Proper Body Mechanics, Levels of Assistance, and Positioning, Bed Mobility

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Three Goals of Proper Body Mechanics

1) Safety
-Maintains balance and control
-Helps to prevent back injuries
2) Helps to be anatomically/physiologically efficient
3) Energy conserving

What is Center of Gravity (COG)?

The point where the mass of a body or an object is centered, also called center of mass

What is Vertical Line of Gravity (VLG)?

An imaginary vertical line bisecting the body into left and right halves and intersecting the center of gravity

What is Base Of Support (BOS)?

The area on which an object rests and that provides support for the the object.

Where is the COG in a typical adult?

In an adult standing upright - typically centered at S2 vertebra.

Where is the VLG in a typical adult?

Usually falls within our feet in relaxed stance.

The 5 Rules for Body Mechanics

1) Keep the load close
2) Create an appropriate BOS
3) Isometric contractions
4) Lift with legs
5) No twisting

6 Ways to Use Body Mechanics

1) Lower your COG
2) Widen your BOS to maintain VGL within your BOS
3) Position your feet in the direction that you want to move
4) Remain close to the object by using short lever arm
and your COG close to object
5) Use large muscle groups
6) Push, pull, and slide before lifting

Objects feel ___________ and are less ___________to your spine when kept close to your ______ and within your ______.

1) Lighter
2) Stressful
3) COG
4) BOS

What are the 3 Types of Lifting Patterns?

1) Traditional
2) Lumbar Lordosis, or Power Lift
3) One-leg stance lift (Golfer's lift)

Properties of Traditional Lifting Model

Uses posterior pelvic tilt concept
Straight thoracolumbar spine
Need to stoop or squat

Steps of Traditional Life

1) Round lower spine by tilting pelvis back, contracting abdomen
2) Keep upper back straight
3) Stoop down low
4) Feet wide apart

Properties of a Power Lift

Very heavy objects
Maintains lumbar lordosis
Half Squat
Hips above knee level
Lift with legs

Steps of a Power Lift

1)Keep arch in back
2)Half Squat only
3)Hips above knee level
4)Lift with legs

Properties of a One-leg stance lift

Light objects
Body weight on forward LE
Opposite LE is raised for counter balance

3 Alternatives to Lifting

1) Push or pull object
2) Ask for assistance and complete two man lift
3) Using mechanical aides such as:
-Raising bed/plinth to your level
-Put objects on stool to raise off floor
-Using mechanical lifts

What is the Functional Independence Measure (FIM)?

An 18 item eval-tool used in rehab to describe a person's function, functional activities (bed mobility, transfers, gait), and how much of the task the individual does and how much help the helper gives.

Independent (I)

Can complete the task without any assistance and without any assistive device (e.g. cane, walker, grab bar)

Modified Independent (Mod I)

Can complete task without assistance but needs to use an assistive device such as:
1) Walker, crutches, canes
2) Sock aides, reacher, dressing stick
3) Grab bars, raised toilet seat
4) Slide board

Supervision (S)

No physical assistance is needed
May require verbal cueing or coaxing
Cues may be needed for Safety, Proper technique, Sequencing, Poor memory

Minimal Assistance (Min A)

Individual performs 75% or more of the effort needed to perform the task

Moderate Assistance (Mod A)

Individual performs 50 - 74% of the effort needed to perform the task

Maximal Assistance (Max A)

Individual performs 25 - 49% of the effort needed to perform the task

Total Assistance (Tot A) or Dependent

Individual performs less than 25% of the effort needed to perform the task

Contact Guard (CG or CTG)

Commonly used term but NOT a FIM term
No physical assistance is given but hands are on the person "just in case" or for manual cues instead of verbal cue

7 Goals of Proper Positioning

1) Ensure patient comfort
2) Maintain integumentary integrity
3) Maintain musculoskeletal integrity
4) Maintain neuromuscular integrity
5) Maintain cardiovascular/pulmonary integrity
6) Provide patient access to the environment
7) Provide proper positioning for intervention(s)

8 Issues to Consider for Positioning

1) Areas of decreased sensation
2) Inability to move or re-position oneself
3) Reduced skin integrity
4) Poor nutrition
5) Impaired circulation
6) Inability to communicate
7) Impaired mental or cognitive status
8) Increased muscle tone or spasticity

Decubitus ulcer

Consists of ulceration and gangrene of a localized area due to pressure from prolonged confinement in bed or prolonged pressure on a bony prominence.
Commonly known as a bed sore.

