Be able to stand on at least one leg
Be able to follow directions
Be able to complete 50% of the work of a sit to stand
Weigh less than 420 lbs
Bariatric Encore is named the EZ stand (800 lbs limit)

47. Total Lift – Opera, Maximove, Golvo (name varies by site)
Used for patients who require moderate to total assist
The patient must:
Be able to tolerate a semi-reclined position
Weigh less than 440 lbs
Bariatric total lift devices are called the EZ lift, Tenor or Viking
Check the equipment’s weight limit prior to use

48. VIDEO: Assisting the Patient using Lift Equipment
4/20/2017
VIDEO: Assisting the Patient using Lift Equipment
Click the screen below to watch a short video demonstrating how to assist the patient using lift equipment
Note: maximize the volume to hear the speaking

49. The Importance of Activity
The purpose of activity in the acute care setting is to:
Prevent functional decline
Reduce delirium
Lower anxiety
Decrease depression/improve mood
Improve blood counts with cardiovascular activity/walking programs
Lower fatigue and pain
Decrease risk for osteopenia with weight bearing exercise
Maximize patient independence
Prevent re-admissions
Improve the patient experience

50. Simple Activity Ideas Get up in a chair to eat meals
Utilize the bathroom when patients can safely walk
Perform self cares up in a chair or at the sink
Change position every 2 hours
Allow the patient to reposition self in bed as much as possible
Encourage walks
Encourage leg and arm exercises in the chair or the bed
Encourage patients to spend time out of the room when they are safe to do so
If your patient is receiving therapy, refer to the Therapy Tips section in Patient Story for additional activity ideas

51. General Mobility Safety
Always use a gait belt
Lock the bed and chair
Have 2 caregivers present the first time helping a patient up
If a patient needs an assistive device to walk – always use it
Don’t rush – allow time for the patient to help
Watch for orthostatic hypotension issues
If a patient has cognitive impairments do not leave them alone in the bathroom or on the commode
Consider asking for a therapy consult if your patient has mobility/safety issues

52. Therapy Roles – Physical Therapy
Physical Therapists and Physical Therapist Assistants (PT, PTA) work with people to improve:
Strength
Endurance
Balance
Mobility: walking, stairs, in and out of bed and chairs
Pain management
Specializations Include:
Arranging for prosthesis or orthotic device, such as a leg brace
Vestibular assessments (possible cause of dizziness)

53. Therapy Roles – Occupational Therapy
Occupational Therapists and Occupational Therapy Assistants (OT, OTA) work with people to improve independence with meaningful daily tasks, such as:
Bathing and dressing
Toileting
Household mobility (tub, toilet, car transfers)
Home management (meal preparation, laundry)
Specializations include:
Vision (low vision, visual perceptual issues)
Splinting and hand/upper extremity therapy (strengthening, coordination)
Cognition (addressing cognitive issues during function)

54. Therapy Roles – Speech Therapy
Speech Therapists, also called Speech Language Pathologists (ST or SLP) work with people to improve:
Communication
Thinking skills
Memory
Swallowing
Specializations include:
Facial neuromuscular re-education
Voice quality and clarity
Accent reduction

55. Therapy Roles – Therapeutic Recreation and Therapy Aides
In some settings you may encounter:
Therapeutic Recreation Specialists (TR) who work with people to improve:
Independence through adaptive leisure activities, including aquatics
Re-integration into the community
Rehab Therapy Aides, whose role involves:
Preparing patients for therapy, including transporting patients and setting up devices
Assisting with therapy treatments

56. Skilled Therapy
Skilled therapy is appropriate when the patient and/or family is ready to learn and will benefit from what is needed to take him/her to a new level of function or independence. The patient needs to show progress in each therapy session. Examples include:
Patient needs to learn use of ambulation device for the first time
Patient has new onset of weakness, balance, ADL decline or cognitive or swallowing deficit
New onset of stroke or other neurological event
New surgery requiring therapy intervention to recover (TKR, THR)

57. When Skilled Therapy is Not Needed
Examples of when skilled therapy is not needed:
Requires repetitive cues or help and no real change is anticipated for completion of ADLs or mobility
Has long-standing cognitive impairment
Passive ROM
Repetitive tasks to maintain a level of function
When the person’s functional ability and skill level requires only guidance to maintain their current level of function, skilled therapy is no longer needed. Family or nursing carry-over is important to maintain the patient’s current level of function.

58. Specific Diagnoses Tips
Click on the appropriate diagnoses below to learn more specific mobility/activity tips. When you are done with that diagnosis, you will be directed back to this slide to chose another diagnosis.
Lumbar/cervical spine surgery
Hip/knee surgery
Abdominal surgery
Lower extremity amputation
Stroke
Parkinson disease
Spinal cord injury
General weakness/frail elderly
Bariatric
Oncology

59. Lumbar Spine Surgical Precautions and Tips
Do not cross legs
Do not twist trunk
Do not bend forward at waist past 90 degree angle
Use log roll technique
Avoid having patients sit in low chairs to avoid extreme bending when sitting or standing
Patients may have a lumbar brace ordered for back support after surgery. Follow surgeon’s orders.
Use ADL equipment for dressing and item retrieval to avoid bending forward. Therapy will help to assess and order this.

60. Lumbar Spine – Log Roll Technique
Bend knees so feet are flat on bed
Roll onto side with shoulders, hips, and knees rotating at same time
Drop feet off bed once in side lying and push to sit up
Reverse process to return to supine position

61. VIDEO: Assisting the Patient to Log Roll
4/20/2017
VIDEO: Assisting the Patient to Log Roll
Click the screen below to watch a short video demonstrating how to assist the patient to log roll
Note: maximize the volume to hear the speaking

62. Cervical Spine Surgical Precautions
Avoid any neck twisting, tilting, nodding or extension
Perform log roll for bed mobility to avoid straining at neck
Patients may have hard or soft cervical collars ordered for neck support. Follow surgeon’s orders.
Remind patients to use squat technique to pick up objects to avoid bending forward
Use straws for drinking to avoid neck extension
Click here when done

63. Posterior Total Hip Replacement (THR) Precautions
To prevent the hip from dislocating, instruct the patient to avoid:
Crossing legs or feet
Sleeping without a pillow between legs
Hip flexion > 90 (bringing knee above hip level)
Hip internal rotation/turning leg inward toward body

64. Posterior Total Hip Replacement (THR) Precautions – Tips
Avoid sitting in low chairs in order to limit hip flexion when transferring from chairs
Place surgical foot forward when standing up or sitting down to avoid breaking the 90 degree hip precaution
Using crutches or a wheeled walker will improve pain control when bearing weight through the surgical leg
Always check orders for any weight bearing restrictions

65. Posterior Total Hip Replacement (THR) Precautions - continued
Assistive devices such as reachers, sock aids, long shoehorn or leg lifters may be needed; OT helps to assess and recommend this equipment
Some of the equipment you may see include:
Sock aide
Long handled equipment
Leg lifter
Reacher

66. Anteriolateral Total Hip Replacement (THR) Precautions
To prevent the hip from dislocating, instruct the patient to avoid:
Crossing legs
Side stepping or turning away from the surgical leg
Taking large steps with the surgical leg
Active abduction/moving leg out to side (use leg lifter or perform passive abduction only)
Hip extension/moving leg behind body
Hip external rotation/turning leg outward
Hip flexion >90 (bringing knee above hip level)

67. Anteriolateral Total Hip Replacement (THR) – Tips
Avoid sitting in low chairs in order to limit hip flexion when transferring from chairs
Place surgical foot forward when standing up or sitting down to avoid breaking the 90 degree hip precaution
Using crutches or a wheeled walker will improve pain control when bearing weight through the surgical leg
Always check orders for any weight bearing restrictions
Assistive devices such as reachers, sock aids, long shoehorn or leg lifters may be needed; OT helps to assess and recommend this equipment

68. Direct Anterior Hip Replacement
This surgery decreases the amount of trauma to the muscles and soft tissues; precautions include:
Avoid externally rotating and extending the hip at the same time (turning leg outward while moving the leg backward)
Do not stand and twist
Do not bend forward past the point of pain
Perform activities “in the Safe Zone” (the pain in the new hip should be minimal and not increase while doing the activity)
Using crutches or a wheeled walker will improve pain control when bearing weight through the surgical leg
Assistive devices such as reachers, sock aids, long shoehorn or leg lifters may be needed; OT helps to assess and recommend this equipment

69. Direct Anterior Total Hip Replacement (THR) Precautions
The patient may do the activities as shown as long as pain in the new hip is minimal and does not increase while doing the activity (Safe Zone). Special equipment may be needed.