What 4 factors put someone at risk for a Decubitus Ulcer?

1) Limited movement or mobility
2) Decreased sensation
3) Poor nutrition
4) Incontinence

Bony Prominences of Head and Trunk in all positions

-Back of Head
-Forehead, Ears
-Spine/Acromion/Base of Scapula
-Spinous Process of Vert
-Sternum
-Lateral Ribs
-Illiac Crest
-Sacrum

Bony Prominences of Upper Extremity

-Medial Lateral epicondyle
-Head of Humerus

Bony Prominences of Lower Extremity

-Posterior calcaneus
-Patella
-Greater trochanter of femur
-Ridge of tibia
-Medial and lateral condyles of femur
-Dorsum of foot
-Malleolus of fibula and tibia

5 Signs and Symptoms of Decubiti

1)Skin redness
2)Blanching remains
3)No capillary refill
4)Localized edema
5)Numbness or tingling

Ways to Prevent Decubiti

Change position frequently (at least every 1 hour or more)
Positioning devices may assist in preventing issues, ie. fleece boots, special boots, specialized beds and mattresses

Contractures

Permanent contraction of a muscle due to spasm or paralysis
Condition of fixed high resistance to the passive stretch of a muscle
Can also have contractures of skin

What 7 factors put someone at risk to develop contractures?

1) Spasticity or abnormal muscle tone
2) Muscle weakness
3) Poor posture
4) Limited mobility
5) Burns
6) Post trauma or surgery
7) Immobilization

What are some devices to help with contractures?

Hand splits, knee splints, and wedges

Issues to Consider when positioning

1) Patient's comfort
2) Patient's modesty
3) Necessary items within Patient's reach

5 Ways to Ensure Patient Comfort

1) Use pillows, wedges and other devices to assist with positioning and support body parts
2) Smooth all sheets, towels, and clothing
3) Talk to your patient and ask them how it feels
4) Check in for facial expression and body language
5) Check in regarding temperature

4 Key Points for Bed Mobility

1) Keep in mind your body mechanics
2) Have the patient do as much for themselves as possible
3)Prepare the environment
4) Check for precautions (e.g. bed rest, weight bearing status, etc)

What are 4 ways to ensure good body mechanics for bed mobilizations?

1) Lowering or raising the bed to a good working height for yourself
2) Lowering the bedrails to work
3) Bending your knees and taking a wide stance
4) Getting help when necessary

3 Overall Approaches to having patient do as much as they can:

1) If patient is alert and oriented explain what you are going to do
2) Wait for the patient to do as much as they can THEN assist as needed.
3) Be prepared to assist an involved limb or limbs that may be

3 Steps to a Clear Environment

1) Have all of the equipment you will need within reach
2) Clear the environment so things are not in your way
3) Be careful of lines, tubes, catheters and make sure there is enough slack

What 4 precautions should you check for before a moving someone in and out of bed?

1) Contraindicated positions
2) weight bearing precautions
3) movement/range precautions or restrictions
4) Braces or other positioning devices that are required

Do NOT EVER leave a patient....

1) Alone or unattended with the bed rails down OR
2) Alone or unattended with the bed elevated

What factors contribute to a patient's level of assistance during bed mobilities?

Differences going to the left vs. the right
Differences with rolling vs. sitting up vs. lying down
ie. a hemiparetic, a person in a cast, with surgical procedure, or in extreme pain.

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