70. SuperCap/SuperPATH Hip Replacement
These patients follow the same safe zone precautions and exercise program that Direct Anterior patients follow
Click here when done

71. Abdominal Surgery Precautions
Educate your patients on the logroll technique for bed mobility, bending the knees and rolling onto the side to push up to a sitting position
This technique will decrease the strain and pain at the abdominal muscles and incisional area
The logroll should be reversed when returning to a laying down position
To see a video on the Log Roll technique, click on the Cervical/Lumbar spine diagnosis when done with this section, if you haven’t reviewed this already
When applying a gait belt prior to transfers and gait, consider your patient’s abdominal incision, drains or lines.
The gait belt may need to be placed under the armpit for comfort.

72. Abdominal Surgery Precautions
Encourage your patients to walk with nursing and therapy for improved lung function after surgery
Patients should hold a pillow to their incision for splinting when doing their deep breathing and coughing techniques to decrease pain as well
Click here when done

73. Lower Extremity Amputation – Positioning
The patient should:
Lie on their back with legs straight
Do NOT put a pillow between their thighs or put a pillow under their residual limb

74. Lower Extremity Amputation – Positioning
The patient should sit in a chair with residual limb supported
Do NOT have the patient sit with their residual limb flexed

75. Lower Extremity Amputation – Positioning
The patient should lie on their stomach; this will prevent hip flexion contractures

76. Lower Extremity Amputation – Mobility
Mobility devices may include a walker, slide board, and wheelchair with residual limb support
Refer to PT Tips section in the Patient Story
Protection of the residual limb is critical, especially during early mobility
Knee immobilizer or therapist fabricated rigid/semi-rigid removable dressing can help protect limb during mobility
Click here when done

77. CVA: Positioning in Bed
Assist with turning weaker patients every two hours to prevent skin breakdown
Elevate the involved upper extremity (UE) on pillows so that the patient’s hand is above heart level to assist with decreasing edema
Consider a heal pressure relief boot to prevent heel breakdown and foot drop when in bed
Roll to the stronger side when sitting up at the edge of the bed to increase patient participation

78. CVA: Positioning in Bed
When lying on back:
Position pillow to support upper arm, elbow and hand
Use foot splint as needed to prevent heel cord tightness or skin breakdown
When lying on unaffected side:
Support affected arm and leg on pillow
Position pillow behind back to prevent backward rolling

79. CVA: Positioning in Bed
When lying on affected side:
Support unaffected leg on pillow
Position affected arm with shoulder blade/shoulder slightly forward
Position pillow behind back to prevent backward rolling

80. CVA: Positioning in the Chair
Have the patient:
Position hips and buttocks back in the chair as far as possible with hips and knees at a 90 degree angle
Place feet on the footrest or flat on the floor
Use pillows to support the patient’s trunk on weaker side as needed
Support involved arm on pillows or a table
Alternate sitting up in chair and lying down for short periods to prevent fatigue

81. CVA: Positioning for Eating
The patient needs to be positioned correctly while eating/ drinking to increase oral intake, promote comfort/safety and prevent aspiration
Click on the link below and review the FYWB:
Positioning During Eating

82. CVA: Transfer Tips – Set-up
Prior to the transfer:
Have knowledge of how the patient transfers
Have all equipment ready: apply gait belt, prepare transfer surface, choose assistive device
Wheelchairs provide support and ease of transfer due to removable armrests and height surface vs room chairs
Position the transfer surface on the patient’s stronger side
Exception: If the patient pushes heavily to one direction, transfer to that direction
Angle the patient’s heels toward the surface you are transferring to for ankle safety

83. CVA: Transfer Tips During the transfer:
Stand in front of the patient with hands around rib cage using a gait belt; consider a second person to stand by
Be mindful of the patient’s:
Involved upper extremity as it may need support due to weakness, decreased sensation or neglect
Involved lower extremity as it may need blocking at the knee to prevent buckling
You may need to use lift equipment if needing more than minimal assist

84. VIDEO: CVA Transfer Tips
4/20/2017
VIDEO: CVA Transfer Tips
Click the screen below to watch a short video demonstrating how to assist the stroke patient to transfer from bed to a chair
Note: maximize the volume to hear the speaking

85. CVA: Vision Problems After Stroke Affecting Mobility
Visual neglect results in some patients ignoring objects to the right or left of midline. If hemiparesis is on the right side, visual neglect will be to the right of midline.
Neglect affects safe positioning of extremities, walking and self-cares
Cue patients to use their hands and eyes to find the entire object/surface in front of them
Click here when done

86. Considerations for Parkinson Disease Patients – Freezing
Freezing – An unpredictable loss of motion
Patients are most likely to freeze when:
Starting to walk
Nearing a target (ex: chair)
Performing two mobility tasks at same time (ex: turning when walking)
Approaching narrow spaces, doorways or thresholds
Changing tasks or motions
Tips/cues to give to patients to overcome freezing:
Count their steps out loud
Visualize stepping through long grass while walking
Visualize beyond the obstacle

87. Considerations for Parkinson Disease Patients – Tremors and Bradykinesia/Hypokinesia
Tremors – Medication timing and optimization of dosing can help to reduce tremors making self-cares and mobility easier
Bradykinesia – Slow movement
Hypokinesia – Small movement
Tips/cues to give to patients with tremors and/or bradykinesia:
Allow extra time to transfer and complete ADL tasks
Cue the patient to move bigger
Do NOT cue the patient to move faster as this has shown to decrease speed and efficiency of movement and causes anxiety

88. Considerations for Parkinson Disease Patients – Medication
Parkinson patients experience medication cycles of ‘on’ and ‘off’ times which affect their mobility
During ‘on’ times, patients may experience:
A burst in ability to move which could put them at risk for falls
Extra muscular movements called dyskinesia or chorea, a side effect of Parkinson medication, can cause them to be unsafe
During ‘off’ times, patients may experience:
An increase in freezing episodes and/or muscle rigidity

89. Considerations for Parkinson Disease Patients – Rigidity
Rigidity – Severe stiffness of the muscles, mainly in the trunk and extremities
Tips/cues to give to patients with rigidity:
Encourage the patient to move their muscles/joints before mobility
Wait until the medication has kicked in as movement will become less rigid
Fixed/stiff facial muscles or flat affect may give the impression that the patient is not experiencing emotion/pain, therefore be sure to carefully address their needs

90. Considerations for Parkinson Disease Patients – Retropulsion/Propulsion
Retropulsion – An involuntary backward walking or loss of balance
Tips/cues to give to patients with retropulsion:
Have the patient lean forward as they sit to help with control of the descent to avoid plopping into position
Propulsion – Fast uncontrolled forward walking/shuffling
Tips/cues to give to patients with propulsion:
Have the patient stop their movement, take a deep breath, and restart walking with cues for big steps
Don't rush the patient as this will cause further uncoordinated movement

91. Considerations for Parkinson Disease Patients – Retropulsion/Propulsion
Patients do not have the ability to stop retropulsion and propulsion easily
Additional cues/tips to give to patients with retropulsion and propulsion:
Keep hand on gait belt at all times to avoid falls
Cue patient to stop, take a deep breath and start over
If using a device, cue the patient to not let the device get too far ahead of them
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92. Considerations for Spinal Cord Injury (SCI)
Due to paralysis, SCI patients may need to use a variation of squat pivot and sliding boards transfers
Caregiver should block one or both of the patient’s knees for stability, safety, and ease of transfer
Lift equipment may be needed
Consult with the therapists treating the patient for tips for your specific patient needs
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93. Considerations for General Weakness and Frail Elderly
When changing positions, allow a few minutes for the patient to stabilize as some older patients are more prone to a decrease in BP upon rising, causing light-headedness
Time up in the chair or walking may be best broken into shorter spans of time to avoid fatigue
Moving from a low surface (chair) to a higher surface (bed), in addition to being fatigued from sitting up for a period of time, may mean the patient will require more assist or lift equipment to return to bed

94. Considerations for General Weakness & Frail Elderly
Skin can be more fragile so ensure the patient does not bump into hard objects during mobility (ie) wheelchair leg rests, commode legs, bedside tables
Eye sight, hearing or dementia can effect mobility safety, so know ahead of time if these are concerns. Accommodate for these by having a clear path and simplifying your instructions as needed
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95. Considerations for Bariatric Patients
Have appropriate bariatric equipment available in the room at all times to avoid the potential of unsafe mobility (gait belt, ambulation device/lift equipment, commode, Patran, chairs).
Patients may be reluctant to discuss their difficulty with mobility/ADLS.  Create an accepting atmosphere leading to more openness with the ultimate goal of keeping both you and the patient safe.
Click here to be taken to the Aurora Safe Lifting Website. In the Bariatrics section, review the following:
Bariatric Rental Equipment List
Bariatrics Toolkit Option from VA Website
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96. Considerations for Oncology Patients
Common long term side effects of cancer or cancer treatment that can affect the patient’s mobility include:
Pain
Fatigue
Swelling (lymphedema)
Bone loss (osteopenia)
Mobility tips:
Allow patient time to move on their own before assisting
Avoid excessive pushing/pulling when assisting with mobility to decrease the risk of fractures
Allow frequent rest breaks
Bone metastases/fragile bones
Change in weight
Memory and thinking problems
Hearing loss
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